PTA135-Unit 3-3-Knee Flashcards
describe Grade I knee ligament sprain
little tear
no loss of function
describe Grade II knee ligament sprain
bigger tear
partial lost of function
describe Grade III knee ligament sprain
complete rupture
complete loss of function
What type of force or injury causes a sprain of the Anterior Cruciate Ligament?
The combined force of
• femoral ER,
• valgus stress,
• internal tibial rotation with or without knee hyperextension while affected foot is planted
state difference between Autograft, Allograft and Ligament Augmentation Device (LAD)
- autograft is replacement tissue taken from same person, intended to be permanent
- allograft is replacement tissue taken from cadaver, intended to be permanent
- LAD is synthetic, intended to be function as a load-sharing implant to protect a biologic graft while it heals, intended to be temporary
discuss the rehab of ACL reconstruction - Maximum Protection Phase
- wks 1-2 - decrease pain and swelling; increase ROM of knee and patella
- wks 1-2 - use bracing until adequate quads control is achieved
- wks 1-2 - all subject to specification of MD
- wks 2-6 -> increase ROM, WB
- wks 2-6 -> facilitate gain control in hams and quads
- wks 2-6 -> gait re-education, static proprioception exercises
list criteria that must be met to move from Maximum to Moderate Protection Phase in ACL rehab
- have full ROM – 0-120 degrees of flexion
- FWB
- Good control of hams/quads
- Control of pain/swelling
discuss the rehab of ACL reconstruction - Moderate Protection Phase
- Wks 6-12 -> improve muscular control, strength, and proprioception
- Wks 6-12 -> aerobic conditioning
- Wks 6-12 -> static to dynamic balance exercises
- Wks 6-12 -> work through full ROM during this stage
- Wks 6-12 -> progressive resistance exercises should be added
- Wk 12 -> by the end of this phase, pt should be able to cycle normally, swim with straight leg kick and jog freely on mini-tramp
discuss the rehab of ACL reconstruction - Minimal Protection Phase
• Wk 12 to 6 months -> gradual re-introduction of sports specific exercises
o Improve agility and neuromuscular control
o Work on reaction times
o Increase total leg strength
state difference between Open Kinetic Chain and Closed Kinetic Chain
OKC - distal segment moves freely, as in seated knee extension
CKC - distal segment is fixed or weight-bearing, as in leg press
why is it important to avoid OKC exercises during ACL reconstruction rehab?
because seated knee extension increases anterior tibial translation and stresses the new graft
state the 4 specific injury mechanisms that can produce a Posterior Cruciate Ligament (PCL) injury
- Dashboard injury - posterior directed force on the anterior aspect of a flexed knee
- Falling on a flexed knee, forcing the tibia posterior
- Hyperflexion of the knee without resultant force on the tibia
- Knee hyperextension-knee dislocation
discuss the rehab of PCL reconstruction - Surgery/Post-op
- Autograft (bone-patellar tendon-bone, hamstring, Achilles tendon), allograft, LAD, suture
- Ice, elevation, pain control
- WBAT use of crutches, amt WB varies per MD
- Neoprene or hinged brace for walking at 1 mo
- Isometrics (no hams isometrics early on)
- SLR hip extension avoided first 4 weeks
discuss the rehab of PCL reconstruction - Non-operative
- RICE to control pain, swelling
- NSAIDs
- FWB asap
- Quad strengthening – quads mimic action of PCL
- Progress to CKC quad exercises
- NO OKC hamstring exercises because of posterior tibial translation force
- Ankle pumps, quad, glut sets, SLR except hip extension
- Return to full activity within 8 weeks
state the MOI that most often causes a Medial Collateral Ligament (MCL) injury
force placed on the knee from the outside, resulting in stress on the inside of the knee (valgus stress)
discuss the rehabilitation progression after a MCL injury
- Protected weight bearing full to partial WB
- Once full ROM (3-6 wks), may discontinue brace if ok with MD
- Continue treatment to decrease swelling and pain
- Strengthen and regain muscular control
- Goal is regain full ROM
- No pain or tenderness
- No instability
- 85-90% normal muscle strength
- General return to sports 8-12 weeks after injury
state the 6 functions of the meniscus/menisci
- Stability
- Shock absorption
- Load transmission-provide for reception of the femoral condyles onto the surface of the tibia
- Joint stress reduction
- Lubrication and nutrition
- Control of motion
state the most common MOI of the Meniscus
- traumatic injury
2. degenerative processes
describe the vascular anatomy of the Meniscus
Zone I - Red on Red - vascular supply intact on both sides, heals better because of blood supply
Zone II - Red on White - vascular supply on one side, may heal because of communication with some blood supply
Zone III - White on White - non-vascular, injury does not heal, surgery required
discuss the rehabilitation progression after a Menisectomy
- Manage pain/swelling with RICE, NSAIDs
- WBAT progress to FWB as pain subsides; crutches 5-7 days
- ROM-wall slides/heel slides, stationary bike, seated knee flexion, wall squats, prone knee extension hangs
- Moderate protection phase 4-8 weeks - can progress CKC exercises
- Minimal protection phase 9th week – normal gain pattern, obtain full ROM equal to opposite side, enhance functional activity
- Criteria for d/c: all of the above plus good quad control, single leg stance > 30 seconds, strength 4+/5
define the Q-angle
- The angle between the line connecting the ASIS to the midpoint of the patella and the extension of the line connecting the tibial tubercle to the midpoint of the patella
- Quadriceps angle
define Arthrogram
Series of images of a joint after injection of a contrast medium (use an arthroscope)
define Arthroscopy
Surgical procedure in which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope
state the 3 Patella Reference Positions
- Normal Patella
- Patella Alta - patella is more superior than normal (greater patellar instability)
- Patella Baja - patella is more inferior than normal (compression force)
discuss the rehabilitation for Anterior Knee Pain (Patellar-Femoral pain)
- Control pain and swelling
- Limit ROM for knee extension to avoid lateral patellar compression pain
- Hip adduction is medially directed pull on patella, so do slight external rotation
- Hip strengthening of abduction, external rotation, extension
- Quad strengthening in isometrics, e-stim and CKC exercises in pain free ranges
- Modify exercises that cause pain, such as descending steps
- Stretching/mobilizing the ITB and hamstrings
- Patellar mobilizations
- Neoprene brace
- Adhesive taping techniques for alignment
list the 5 types of Patellar Fractures
- Nondisplaced
- Transverse
- Lower pole/upper pole
- Comminuted
- Vertical
discuss rehabilitation for Patellar Fracture - Non-displaced
Treated conservatively
- Immobilization in full extension to reduce stress on patella
- Once bone healing is sufficient, progress with quad sets, terminal knee extension, SLR
discuss rehabilitation of Patellar Fracture - Displaced
Treated with ORIF
- Immobilize knee in 20 degrees of knee flexion to help support the dynamic compression of ORIF
- Flexion out of the brace is limited to 100 degrees of flexion for at least 6 weeks
define Housemaid’s Knee
- Bursitis of the knee
- Inflammation of the prepatellar burse due to chronic irritation or trauma
- From excessive kneeling or crawling on knees or a from a blow to the front of the knee
define Chondromalacia
- Condition in which the cartilage on the undersurface of the patella deteriorates and softens
- Often seen as overuse injury in runners
what is the most common MOI for Patellar Fractures?
contact with a hard surface
name three tests for Meniscus injury
McMurray
Apley
Thessaly
name two tests for ACL injury
Anterior Drawer
Lachman’s
name two tests for PCL injury
Posterior Drawer
Posterior Sag/Godfrey/Gravity Sag
name test for MCL injury
Valgus
name test for LCL injury
Varus
describe McMurray Test
- meniscus
- Supine, full knee flex. Rotate tibia, extend knee while applying valgus or varus force.
- Positive for meniscal tear if feel click
describe Apley Test
-meniscus
-Prone, apply compression or distraction and rotate tibia
-Positive if pain, clicking.
Indicative of ligamentous if pain in distraction
describe Thessaly Test
- meniscus
- Standing one leg, twist three times
- Positive if pain
describe Anterior Drawer Test
- ACL
- Supine, knee at 90, pull ‘drawer’ open
- Positive if displaced more than 5 mm
describe Lachman’s Test
- ACL
- Supine, knee at 20-30, pulled anteriorly
- Positive if end feel mushy, infrapatellar slope disappers
describe Posterior Drawer Test
- PCL
- Supine, knee at 90, push ‘drawer’ closed
- Positive if displaced more than 5 mm
describe Posterior Sag/Godfrey/Gravity Sag Test
- PCL
- Supine, both knees at 90, both hips at 90. Bilateral examination of tibia placement
- Positive if tibia hanging too low
describe Valgus Test
- MCL
- Supine, knee extended, valgus force; knee flex 20-30 valgus force
- Positive if pain or valgus movement with no end point
describe Varus Test
- LCL
- Supine, knee extended, varus force; knee flex 20-30, varus force
- Positive if pain or varus movement with no end point
