MS - Knee Pain

Question 1

What are menisci?

Answer 1

C-shaped wedges of fibrocartilage between tibial plateau and femoral condyle

Question 2

What do menisci prevent?

Answer 2

Bone on bone friction

Question 3

What is special about the medial meniscus?

Answer 3

it is larger and more tightly tethered to the tibia

Question 4

What are the two common groups of incidence for meniscal injuries?

Answer 4

young athletes and men/women over 55

Question 5

What is the MOI for meniscal injuries?

Answer 5

Twisting motion with foot planting on ground; wearing down with age

Question 6

What are the symptoms of meniscal injuries?

Answer 6

Locking/popping
Catching
Painful clicking
“giving way” - can still put all weight on injured leg

Question 7

What are the signs of a meniscal injury?

Answer 7

Edema/hemarthrosis that develops slower than ACL injury
decreased ROM
May block full extension
Joint space tenderness in 60-80% of patients

Question 8

How is a meniscus injury diagnosed?

Answer 8

MRI

Question 9

What is a non-surgical treatment option for meniscal injury?

Answer 9

RICE - when there are no mechanical symptoms and in the case of a degenerative tear

Question 10

What are the two types of surgical treatments for meniscal injury?

Answer 10

Arthroscopic debridement or repair

Question 11

What type of patients typically undergo surgical repair for meniscal injury?

Answer 11

Younger patients
Locked knee symptoms
Non-responsive to non-surgical intervention

Question 12

What type of tear is possible to repair?

Answer 12

peripheral

Question 13

What is meniscal surgery that removes part of the meniscus?

Answer 13

Partial meniscectomy

Question 14

What is inserted into the knee for an arthroscopic surgery?

Answer 14

camera and irrigating instrument

Question 15

What is the main stabilizing ligament of the knee joint?

Answer 15

Anterior cruciate ligament

Question 16

What is the job of the anterior cruciate ligament?

Answer 16

absorbs forces as the knee is in motion (esp. deceleration); keeps tibia from moving forward in relation to the femur

Question 17

Does an ACL injury require contact?

Answer 17

Most commonly a non-contact injury

Question 18

Are men or women more likely to injure their ACLs?

Answer 18

Women are 2-8 times more likely to tear than males

Question 19

What is the highest incidence of ACL injuries?

Answer 19

14-18 year old girls; at this age, 4-5 times more likely to be female than male

Question 20

How much more likely are women than men to injure their ACLs at the college age?

Answer 20

2-3x

Question 21

What caused an increased involvement in women’s sports and when?

Answer 21

Title IX
1972 - 264,000 HS female athletes
2006 - 3.5 million HS female athletes

Question 22

What is a Q angle?

Answer 22

Women have wider pelvises than males

Question 23

What is the quad to hamstring relationship that effects ACL injuries?

Answer 23

Quadricep muscles pull on ACL (increase anterior tibial movement) while hamstring muscles protect ACL (moves tibia posteriorly); an imbalance can cause quads to pull on ACL and increase risk of injury

Question 24

What structures are part of the terrible triad?

Answer 24

ACL, MCL, Medial meniscus

Question 25

What is the MOI for ACL injury?

Answer 25

when ligament is stretched beyond its normal elasticity; Plant and Pivot; sudden deceleration and pivoting

Question 26

What puts the knee in a vulnerable position for an ACL tear?

Answer 26

hyperextension

Question 27

How should one properly land compared to how many women tend to land when jumping?

Answer 27

One should land on their toes with knees and hips bent; Women tend to land with knees and hip not sufficiently bent, with valgus and not on their toes

Question 28

How does hemarthrosis present in an ACL tear?

Answer 28

quick onset; swelling and pressure

Question 29

What is used to diagnose ACL injury?

Answer 29

MRI

Question 30

What is the treatment for ACL injury?

Answer 30

RICE/crutches; Aspirin for hemarthroses; Knee immobilizer or range-of-motion brace

Question 31

What is important to have early in an ACL injury

Answer 31

ROM

Question 32

What does ACL injury treatment depend on?

Answer 32

patient's age and activity level

Question 33

What is the best option for successful return to function?

Answer 33

ACL surgery

Question 34

What are three test done in a PE to determine if the ACL is damaged?

Answer 34

Anterior drawer test Lockman test Pivot shift (clunk)

Question 35

What are 5 ways to prevent ACL injuries in girls and women?

Answer 35

Avoid vulnerable positions (esp when landing) Increase flexibility Increase strength Engage in explosive exercises that increase power, strength, and speed Increase proprioception through development of agility

Question 36

What is the best treatment for ACL injury?

Answer 36

Prevention

Question 37

What collateral ligament injury is more common?

Answer 37

MCL

Question 38

What are symptoms of an MCL injury?

Answer 38

Pain; inability to continue activity after injury

Question 39

What are the physical exam findings for an injured MCL?

Answer 39

Pain to palpation of MCL Laxity to valgus stress test (test at 30 degrees of flexion) Edema not usually present

Question 40

How is an MCL injury diagnosed?

Answer 40

MRI

Question 41

What is the MOI of LCL injury?

Answer 41

Varus force

Question 42

What are the symptoms of an LCL injury?

Answer 42

Pain on lateral aspect of knee; if no other structural injury, patient will be able to resume activities

Question 43

What are the physical exam findings of an LCL injury?

Answer 43

Pain to palpation on lateral aspect of knee; may be edema; varus laxity

Question 44

How is an LCL injury diagnosed?

Answer 44

MRI

Question 45

Describe varus force

Answer 45

medial to lateral force; damage to LCL

Question 46

Describe valgus force

Answer 46

lateral to medial force; damage to MCL