MS1: Orthopedic Conditions of the Knee Flashcards
what type of joint is the tibio-femoral joint
modified hinge kase flex-ext, some rotation and abd-add
describe the knee joint
largest and most complex
what type of joint is the patellofemoral joint
plane nag glide up and down yung patella during flex-ext
purpose of patellofemoral joint
protects anterior knee
ANATOMICAL PULLEY para mas madali mag extend quads
what type of joint proximal tibia-fibula
synovial plane; gliding during movement ng ankle
nerve supp ng proximal tibia-fibula
common peroneal nerve
stability of joint depends on
strength and action of surrounding muscles
ligaments
what is the capsule
surrounds the joint
attached to margins ng articular surfaces
ant and post ligaments strengthen
purpose of interosseous membrane
connects shaft ng tibia and fibula
extracapsular ligaments
pattelar lig
LCL and MCL
lateral collateral
medial collateral
oblique popliteal
patellar ligament
distal part of quads
collateral ligs of knee
LCL - add; rounded
MCL - abd; flat
oblique popliteal lig
expansion ng semimemb
strength sa posterior
intracapsular ligs
ACL
PCL
menisci
ano mas mahina acl o pcl
acl is weaker kase poor blood supply
stronger PCL
acl prevents what
posterior displacement of femur and ant ng tibia
HYPEREXTENSION
location of cruciates
center of knee; stability
when is ACL taut and laxed
taut kapag ext
lax pag flex
when is PCL taut
knee flex
what does PCL prevent
ant disp ng femur tas post ng tibia
main function of ACL
rotational stability
main function of PCL
stabilizer kapag weight bearing in flexed knee
which is more mobile na meniscus
lateral
compare the shape ng menisci
lat - circular and smaller
med - broad and C SHAPED
what acts on extension
quads; limited by cruciates and collateral
when does rotation happen
knee is flexed
what acts on flexion
hamstring; limited by contact of calf and thigh
what acts on medial rot
popliteus, semimemb, semiten
checked by cruciates
what acts on lat rot
biceps femoris
checked by collateral
where is the supracondylar area
zone betw femoral condyles sa metaphysis
10-15 cm distal femur
bat may physiologic valgus yung femur
kase medial condyle extends more distally and mas convex
deforming force of gastroc on distal femur fractures
flexes distal fragment
POSTERIOR ANGULATION
deforming force of quads and hams on distal femur fractures
proximal traction
SHORTENS LE
mechanism of injury in DFF
axial load in varus, valgus or rotational
young - MVA or fall ng mataas
elderly - slip or fall on flexed
general principles of treatment of DFF
restore congruity
stabilize; fragment sa shaft
indirect reduction to preserve bv
early knee ROM
non-op of DFF in NON DISPLACED
hinged knee brace; FULL TIME - 6-8 WKS
closed chain ROM 3-4 wks
partial weight bearing
non-op of DFF in DISPLACED
traction then brace; 6-12 wks
op treatment of DFF
plate fixation or nail
SEVERE - arthroplasty
complications of op treatment in DFF
nonunion
malalignment
loss of fixation
infection
knee pain stiff
painful hardware kase weather
describe the etiology og knee dislocations
UNCOMMON PERO LIFE THREATENING
mech of injury ng knee disloc
MVA and dashboard; HE
athletic injury or fall; LE
rupture ng 3/4 ligs; ACL, PCL, MCL, LCL
diagnosis ng knee disloc
tibia mag move
ant
post
medial or lat
rot
posterolat
most common type of knee disloc
POSTEROLATERAL
treatment of knee disloc
emergent reduction
REVASCULARIZE WITH IN 6 HOURS
ligament reconstruct - mas ok pag acute
EARLY ROM
complications of knee disloc
vasular injury
neurologic - PERONEAL - ant comp - FOOT DROP
stifness - MOST COMMON
lax ligaments
escribe neurologic copli on knee disloc
MAIPIT PERONEAL SO FOOT DROP KASE ANT COMP MUSCLES
most common compli of knee disloc
stifness or arthrofibrosis
functions of the patella
inc mechanical advantage of quads tendon
aid nourishment
protect condyles ng femur
largest facet of patella
lateral - 50% of pattela
what is the Q angle
hindi pantay yung femoral head sa patella
ensures na pull ng quads is laterally directed
normal Q angle
3.5 DEG - MALE
4.6 DEG - FEMALE
most common type of patellar disloc
lateral dislocation
occurence of patellar disloc
more common in women - physiologic laxity bc hormones at inc Q angle
hypermobility ng ligs at soft tissue disorders
congenital abnormalitites ng knee, PATELLA ALTA
relate inc Q angle to patellar disloc
increase chance kse mas lateral magiging pull ng quads - lateral disloc
clinical presentation of patellar disloc
BIGLANG NAPALUHOD TAS DISPLACED NA
hemarthrosis
cant flex knee
displaced patella on palpation
pag chronic - + apprehension test
non op treatment of patellar disloc
reduction tas casting in knee ext
pwede mag ambulate locked ext for 3 wks tas iso quads
6-8 pwede na walang brace
when can tanggal brace for patellar disloc
6-8 wks
op treatment of patellar disloc
pag recurrent disloc; RARE
occurence of patellar fractures
NADAPA TAS NAKALUHOD
NOT COMMON 1% LANG
mas common sa male; 2:1
20-50 yo
bilat is uncommon
significance of medial and lateral extensor retinacula
preserves active extension in patellar fractures
mechanism of injury of patellar fracture pag DIRECT
trauma to patella; abrasions pag open
minimal displacement; preserved yung med and lat retincular eme eme
MAY KNEE EXT
mechanism of injury of patellar fracture pag INDIRECT
MOST COMMON
forced quads contract while knee is semiflexed in stumble or fall
TRANSVERSE FRACTURE PATTERN
NO KNEE EXT
indications of non op in patellar fracture
non or minimal lng displace
INTACT EXTENSOR MECHANISM
non op in patellar fracture
knee immobilizer ng 4-6 wks
early weight bearing as tolerated; crutches
SLR and quads iso - active flex-ext strengthening w hinged knee brace
indications of op in patellar fracture
more than 2 mm incongruity
more than 3 mm displacement
open fracture
op in patellar fracture
repair retinacular disruption
post op mag splint 3-6 wks tas early ROM
partial to FWB by 6 wks
major weight bearing bone of the leg
tibia - 85%
compare the 2 tibial plateaus
med - larger more concave
lat - higher and convex
what are the 3 bony prominences of the tibial plateau
tibial tubercle - patellar tendon
pes anserinus - medial hams
gerdy’s tubercle - IT band
what is the more common type of tibial plateau fracture
lateral
causes of medial plateau fracture
MVA
injury to LCL, peroneal nerve and popliteal vessels
mechanism of TPF
varus or valgus force during axial loading
MORE COMMON IN YOUNG
BICONDYLAR SPLIT; sa gitna na fracture pag extended knee
mechanism of TPF in YOUNG
MVA
split fracture and ligamentous disruption
mechanism of TPF in ELDERLY
falls
depression and split-depression
LOWER RATE NG LIGAMENT DAMAGE
associated injuries sa TPF
meniscal tears - 50%
cruciate or collat tears - 30%
- young adults
peroneal nerve or popliteal nuerovascular lesions
explain peroneal nerve or popliteal nuerovascular lesions in TPF
lateral frcture ma impinge
pag medial; na pppull LCL so ma iimpinge din
non op of TPF
protected Wb and EARLY ROM in hinge brace
isp quads to passive to active
PWB for 8-12 wks until kaya mag FWB
op of TPF
post op - NO WB with passive and AROM
WB at 8-12 wks
indications of op TPF
split fracture
open
compartment synd or vascular injury
instability and step off
compli of TPF
knee stiff
infection
compartment synd
malunion
arthritis
peroneal nerve or popliteal artery injury
avascular necrosis
pathology of patellofemoral pain
pain in patella worsened by sitting, stairs or pataas na walk and squats
occurence of patellofemoral pain
NON ATHLETE MAS COMMON SA WOMEN
PAG ATHLETE SA MALE MAS COMMON
causes of patellofemoral pain
femoral trochlear dysplasia - di enough yung sulcus to prevent patellar disloc
morphology and congruence ng patella
baja or alta
q angle
why are women more susceptible to anterior knee pain
broad pelvis produces inc valgus angle or Q angle
increase din femoral anteversion which increases valgus angle
what are patellar compression syndromes
from overstained patella tas restricted yung motion ng surrounding tissues
cause LPCS
tight lateral retinaculum produces patellar tilt = compression
diagnosis LPCS
if decreased yung medial patellar glide and kita na lateral tilt
clinical manifestation LPCS
VMO is atrophied kase medial stabilizer sha; ni ccounter act nya lateral tilt
so pwede mag inflamme or pain
treatment of LPCS
stretching of lateral retinacular structures
patellar taping to correct tilt
stretch hams, quads and ITB
strengthen VMO
AIF
activity modification; minimize stairs and deep squat
cause of IPCS
related sa direct trauma or hyperplasia after surgery due to immob
both medial and lat tight do di talaga maka glide
globar patellar pressure syndrome
dec knee flex-ext
prodromal stage of IPCS
2-8 wks after trauma
rehab w early patellar mob
stretch hams, quads, hip flexors, gastroc and ITB; restore knee ext
PALAKAS QUADS
hold glide for long duration
active stage of IPCS
mas humigpit - wala passive and active knee ROM
texture changes sa patella tendon
+ shelf sign - abrupt step off ng patellar tendon sa tibial tubercle
REQUIRES SURGERY - daily CPM to full AROM, extension splints at night
residual stage of IPCS
at 8 mo. or years - SIGNIFICANT ARTHROSIS AND LOW RIDING PATELLA
knee pain, stiff and swell; CREPITUS
10 deg or more loss in ext
25 deg or more loss on flex
and dec patellar glide
atrophy of quads, paplpable crepitus,
FLEXED KNEE GAIT
common cause of pain and functional disability
articular cartilage defect
treatment for articular cartilage defect
usually surgical
debride, transplant and microfracture
post op rehab for articular cartilage defect PROLIFERATION
4-6 wks post op
protect, dec swell and gradual PROM and limited WB para may control n s quads
ice tas heat
post op rehab for articular cartilage defect TRANSITION
4-12 wks post op
PWB to FWB and full ROM na
resumes to normal activities PERO NO SPORTS PA
post op rehab for articular cartilage defect REMODELING
3-6 months post op
improvement of symptoms tas NORMAL ROM
low to mod impact activities - BIKE, GOLF, walking malayo
post op rehab for articular cartilage defect MATURATION
4-6 or 15-18 months post op; depends sa lesion size and loc and surgery na ginawa
YES NA TO SPORTS
most common disability in US
tibiofemoral osteoarthritis
occurence of tibiofemoral OA
63-94 yo
degenerative so wear and tear
obses, overuse or from prev injury
most common type of arthritis sa elderly
knee OA
clinical findings of TF OA
swelling
warm to touch
pain in WB and sometimes kahit nag rrest
loss of motion
conservative treatment of TF OA
palakasin quads tas aerobic SWIMMING
exercise talaga
op treatment of TF OA
total knee arthroplasty
w ICE, ROM, iso ng quads, mobilize patella tas gait traini
occurence of chondromalacia patella
12-35 yo FEMALE
softening of cartilage sa posterior ng patella
two types of chondromalacia patella
surface degen of patella - age dependent ASYMPTOMATIC
basal degen - trauma and abnormal tracking of patella kase LAX LIG
grade 1 of chondromalacia patella
CLOSED disease
softening is reversibele lessen lang activity
intacts pa joint surface pero SPONGY
may blister
grade 2 of chondromalacia patella
OPEN disease
may fissure yung blister
grade 3 of chondromalacia patella
severe fibrillation or mas malalaim na fissure
CRABMEAT APPEARANCE
grade 4 of chondromalacia patella
full thickness na fibrillation - eroded hanggang bone
leads to OA
occurence of ACL tear
women more than men in sports
pathology of ACL tear
sudden deceleration or change in direction tas fixed yung foot
knee popping as tibia moves anteriorly
classic sign of ACL injury
acute hemarthrosis - blood into joint cavity
ACL risk factors
narrow intercondylar notch
joint laxity - more in women
hormones - estrogen, estradiol and relaxin; WOMEN
pelvics an TF angle; inc Q angle
smaller ACL sa female tas weaker muscles nila
most common meniscal tear
bucket handle
unhappy triad
medial meniscus
MCL
ACL
most common mechanical symtom in knee
meniscal tear
which is more common med or lat meniscal tear
medial
cause of meniscal tear
turn or twist or change direction while WB
pwede din trauma to lat or med ng knee pag naka plant yung foot
clinical manifestation of meniscal tears
sweeling, pop or clinc and pain along joint
lead to arthritis kase bone to bone contacts since wala na meniscus
plica syndrome
anterior pain
click, lock or pseudolocking of knee
can mimic acute internal derangement of knee
treatment for plica
strecth of quads, hams and gastroc
iso, cryo, ultra, patellar brace and AIF
cause of patellar tendinitis
overuse
eccentric overload during jumping, landing downhill run DECELERATION
bigblang mapapa squat tas babalik sa standing
treatment for patellar tendinitis
eccentric strength
5 min warmup w 5 static stretch held for 15-30 secs
ITB friction syndrime
overuse in long distance runners
repeptitive stress injury as ITB slides sa lat femoral condyle at 30 deg flexion
GURDEYS - tender upon palpation
+ obers
treatments for ITB syndome
modify activity - lessen mileage, changeike seat or shoes
ice and heat
palakas hip abd
stretch ITB
osgood-schlatter
avulstion ng patellar tendon sa tibia
teen agers mas common sa male ; due to growth spurt
sinding-larsen-johanssen syndrome
sa inferior patella nag apophysitis
sa immature or pre growth spurt
fragmentation ng tibial tubercle or inferior patella
