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PTA - Pathology > PTA135-Unit 3-3-Knee > Flashcards

PTA135-Unit 3-3-Knee Flashcards

1
Q

describe Grade I knee ligament sprain

A

little tear

no loss of function

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2
Q

describe Grade II knee ligament sprain

A

bigger tear

partial lost of function

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3
Q

describe Grade III knee ligament sprain

A

complete rupture

complete loss of function

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4
Q

What type of force or injury causes a sprain of the Anterior Cruciate Ligament?

A

The combined force of
• femoral ER,
• valgus stress,
• internal tibial rotation with or without knee hyperextension while affected foot is planted

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5
Q

state difference between Autograft, Allograft and Ligament Augmentation Device (LAD)

A
  • 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
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6
Q

discuss the rehab of ACL reconstruction - Maximum Protection Phase

A
  • 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
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7
Q

list criteria that must be met to move from Maximum to Moderate Protection Phase in ACL rehab

A
  • have full ROM – 0-120 degrees of flexion
  • FWB
  • Good control of hams/quads
  • Control of pain/swelling
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8
Q

discuss the rehab of ACL reconstruction - Moderate Protection Phase

A
  • 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
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9
Q

discuss the rehab of ACL reconstruction - Minimal Protection Phase

A

• 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

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10
Q

state difference between Open Kinetic Chain and Closed Kinetic Chain

A

OKC - distal segment moves freely, as in seated knee extension
CKC - distal segment is fixed or weight-bearing, as in leg press

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11
Q

why is it important to avoid OKC exercises during ACL reconstruction rehab?

A

because seated knee extension increases anterior tibial translation and stresses the new graft

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12
Q

state the 4 specific injury mechanisms that can produce a Posterior Cruciate Ligament (PCL) injury

A
  1. Dashboard injury - posterior directed force on the anterior aspect of a flexed knee
  2. Falling on a flexed knee, forcing the tibia posterior
  3. Hyperflexion of the knee without resultant force on the tibia
  4. Knee hyperextension-knee dislocation
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13
Q

discuss the rehab of PCL reconstruction - Surgery/Post-op

A
  • 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
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14
Q

discuss the rehab of PCL reconstruction - Non-operative

A
  • 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
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15
Q

state the MOI that most often causes a Medial Collateral Ligament (MCL) injury

A

force placed on the knee from the outside, resulting in stress on the inside of the knee (valgus stress)

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16
Q

discuss the rehabilitation progression after a MCL injury

A
  • 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
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17
Q

state the 6 functions of the meniscus/menisci

A
  • 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
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18
Q

state the most common MOI of the Meniscus

A
  1. traumatic injury

2. degenerative processes

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19
Q

describe the vascular anatomy of the Meniscus

A

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

20
Q

discuss the rehabilitation progression after a Menisectomy

A
  • 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
21
Q

define the Q-angle

A
  • 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
22
Q

define Arthrogram

A

Series of images of a joint after injection of a contrast medium (use an arthroscope)

23
Q

define Arthroscopy

A

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

24
Q

state the 3 Patella Reference Positions

A
  • Normal Patella
  • Patella Alta - patella is more superior than normal (greater patellar instability)
  • Patella Baja - patella is more inferior than normal (compression force)
25
Q

discuss the rehabilitation for Anterior Knee Pain (Patellar-Femoral pain)

A
  • 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
26
Q

list the 5 types of Patellar Fractures

A
  • Nondisplaced
  • Transverse
  • Lower pole/upper pole
  • Comminuted
  • Vertical
27
Q

discuss rehabilitation for Patellar Fracture - Non-displaced

A

Treated conservatively

  • Immobilization in full extension to reduce stress on patella
  • Once bone healing is sufficient, progress with quad sets, terminal knee extension, SLR
28
Q

discuss rehabilitation of Patellar Fracture - Displaced

A

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
29
Q

define Housemaid’s Knee

A
  • 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
30
Q

define Chondromalacia

A
  • Condition in which the cartilage on the undersurface of the patella deteriorates and softens
  • Often seen as overuse injury in runners
31
Q

what is the most common MOI for Patellar Fractures?

A

contact with a hard surface

32
Q

name three tests for Meniscus injury

A

McMurray
Apley
Thessaly

33
Q

name two tests for ACL injury

A

Anterior Drawer

Lachman’s

34
Q

name two tests for PCL injury

A

Posterior Drawer

Posterior Sag/Godfrey/Gravity Sag

35
Q

name test for MCL injury

A

Valgus

36
Q

name test for LCL injury

A

Varus

37
Q

describe McMurray Test

A
  • meniscus
  • Supine, full knee flex. Rotate tibia, extend knee while applying valgus or varus force.
  • Positive for meniscal tear if feel click
38
Q

describe Apley Test

A

-meniscus
-Prone, apply compression or distraction and rotate tibia
-Positive if pain, clicking.
Indicative of ligamentous if pain in distraction

39
Q

describe Thessaly Test

A
  • meniscus
  • Standing one leg, twist three times
  • Positive if pain
40
Q

describe Anterior Drawer Test

A
  • ACL
  • Supine, knee at 90, pull ‘drawer’ open
  • Positive if displaced more than 5 mm
41
Q

describe Lachman’s Test

A
  • ACL
  • Supine, knee at 20-30, pulled anteriorly
  • Positive if end feel mushy, infrapatellar slope disappers
42
Q

describe Posterior Drawer Test

A
  • PCL
  • Supine, knee at 90, push ‘drawer’ closed
  • Positive if displaced more than 5 mm
43
Q

describe Posterior Sag/Godfrey/Gravity Sag Test

A
  • PCL
  • Supine, both knees at 90, both hips at 90. Bilateral examination of tibia placement
  • Positive if tibia hanging too low
44
Q

describe Valgus Test

A
  • MCL
  • Supine, knee extended, valgus force; knee flex 20-30 valgus force
  • Positive if pain or valgus movement with no end point
45
Q

describe Varus Test

A
  • LCL
  • Supine, knee extended, varus force; knee flex 20-30, varus force
  • Positive if pain or varus movement with no end point

PTA - Pathology (7 decks)

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