Ortho II: Knee (PCL, Meniscus, OA) Flashcards by Colin LaCombe

What are common settings for ACL injuries?
-3 things

Work related
MVA
Athletics

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How common are isolated PCL injuries?

Less common compared to combined injuries

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What are common MOI for contact PCL injuries?
-2 things

MVA knee into dashboard
Fall on flexed knee with ankle plantarflexed

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What is the common MOI for non-contact PCL injuries?

Knee hyperextension

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What might a patient tell you if they had a PCL injury?
-4 things

May describe a pop
Vague pain
Minimal swelling in popliteal fossa
Possibly instability

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Where is pain typically located in the case of chronic PCL injury?

Patellofemoral pain

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What can be seen during observation in the presence of a PCL injury?
-2 things

Antalgic gait
Knee effusion

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What mobility impairments may be seen during examination in the presence of a PCL injury?

Minimal impairment

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What strength impairments may be seen during examination in the presence of a PCL injury?

Quad deficit due to pain

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What stability impairments may be seen during examination in the presence of a PCL injury?
-2 things

Positive laxity testing with posterior stress
Patient may not have sense of instability

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What tests can be used to assess laxity of the PCL?
-3 things

Godfrey’s test/Sag sign
Posterior drawer
Quad active drawer

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What can be done to assess for combined injury when assessing the PCL?
-2 things

Posterolateral rotary instability
Posteromedial rotary instability

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What are the indications for non-surgical intervention of a PCL injury?
-2 things

Grade 1 or 2
Functional knee

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What is the timeline for Phase 1 of non-surgical intervention for PCL injuries?

Weeks 1-3

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What should be done in Phase 1 of non-surgical intervention for PCL injuries?
-4 things

Pain and swelling control
Ambulation
Mobility exercises
Strengthening

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What are the guidelines for ambulation in Phase 1 of non-surgical intervention for PCL injuries?

Week 1: WBAT with crutches and brace in full extension
Week 2-3: Progress to full weight bearing

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What range of motion should be used for mobility exercises in Phase 1 of non-surgical intervention for PCL injuries?

0-60 degrees

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What are the guidelines for strengthening in Phase 1 of non-surgical intervention for PCL injuries?

Week 1: Isometric quad exercises
Weeks 2-3: Mini squats to 45 degrees

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What is the timeline for Phase 2 of non-surgical intervention for PCL injuries?

Weeks 3-6

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What should be done in Phase 2 of non-surgical interventions for PCL injuries?
-6 things

Stationary cycling
Stair climber
ROM to tolerance
Strengthening
Proprioceptive exercise
Monitor ROM, pain, and swelling

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What strengthening exercises are recommended during Phase 2 of non-surgical intervention for PCL injuries?
-3 things

Leg press from 0-60 degrees
Step-ups
Calf raise

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What is the timeline for Phase 3 of non-surgical intervention for PCL injuries?

Weeks 6-12

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What should be done in Phase 3 of non-surgical intervention for PCL injuries?
-3 things

Running program
Strengthening
Functional progression to sport

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What are the criteria for return to sport/work following a PCL injury?
-4 things

Full ROM
Strength 75-85% of contralateral limb
Completion of functional progression
Bracing

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When is a primary repair for a PCL indicated?

Avulsion fracture

What should be avoided following PCL surgical reconstruction? -2 things

Limit squats to 45 degrees knee flexion Non open chain flexion

What combined ligament injuries create AMRI?

MCL and ACL

What combined ligament injuries create PLRI?

PCL and LCL

What combined ligament injuries create ALRI?

ACL and LCL

What combined ligament injuries create PMRI?

PCL and MCL

What are knee dislocations usually accompanied by?

Vascular and neuro injury

What needs to be done if a knee dislocation occurs? -2 things

Medical emergency Requires surgical intervention

What is the rehab course for knee dislocations?

Depends on specific injury and surgery

What is the mechanism of injury in meniscus injuries?

Usually traumatic non-contact Rotation of flexed knee on planted foot Possibly degenerative in older adults

What often accompanies a contact meniscus injury?

Other ligament injury

What is the most common type of meniscus injury?

Medial meniscus tears

Where is the most vascularization in the meniscus and what is the significance of this?

Outer 1/3 If damaged here, surgeon more likely to repair than do meniscectomy

What might a patient tell you about if they have a meniscus injury? -5 things

"Twisted my knee" Pop Joint line pain that increase with WB Swelling Locking/catching

What can be seen during observation in the presence of a meniscus injury? -2 things

Effusion Flexed knee gait pattern

What might be seen when assessing mobility in the presence of a meniscus injury? -2 things

Loss of full extension due to mechanical block Pain increase with flexion past 90 degrees

What might be seen when assessing muscle strength in the presence of a meniscus injury?

Loss varies and depends on acuity

What manual tests should be used to assess for a meniscus injury? -2 things

Mcmurrays Thessaly

What is the Cluster test for meniscus injuries? -5 things

Locking Joint line tenderness McMurrays Pain with flexion Pain with hyperextension

What are the types of meniscus tears? -5 things

Radial Longitudinal Horizontal Flap Degenerative

What is the name of a significant tear of the meniscus that causes a lot of pain?

Bucket handle tear

What does a bucket handle tear develop from?

Longitudinal tear

What effect does PT have on meniscus tears?

PT has no effect, focus on restoration of function

What should PTs use as interventions for meniscus tears? --6 things

Pain/swelling control Restore knee mobility Restore strength Gait training Address ergonomic issues Return to function

What are the types of meniscal surgeries? -3 things

Meniscectomy Meniscal repair Meniscal replacement

What are the types of meniscal replacements? -2 things

Implant Allograft

What are the typical precautions post meniscal repair? -2 things

WB limitations No open chain hamstring exercises

What are the guidelines for post-surgical rehab following meniscectomies? -6 things

Decrease pain and swelling Minimal WB restriction Improve mobility Improve strength Improve proprioception Return to activity in 4-6 weeks

What is a discoid meniscus?

Congenital anatomic variant of meniscus

What are the types of discoid meniscus?

Complete or incomplete

What can be a result of someone having a discoid meniscus? -2 things

Lateral compartment pain Loss of knee ROM

What should be done to fix a discoid meniscus?

Surgical intervention to reshape the meniscus

What is osteochondritis dessicans?

Focal defect of articular cartilage

Where can osteochondritis dissecans occus? -3 things

Medial femoral condyle Patella Lateral femoral condyle

How common and at what age does osteochondritis dissecans occur?

30-60/100,000 Usually at teen years

What often causes osteochondritis dessicans? -3 things

Trauma/bone bruise Ischemic necrosis Genetic factors

What are the typical symptoms of osteochondritis dessicans? -3 things

Pain that is not well localized Swelling Mechanical locking

When should osteochondritis dessicans be treated conservatively?

If stable fragment

When should osteochondritis dessicans be treated surgically?

If free fragment

How should osteochondritis dessicans be treated conservatively? -2 things

Limit weight bearing Activity modification

How can osteochondritis dessicans be treated surgically? -3 things

Microfracture Osteochondral graft Autologous chondrocyte implantation

What are some risk factors for developing knee OA? -7 things

BMI over 30 Age Female Black Knee trauma Physical workload Bone mineral density

What are some common misunderstandings about knee OA? -3 things

Running does not increase risk Not normal aging feature Not wear and tear

What symptoms are including the cluster for Knee OA? -5 things

Age over 38 Knee pain most days Joint crepitation Morning stiffness Enlargement of knee

What can be seen during observation in the presence of knee OA? -3 things

Joint effusion Abnormal frontal plane angulation Baker's cyst

What can be seen in gait observation in the presence of knee OA? -5 things

Slower speed Decreased stride length Prolonged stance phase Decreased knee flexion ROM Increased external adduction moment

What gait abnormality increases risk of progression of medial knee OA and is a predictor of poor physical function?

Varus Thrust

What mobility impairments are typically seen in the presence of knee OA?

Loss of sagittal plane motion

What strength impairments are typically seen in the presence of knee OA? -2 things

Knee extensor weakness Hip muscle weakness

What are the hallmark radiographic changes in knee OA? -3 things

Marginal bone spurs Decreased joint space Subchondral sclerosis

What factors are associated with greater functional loss related to knee OA? -4 things

Increased knee laxity Greater pain Higher BMI Severity of OA

What does OARSI recommend as interventions for individuals with knee OA? -6 things

Biomechanical interventions Intra-articular corticosteroids Land and water exercise Self-management education Strength training Weight management

What did Roddy 2005 find as effective treatment for knee OA? -2 things

Aerobic exercise Home based strengthening

What did Franse 2004 find as effective treatment for knee OA?

Land based therapeutic exercise

What did Diracoglu 2005 find as effective treatment for knee OA?

Found that a program with combination of strengthening, kinesthesia, and balance training was more effective than just strengthening

What biomechanical interventions are recommended for conservative treatment of knee OA? -4 things

Unloader bracing Heel wedge Shock absorbing insoles Assistive devices

What did Christianson 2007 find as effective treatment for knee OA?

Weight loss leads to decreased pain and decreased disability

What are the surgical intervention options for knee OA?

Arthroscopy High tibial osteotomy Total knee replacement Joint fusion