Management of Knee Dysfunction

Question 1

What is Osteoarthritis (DJD)?

Answer 1

A degenerative joint disease affecting 1/3 of people over 65, characterized by pain, muscle weakness, joint laxity, and limitation of joint motion leading to disability.

can be a genu varum or valgum deformitity

Question 2

What are the risk factors for Osteoarthritis?

Answer 2

Excess weight, joint trauma, developmental deformities, weakness, and tibial rotation.

Question 3

What are the common symptoms of Rheumatoid Arthritis?

Answer 3

Inflammation, limited motion, and joint deformity, primarily affecting hands, feet, and knees.

typically appears on the hands, feet, and knees

Question 4

What is Post Immobilization Hypomobility?

Answer 4

A condition affecting the capsule, muscles, and soft tissue after a period of immobilization.

Question 5

What is the focus of the Protection Phase in Joint Hypomobility Management?

Answer 5

Control pain, protect the joint, educate the patient, and adapt function.

Question 6

What techniques are used to maintain soft tissue and joint mobility? How do you maintain muscle function?

Answer 6

P, AA, or AROM and Grade I or II joint distraction.

Maintain muscles through setting exercises

Question 7

What is the goal of Controlled Motion and Return to Function in Joint Hypomobility Management?

Answer 7

Educate the patient, decrease pain from mechanical stress, improve muscle performanece, and increase joint play and range of motion.

Question 8

What exercises are recommended to improve muscle performance during controlled motion phase?

Answer 8

Open kinetic chain (OKC) and closed kinetic chain (CKC) exercises, progressive strengthening, and endurance training.

Question 9

What are the indications for joint surgery?

Answer 9

Symptomatic knee, size of lesion, depth and location of lesion, time since injury, age, and activity level of the patient.

Question 10

How is lesion size and rehab related

Answer 10

Larger the lesion, slower the progression of rehab

Question 11

Rehab for Articular Cartilage defect

Answer 11

• Early but controlled ROM (CPM, PROM, AAROM)
• Protected Wbing initiated early (adherence to Wbing status is critical to success
  
  • Longer period of protected Wbing for osteochondral transplantation and ACI
  • Longer period of protected WBing for femoral condyle (8-12 wks)than for patellar defect (4 wks)
  • FWBing not until 8-12 wks
• Protective bracing
  
  • Locked in extension (except for rehab)
  • Worn during WBing activities 4-6 wks
  • Worn during sleep (4 wks)
  • Unloading brace maybe used for femoral condyle defect

Question 12

When do you return to functional activity following articular cartilage deficit?

Answer 12

• Low impact sports (swimming, skating, cycling)
  
  • High impact sports permitted (Jogging, running, aerobics)
  • 8-9 months for small lesions
  • 9-12 months for larger lesions
• Sport activities permitted at 12-18 months

Question 13

What are the indications for Total Knee Arthroplasty?

Answer 13

Severe joint pain with weight-bearing, extensive destruction of articular cartilage, knee deformity, gross instability, and failure of non-operative management.

Question 14

What are the exercise precautions post Total Knee Arthroplasty?

Answer 14

Monitor incision integrity, delay straight leg raises, determine time frame for resistive exercises, and avoid joint mobilization techniques for constrained knees.

Question 15

What are common outcomes after Total Knee Arthroplasty?

Answer 15

Significant pain relief, variable range of motion, and strength and endurance improvements over time.

Question 16

What are the mechanisms of injury for Anterior Cruciate Ligament injuries?

Answer 16

Contact injuries from a blow creating valgus stress and non-contact injuries from external rotation on a planted foot or hyperextension.

Question 17

What is the gender bias in ACL injuries?

Answer 17

Females are 3 times more likely to tear their ACL compared to males.

Question 18

What are the advantages of Bone-tendon-bone autograft for ACL reconstruction?

Answer 18

High tensile strength, reliable fixation, rapid revascularization, and ability to return to pre-injured activities.

Question 19

What are the disadvantages of Semitendinosus-gracilis autograft?

Answer 19

Less reliable tendon-bone fixation, longer healing time, and potential for hamstring muscle strain.

Question 20

What are the criteria to return to high-demand activities after ACL reconstruction?

Answer 20

No knee pain or swelling, full active knee range of motion, quad strength >85-90%, and acceptable patient-reported score.

Question 21

What are the goals for non-operative management of ligament injuries in the first 4 weeks?

Answer 21

Protect healing tissues, prevent reflex inhibition, decrease joint effusion, decrease pain, and establish a home exercise program.

Question 22

What interventions are recommended after 4-8 weeks of non-operative management?

Answer 22

Full, pain-free range of motion, restore muscular strength, normalize gait, and adherence to the home exercise program.

Question 23

What should be focused on after 8 weeks of non-operative management?

Answer 23

Increase strength, power, endurance, neuromuscular control, and dynamic stability.

Question 24

TKR Interventions for each phase of rehab

Answer 24

Question 25

What is Patellofemoral Dysfunction?

Answer 25

A condition characterized by pain and dysfunction in the patellofemoral joint.

Question 26

What are local factors contributing to PF symptoms?

Answer 26

Structures around the patella and symptoms provoked by faulty mechanics.

Question 27

What are distal factors contributing to PF symptoms?

Answer 27

Factors arising from the foot/ankle complex.

Question 28

What is an example of a distal factor?

Answer 28

Excessive pronation.

Question 29

What are proximal factors contributing to PF symptoms?

Answer 29

Factors arising from the hip.

Question 30

What is an example of a proximal factor?

Answer 30

Increased hip adduction and internal rotation during activities.

Question 31

What is PF instability?

Answer 31

A condition where the patella does not track properly in the femoral groove.

Question 32

What is PF pain with malalignment or biomechanical dysfunction?

Answer 32

Pain resulting from improper alignment or movement mechanics.

Question 33

What is PF pain without malalignment?

Answer 33

Pain that occurs despite proper alignment.

Question 34

What are some soft tissue lesions associated with PF dysfunction?

Answer 34

Tight medial and lateral retinacula, patellar pressure syndrome, osteochondritis dissecans, traumatic patellar chondromalacia, PF osteoarthritis, and apophysitis.

Question 35

What does the evidence say about PF pain?

Answer 35

Altered lower extremity kinematics and strength of hip musculature are found in patients with PF pain, especially women.

Question 36

What is the relationship between hip movement and PF pain?

Answer 36

PF pain patients present with greater hip adduction and internal rotation during weight-bearing activities that involve knee flexion.

Question 37

What is the conclusion regarding knee and proximal body regions?

Answer 37

There is an interdependence between the knee and the proximal regions of the body.

Question 38

What happens to patellofemoral joint stress during OKC leg extension?

Answer 38

The moment arm increases from 90 degrees to full extension, increasing the patellofemoral joint reaction force.

Question 39

What happens during CKC exercises like squats?

Answer 39

As the knee flexes from 0 to 90 degrees, the moment arm increases while the patellar contact area also increases.

Question 40

What are high patellofemoral stress activities?

Answer 40

Open chain leg extension from 45 to 0 degrees.

Question 41

What are low patellofemoral stress activities?

Answer 41

Open chain leg extension from 90 to 45 degrees and closed chain squats or leg press from 45 degrees to 0 degrees.

Question 42

What is the management approach during the protection phase for patellofemoral symptoms?

Answer 42

Treat with ice, rest, gentle motion, and muscle setting exercises.

Question 43

What should be done to reduce irritating forces in the protection phase?

Answer 43

Splinting of the patella with a brace or tape.

Question 44

What is the goal during the controlled motion and return to function stage?

Answer 44

Correct/modify biomechanical factors and increase strength, dynamic control, and pain-free mobility.

Question 45

What should patients avoid to manage patellofemoral symptoms?

Answer 45

Positions and activities that provoke symptoms, such as climbing stairs and prolonged sitting.

Question 46

What flexibility exercises are recommended?

Answer 46

Stretching of the gastrocnemius/soleus, quadriceps/hamstrings, and TFL.

Question 47

What are some techniques for patellar mobilization?

Answer 47

Medial glide, medial tipping of the patella, and patellar taping.

Question 48

What is emphasized for improving muscle performance?

Answer 48

VMO emphasis and developing awareness of VMO contraction/activation.

Question 49

What are some OKC exercises for PF dysfunction?

Answer 49

Quad sets, quad sets with straight leg raises, resisted isometrics, and straight leg raises.

Question 50

What are some CKC exercises for PF dysfunction?

Answer 50

Wall slide, forward step up, mini squat, reverse step up, and lateral step up.

Question 51

What should be done if full weight-bearing is painful?

Answer 51

Switch to partial weight-bearing.

Question 52

What should be included in dynamic exercises for PF dysfunction?

Answer 52

Progress from bilateral weight-bearing to unilateral weight-bearing, and include balance and agility training.

Question 53

What is important for functional activities in PF rehabilitation?

Answer 53

Add movement reeducation into activity-specific drills to improve proper movement strategies.

Question 54

What is the mechanism of injury for meniscal injuries?

Answer 54

Medial meniscus is injured more than lateral, often with the foot fixed and femur internally rotated.

Question 55

What is the non-surgical management for meniscal injuries?

Answer 55

Decrease pain and swelling, and increase strength and endurance once acute symptoms decrease.

Question 56

What are some surgical management options for meniscal injuries?

Answer 56

Partial meniscectomy and meniscal repair.

Question 57

What factors influence rehabilitation progression post-meniscal repair?

Answer 57

Location and size of tear, type of tear, type of surgical fixation, alignment of knee joint, and concomitant injuries.

Question 58

What are general exercise precautions after meniscus repair?

Answer 58

Progress cautiously with central zone lesions and call a doctor if clicking occurs.

Question 59

What are some early and intermediate rehabilitation guidelines?

Answer 59

Increase knee flexion gradually and avoid going past 45 degrees for weight-bearing for 4 weeks.

Question 60

What are advanced rehabilitation guidelines for meniscus repair?

Answer 60

No deep squatting, lunges, or twisting for 4-6 months.

Question 61

What should be avoided during return to activity after meniscus repair?

Answer 61

Prolonged squatting in full flexion and activities involving repetitive high joint compressions.