lecture 9: conditions of the knee Flashcards
what are the two joints that make up the knee
tibiofemoral joint
proximal tibiofibular joint
what type of jointt is the tibiofemoral joint and explain what that means
synovial hinge
=flexion and extension
what type of joint is the tibiofibular joint and explain
plane synovial joint
=gliding up and down,ant and posterior
what is the primary function of the proximal tibiofibular joint
dissipate the torsional stress applied to tthe ankle
what are some ligaments of the knee joint
menisci PCL ACL meniscofemoral lateral coll. and medial collacteria
what is the mainn weight bearing bone of the body
tibia
what percentage of weight does the tiba bear
80%
how much weight percentage does the fibula hold
15-20%
if you injury your tibia, can you walk on it and why
no t usually because it bears most the weight
which fracture is longer to heal and why (tibia or fibula)
tibia because you cannot walk on it which takes longer to recover
can you usually still walk with fibula fracture
yes
true or false: the knee usually compensates for other strucures? explain
true because there are so many msucles (from ankle and hip) that cross in that area which makes the knee compensate for if thre is any weakeness anywhere
if there is knee nerve damage, you will only feel it in the knee?
no because the nevre at the knee splits meaning yoy can feel symptoms in other places
what are the knnerves that pass posterior to the kneeS
sciatic (tibial and common fib)
what are the nerves that pass anterior to the knee
saphenous, deep and superficial peroneal
what are the functions of the meniscus
Absorption and dissipation of forces. Improve joint congruency and the stability of the joint.
since the meniscus is mostly water it helps with …
lubrification
what percentage of the meniscus is water
74%
with WB movements, what happens to the fluid in the meniscus
most of the fluid is pushed in the joint to promote gliding and lubrification.
the meniscus is thicker on the medial or lateral aspect
thicker on lateral
is there more movement on the medial or lateral side of the meniscus
mor emovement laterally
where are both horns of the menisucs attached to
are attached to the tibial plateau and linked together with the transverse ligament.
how are the two meniscus attached to each other
trhoug hthe traverse ligament
where is the medial meniscus attached to
medial meniscus is attached to the MCL and the semimembranosus muscle.
where is the lateral menisucs connected to
The lateral meniscus is connected to the PCL and popliteus muscle.
which meniscus is more easily injured
medial
what is the function of bursae
Reduce friction between two structures.
q
the post bursea comminicates with what
with the joint capsule
how can the bursae be inflammed
with intracapsular injuries
the fluids in the bursae are influenced by what
postition of the joint
the postiion of the joint affects what in the bursa
fluid
if there is flexion of the knee, what happens to the bursa
fluid will be pushed posteriorly
if there is extension of the kne, where will the fluid in bursea be pushed
extension will push fluids anteriolrly
true or false; a brusea cannot rupture
false it can rupture with traumatic events
what are the structures that provide dynamic stability to the posterolateral knee
include the iliotibial band, long and short heads of the biceps femoris muscle, and the lateral head of the gastrocnemius muscle.
the include the iliotibial band, long and short heads of the biceps femoris muscle, and the lateral head of the gastrocnemius muscle provide STATIC stability
false, dynamic
the posterolateral corner of the knee is very stable/unstable
stable
Anatomic components comprising the posterolateral corner of the knee serve to provide what to the poserolotaral corner
both dynamic and static stability to the posterolateral corner
the structures of the posterolateral prevent what movements
preventing hyperextension, tibial external rotation and varus angulation.
the ligaments in the posterolateral corner provide dynamic or static stability
stabtic
what are the primary ligaments that provide static sttability to the knee
lateral collateral ligament, popliteus tendon, and popliteofibular ligament.
what are the secondary static stabilizers of the posterolateral corner
lateral capsule ligament, the coronary ligament and the fabellofibular ligament.
a medial collateral ligament sprain creates what type of instability
straight medial instability
what structues are damaged in a medial collateral lgiament sprain
MCL damaged, potentially the posteromedial capsule and PCL
in a medial collateral ligament sprain there will be varus or valgus insptabilt
valgus
what is the MOI of medial collateral lig sprain
valgus force inn weight bearing psotitionn
what is more common MCL or LCL sprains
MCL more common
what type of isntability arrises from LCL
straight lateral instability
tension on lateral comparment causes what in LCL sprains
Tension on lateral compartment, damage to LCL, lateral capsule ligaments and potential PCL
why is LCL sprain rare
, since biceps femoris, IT band and popliteus provide strong stability
what type of isntability do you have in ACL tear
sraight anterior disability
what are the forces associated with ACL tear
Cutting, decelerating, change of direction, and landing
when you have an ACL tear what is the motion of the bones
Tibial plateaus subluxes anteriorly on the femur
there is a higher rate of ACL tears in women or men
in women
what ratio is important in ACL tears and explain
Quad to hamstring ration (lack of eccentric hamstring)
=your must have a good ration to provent anterior translation of the tibia (caused by the quads)
true or false; the middle of the ACL isnt painful but sides are
rtue
for ACL sprain, it can be non traumatic?
true
what are the SS for ACL tear
Popping, tearing sensation- 80% of patients Rapid swelling Hamstring spasm Pain deep in the knee Feeling of “giving away”
what symtpom is common is 80% of patients with ACL tear
poppint, tearing senstaion
what is the main MOI for PCL tear
knee hyper flexion
Posterior glide of the tibia on the femur
why is the PCL harder to tear
it is thicker and more solid
what is the difference in ACL vs PCL tear
for PCL you need direct contact to push it posteriorly to tear whereas ACL does not need to be traumatic.
what is the role of the hamstrings in ACL tears
quads pulls on tibia forward threfore the hamstrings need to be strong to combat that
(to protect against anterior glide)
in the acute phase of ligament sprains, what is the mamangement
PEACE & LOVE Early strengthening Maintain full ROM Swelling management Proprioception Pain management
what is needed before going into surgery for lig sprains
they need to maintain full ROM
the treatment for MCL is usually conservative or invasive
conservative
what is the healing process ofr MCL
4-6 monthos
why is bracing sometimes recommeded for MCL tear
to help with fear but not necsessary since the muscles around it should stabilze it with rehabilitation
for MCL sprain, do they usually operate
no
if you completely tear your MCL, will there be laxity still
yes
when do you use surgery for PCL
surgery for severe tears
true or false: you can use bracing for PCL
true it might help with fear
what is the rehab time for PCL
6 montsh
is the treatment for LCL conservative or invase
conservation
what needs to be streignthed after LCL injury
biceps femoris, IT band and popliteus strengthening
ACL tear is usually surgical repair or conservattive
surgical repair
what is the rehab period for ACL
6 months
true or false, the quicker you get out of rehab for acl, the less likely you are to get injured
false, Every extra month of rehab decreases the risks of re-injury
anteromedial rotary instability is caused by what moement of the bones
anterior external rotation of the medial tibial condyle on the femur
true or false:
Instabilities are not necessarily unidirectional.
what are the strucutes associated to anteromedial rotary instability
medial compartment ligaments and oblique popliteal
anteromedial rotary instabiltiy is accentuated by what
Accentuated by medial meniscus tear and ACL (unhappy triad)
what is the unhappy triad
ACL, MCL and medial meniscus
what is the movement of bones in anterolateral rotatry instability
anterior internal subluxation of the lateral tibial condyle on the femur
what strucures are usually damaged in anterolateral rotary instability
ACL main ligament damaged, IT and lateral capsule ligaments as well
which type of instability is the most rate
posteromedial
why is the posteromedial rotaary rare
beacuse of amount of muscles in this area
what is the movement of bones in posteromedial rotary instab./
The medial tibial plateau shifts posteriorly on the femur and opens medially
what are the structures injuryed in posteromedial roray instab.
Superficial MCL, posteromedial capsule, oblique popliteal ligament, both cruciate ligaments*** severe injury
what are some of the muscles in the posteromedial area
sartorius, gracilis semi tend and mem and medial gastroc
what is the MOI for posterolotary rotary isntabi
Sudden anteromedial force that brings the knee joint from full knee extension into hyperextension, combined with varus moment
what structutes are usually injured in posterolateral rotary instab
PCL, arcuate-popliteal complex, posterolateral capsule and LCL
when injuring one quadrant, you should only focus on rehabingt that 1 quadrant?
no , also strngthing and rehab oppsotie quadrant
what are the 3 types of acute/traumatic meniscus tears
longitudinal
radial
horizontal
what are the three types of chronic/degenerative mendiscus tears
bucker handle
parrot beak
flap
a longitunial tear may lead to
buckle handle
a radial tear may lead to
parrot beak
a horizontal tear may lead to
flap tear
what type of tear can lock the knee joint
flap tear
what is the percetttage of colalgen 1 in meniscus
75% type 1 collagen
whatt are the functions of the mensicus
Distribute load (90% in knee flexion/ 50% in knee extension)
Joint lubricant
Deepens the articulation
Increases stability
Limits femoral translation on tibial plateau
what is the load distribution for menisucs
90% in knee flexion/50% in knee extension
explains why deepending the articulation of the knee is good
increases stability
limits femoral translation on tibial plateau
what is the medial attachement of menisuc
MCL
what is the lateral attachement of the meniscus
meniscofemoral ligament
what is the anterior attachement of he meniscus
ACL, transverse ligament (between both meniscus) and the patellomeniscal ligament (thickening of the anterior capsule)
what is the posterior attachment of the meniscus
PCL, semimembranosus muscle (medial) and popliteus (lateral).
what influecnes the movement of the medial meniscus and why
the semimembranosus by constaction
the blank meniscus is less mobile
medial
what is the different in medial vs lateral transltation
medial : 2-5 mm
lateral 9-11 mm
AP plane
what forces cause meniscal tears
compression, tensile, shearing with rotation (on femor on fixed tibia)
why is medial more injured than lateral menisuc
due to decrased mobility
meniscus tears can be acute trauma only
false, also degenratice
what are the 3 knee injury classifcationns
red/red
red/white
white/white
which classification is the best to heal and why
red/red
most vasculature so more blod
which classifcation is the worst to heal
white white
no blood supply
describe the locationn of meniscus tear inn red red
Occur in the vascularized outer third of the meniscus
describe the lcoatinn of red white tear
Occur in the middle-third of the meniscus where the vascular supply is predominately located at the outer edge of the tear
decrsibe the locationn of the white white tear
Occur in the inner third and where no blood supply exists.
what is healinng of the menisuc tear based on
type of tear and severity
which heals are easier to heal, lonngitudinnal or radial
lonngituinal
traumatic and acute or chronnic and degenrative have higher healing rates
traumatic and acute
what it the MOI for meniscus tear
cutting or shearing forces
compressio
true or false: you will feel dull pain at the time of injury for mensicus tear
false, sharp
where will you feel pain with a mensicus tear
pain along the cpllataeral lig
pain with rotationn and extreme flexionn
is there more or less swelling in menisuc vs acl
lesss joint effusion for menisum (less blood supply
will your knee by givibg out with menisuc tears
yes
what is managemnt for menisuc tears
PEACE & LOVE Pain management Swelling management Gait retraining Proprioception Maintain ROM Standard of care is the conservative management Surgery has a greater chance of leading to degenerative arthiritis
why is the menicus healing usually done conservatively
because
Surgery has a greater chance of leading to degenerative arthiritis
what are the cases where we would do surgery on the minsucs
tear geater than 1cm less than 4 cm
if its a long tear (vertical) vs a horsonntal
if it occurs in the red red rad
where will you feel pain for patellofemoral pain syndorm
pain in the patellofemoral joint (feel clicking)
what is patellogemoral syndrom
when the patella is not follownig its usually track in the groove
what can patellofemoral pain symdrome be cauesd be
muscle imbalacnes (quads) malalighments
what are the signs are symptoms for patellogemoral
Anterior knee pain, dull and achy
Increases with squatting, sitting in tight space and descending stairs
Point tenderness over lateral facet of patella
Crepitus
when dopes pain get worse for patellofemoral pain symdrome
incraeses with squating, knee flexion (sitting) and descing stairs
what is chondromalacia patiella
degeneration of the articular cartilage of the pate;;a
what facets are most affects wtith chondromallacia patiella
medial and lateral facets
what are the forcest that cause chondromalacia patiella
shearing and compressire
what ate the 4 stages of chondromalacia patella
1) articular cartilage
2) fissures
3) fibrulations
4) exposes bone
patellar instabilities and discolations are more common laterally or medially
lateally
what are the 4 causes of patellar dispplacement
- muscle imblances
- bony deformation
- cutting motion
- q angle
explain q angle
angle between your patella and your quads
+ q angle= more valgus
what is patella plica
sydrome where synoval lining folds into knee joint cavity
how can the synovial lining become inflammed for patella plica
repreatd direct blows to capsule or repeating stresses as it passese over femoral condyles
whay is the patella plica impinged from
patellogemoral joint
true or false: patella plica is aggravted by quad exercises
true
what are thr 4 signs are symptoms of patella plica
- movie like going signs (bilateral stiffness caused by knee flexion for too long)
- sharp pain for 8-10 steps (max stretched and impiged within patellofem joint)
- pseudol locking meniscus tears)
- pop or snap in knee extension
what2 syndromes have movie going synfomr
patella plica syndrome
patellofemoral pain syndomr
what ia patellar tendinitis (jumpers knee)
Inflamed/irritated tendon from repetitive or eccentric knee extension activities
jumpers knee (patellar tendinitis) is caused by extrincis or intrinnsic factors
both
where will you feel pain in patellar tendinitis
at the patellar tendon (sharp or achy)
what is the complication that patellar tendinitus can lead to
patella tendon rupture or patellar avulsion
what are two common conditions that cause bone defromation of the knee in kids
osgood schlater
sining larsen johanson
what is osgood slater disease
traction type injury to the tibial apophysis where patella tendon meets tibial tubuercle (muscles full on it)
who is more likely to get osgood slater
women 8-13
men 10-15
=near growth spurts
what is the main obivious sign of osgood slaters
enlarged and prominent tibial tuberly
true or false: there wont be any pain for osgood slaters
false, during activtiy
what van you wear to relieve pain from osgood slaters
tendon straprs which creates new point of muscle insertion ehile on
what singing larson johanson syndrome
ssimilar to osgood
however it is deformtion/excessive strain on the inferior patella pile (at origin or patella tendon)
which ager is more likely to get sinding larsenjohanson
kids 8-13 bones are growing
osgood slater is an injury to where
tibial apopyshysis (where tendon meets tubercle)
sining larsen johanson is an injury to where
closer to the patella
the patella tendon origion
what is IT band frcition syndrome
IT moves ove lateral condyle of femur
becomes irritated gfrom snapping force
when is IT band friction syndrome paricularly intense
durinng strike through contact (mid foot stance)
first 30 degrees from flexion to extension
what part of the knee will be inn painnn
lateral aspect of the knee )2-3 cm above joint line)
and may raidate to thigh or distal tiabial attachment
what are some intrinsic factors that cnan cause IT band frctiin syndrome
Intrinsic factors- muscle weaknesses/imbalance, genu valgum, leg length discrepancy, tightness in gluteals/TFL
true or false: training errors can have an effect on IT band friction
true
what is the management for ALL TENDINOUS PATHLOGIES
Pain management
Isometric strength
Eccentric strength
Gradual re-exposure to mechanical stress (hydrotherpay) Biomechanical analysis (running, gait and other functional movements)
chondral and osterochondral fractures involve what
articulat cartilage and bone att the jpint
what makes up 75% of the lesions in chondral and osteogchondra fractions
femoral
what is the MOI for chondral and osteroxhonrdral factures
compression with shearing
rotaion
when will you get locking in chondral anf osteochondril fractures
if the joint fisplaces (osteochondritis dissecans)
what are the strectures intra artticulr/capsular that cause the most swelling
ACL
PCL
medial and latt meniscus
what are the strucures that cause swelling in the extrecapsular
patellar lig patellar retinatum MCL LCL popliteal lig anteriolat lig
