Management of Knee Dysfunction Flashcards
What is Osteoarthritis (DJD)?
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
What are the risk factors for Osteoarthritis?
Excess weight, joint trauma, developmental deformities, weakness, and tibial rotation.
What are the common symptoms of Rheumatoid Arthritis?
Inflammation, limited motion, and joint deformity, primarily affecting hands, feet, and knees.
typically appears on the hands, feet, and knees
What is Post Immobilization Hypomobility?
A condition affecting the capsule, muscles, and soft tissue after a period of immobilization.
What is the focus of the Protection Phase in Joint Hypomobility Management?
Control pain, protect the joint, educate the patient, and adapt function.
What techniques are used to maintain soft tissue and joint mobility? How do you maintain muscle function?
P, AA, or AROM and Grade I or II joint distraction.
Maintain muscles through setting exercises
What is the goal of Controlled Motion and Return to Function in Joint Hypomobility Management?
Educate the patient, decrease pain from mechanical stress, improve muscle performanece, and increase joint play and range of motion.
What exercises are recommended to improve muscle performance during controlled motion phase?
Open kinetic chain (OKC) and closed kinetic chain (CKC) exercises, progressive strengthening, and endurance training.
What are the indications for joint surgery?
Symptomatic knee, size of lesion, depth and location of lesion, time since injury, age, and activity level of the patient.
How is lesion size and rehab related
Larger the lesion, slower the progression of rehab
Rehab for Articular Cartilage defect
- 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
When do you return to functional activity following articular cartilage deficit?
- 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
What are the indications for Total Knee Arthroplasty?
Severe joint pain with weight-bearing, extensive destruction of articular cartilage, knee deformity, gross instability, and failure of non-operative management.
What are the exercise precautions post Total Knee Arthroplasty?
Monitor incision integrity, delay straight leg raises, determine time frame for resistive exercises, and avoid joint mobilization techniques for constrained knees.
What are common outcomes after Total Knee Arthroplasty?
Significant pain relief, variable range of motion, and strength and endurance improvements over time.
What are the mechanisms of injury for Anterior Cruciate Ligament injuries?
Contact injuries from a blow creating valgus stress and non-contact injuries from external rotation on a planted foot or hyperextension.
What is the gender bias in ACL injuries?
Females are 3 times more likely to tear their ACL compared to males.
What are the advantages of Bone-tendon-bone autograft for ACL reconstruction?
High tensile strength, reliable fixation, rapid revascularization, and ability to return to pre-injured activities.
What are the disadvantages of Semitendinosus-gracilis autograft?
Less reliable tendon-bone fixation, longer healing time, and potential for hamstring muscle strain.
What are the criteria to return to high-demand activities after ACL reconstruction?
No knee pain or swelling, full active knee range of motion, quad strength >85-90%, and acceptable patient-reported score.
What are the goals for non-operative management of ligament injuries in the first 4 weeks?
Protect healing tissues, prevent reflex inhibition, decrease joint effusion, decrease pain, and establish a home exercise program.
What interventions are recommended after 4-8 weeks of non-operative management?
Full, pain-free range of motion, restore muscular strength, normalize gait, and adherence to the home exercise program.
What should be focused on after 8 weeks of non-operative management?
Increase strength, power, endurance, neuromuscular control, and dynamic stability.
TKR Interventions for each phase of rehab
What is Patellofemoral Dysfunction?
A condition characterized by pain and dysfunction in the patellofemoral joint.
What are local factors contributing to PF symptoms?
Structures around the patella and symptoms provoked by faulty mechanics.
What are distal factors contributing to PF symptoms?
Factors arising from the foot/ankle complex.
What is an example of a distal factor?
Excessive pronation.
What are proximal factors contributing to PF symptoms?
Factors arising from the hip.
What is an example of a proximal factor?
Increased hip adduction and internal rotation during activities.
What is PF instability?
A condition where the patella does not track properly in the femoral groove.
What is PF pain with malalignment or biomechanical dysfunction?
Pain resulting from improper alignment or movement mechanics.
What is PF pain without malalignment?
Pain that occurs despite proper alignment.
What are some soft tissue lesions associated with PF dysfunction?
Tight medial and lateral retinacula, patellar pressure syndrome, osteochondritis dissecans, traumatic patellar chondromalacia, PF osteoarthritis, and apophysitis.
What does the evidence say about PF pain?
Altered lower extremity kinematics and strength of hip musculature are found in patients with PF pain, especially women.
What is the relationship between hip movement and PF pain?
PF pain patients present with greater hip adduction and internal rotation during weight-bearing activities that involve knee flexion.
What is the conclusion regarding knee and proximal body regions?
There is an interdependence between the knee and the proximal regions of the body.
What happens to patellofemoral joint stress during OKC leg extension?
The moment arm increases from 90 degrees to full extension, increasing the patellofemoral joint reaction force.
What happens during CKC exercises like squats?
As the knee flexes from 0 to 90 degrees, the moment arm increases while the patellar contact area also increases.
What are high patellofemoral stress activities?
Open chain leg extension from 45 to 0 degrees.
What are low patellofemoral stress activities?
Open chain leg extension from 90 to 45 degrees and closed chain squats or leg press from 45 degrees to 0 degrees.
What is the management approach during the protection phase for patellofemoral symptoms?
Treat with ice, rest, gentle motion, and muscle setting exercises.
What should be done to reduce irritating forces in the protection phase?
Splinting of the patella with a brace or tape.
What is the goal during the controlled motion and return to function stage?
Correct/modify biomechanical factors and increase strength, dynamic control, and pain-free mobility.
What should patients avoid to manage patellofemoral symptoms?
Positions and activities that provoke symptoms, such as climbing stairs and prolonged sitting.
What flexibility exercises are recommended?
Stretching of the gastrocnemius/soleus, quadriceps/hamstrings, and TFL.
What are some techniques for patellar mobilization?
Medial glide, medial tipping of the patella, and patellar taping.
What is emphasized for improving muscle performance?
VMO emphasis and developing awareness of VMO contraction/activation.
What are some OKC exercises for PF dysfunction?
Quad sets, quad sets with straight leg raises, resisted isometrics, and straight leg raises.
What are some CKC exercises for PF dysfunction?
Wall slide, forward step up, mini squat, reverse step up, and lateral step up.
What should be done if full weight-bearing is painful?
Switch to partial weight-bearing.
What should be included in dynamic exercises for PF dysfunction?
Progress from bilateral weight-bearing to unilateral weight-bearing, and include balance and agility training.
What is important for functional activities in PF rehabilitation?
Add movement reeducation into activity-specific drills to improve proper movement strategies.
What is the mechanism of injury for meniscal injuries?
Medial meniscus is injured more than lateral, often with the foot fixed and femur internally rotated.
What is the non-surgical management for meniscal injuries?
Decrease pain and swelling, and increase strength and endurance once acute symptoms decrease.
What are some surgical management options for meniscal injuries?
Partial meniscectomy and meniscal repair.
What factors influence rehabilitation progression post-meniscal repair?
Location and size of tear, type of tear, type of surgical fixation, alignment of knee joint, and concomitant injuries.
What are general exercise precautions after meniscus repair?
Progress cautiously with central zone lesions and call a doctor if clicking occurs.
What are some early and intermediate rehabilitation guidelines?
Increase knee flexion gradually and avoid going past 45 degrees for weight-bearing for 4 weeks.
What are advanced rehabilitation guidelines for meniscus repair?
No deep squatting, lunges, or twisting for 4-6 months.
What should be avoided during return to activity after meniscus repair?
Prolonged squatting in full flexion and activities involving repetitive high joint compressions.
