Quiz #9 Flashcards
do SCFEs happen more in younger or older populations?
younger (12 for girls, 14 for boys)
what is the most common disorder of the hip in adolescents?
SCFE
what is SCFE?
displacement of the femoral neck from the capital femoral epiphysis
the neck migrates up and out as the head remains in the acetabulum
does coxa vara or coxa valga cause more shear forces?
coxa valga
t/f: SCFEs often occur from innocuous causes
true, things that you wouldn’t expect to cause damage do
what is the initial symptom of a SCFE in 45% of cases?
knee and lower thigh pain
what is done to determine if the hip is stable or unstable with a SCFE?
radiographs, physical exam, and symptoms
t/f: intervention for SCFE is focused on relief of symptoms and containment of the femoral head
true
what is the PT focus on SCFE treatment?
strength and ROM once stability is achieved (don’t often see them prior to surgery)
SCFE is bilateral in ___% of cases
20
if a SCFE is found in one leg, there is a __% chance it will occur in the other leg too
40
t/f: there is a risk for AVN in SCFEs
true
what are the 2 types of femoroacetabular impingement syndromes?
cam impingement
pincer impingement
what is a cam impingement?
abnormal shape of the sup/ant FEMORAL head and neck
what is the ratio of males to females affected by cam impingements?
14:1 (young males mostly)
t/f: cam impingements are associated with future development of osteoarthritis
true
what is a pincer impingement?
abnormal bone growth of ant/sup ACETABULUM
what is the ratio of females to males (age 40) affected by pincer impingements?
3:1
t/f: both cam and pincer impingements can occur together and most have an element of both
true
what is the presentation of femoroacetabular impingement syndrome?
loss of ROM prior to onset of pain
unilateral ant hip/groin pain
pain and decreased flex and IR
pain with sitting, squatting, and sports
clicking/popping w rotation
may just initially feel stiff with no pain
how is femoroacetabular impingement syndrome diagnosed?
(+) FADIR (flex, add, IR)
plain film x-ray
MRI arthrogram (labrum)
will putting a pt into ant or post pelvic tilt help with a femoroacetabular impingement?
posterior pelvic tilt will help, anterior pelvic tilt will irritate it
what are the surgical interventions for a pincer impingement?
peel off labrum
resect bone
repair labrum
what are the surgical interventions for a cam impingement?
remove excess bone
contour the head
can increased lower abdominal strength reduce anterior pelvic tilt in impingements at the hip?
possibly
what are the PT interventions for femeroacetabular impingement syndrome?
hip jt manual therapy
strengthening (adductors, abductors, extensors, ERs and trunk)
functional progression and education targeted at individual physical impairments
not fixing the impingement but improving ROM and relieving symptoms
t/f: there is chondrocyte proliferation of the labral fibrocartilage at the border of an acetabular labral tear
true
where is there increased microvascularity in an acetabular labral tear?
at the base of the tear adjacent to the bone insertion
t/f: there is osteophyte formation with an acetabular labral tear
true
which type of femoroacetabular impingement can lead to calcification of the labrum, further deepening the acetabulum?
pincer impingment
do acetabular labral tears occur more in younger or older populations?
younger
what is a common cause of hip dysfunction in the active populations?
acetabular labral tears
what position can cause an acetabular labral tear?
ER with hyperextension of the hip
what is the cause of athletes with groin pain in more than 20% of cases?
acetabular labral tears
what can put an older person at risk for acetabular labral tears?
hx of hip or acetabular dysplasia
how are acetabular labral tears classified?
by location, etiology, and anatomic features
order these from most to least common location for an acetabular labral tears: posterior, superior (lateral), anterior
anterior>posterior>superior (lateral)
what are the etiologies of acetabular labral tears?
degenerative, traumatic, and idiopathic
what are the anatomic features of various acetabular labral tears?
radial flap, radial fibrillation, longitudinal, and detached
what is the most common anatomical feature of an acetabular labral tear?
radial flap
what is the least common anatomical feature of an acetabular labral tears?
longitudinal
how is an acetabular labral tears diagnosed?
with resisted straight leg raises
pain in groin, trochanter, and buttock with flexion and rotation
sharp pain with clicking, catching or locking
confirmation with MRI arthrogram
what is the test for an anterior acetabular labral tears?
reproduction of symptoms with abd, ER, flex TO add, IR, ext
what is the test for a posterior acetabular labral tear?
reproduction of symptoms with add, IR, ext TO abd, ER, flex
what are the interventions used to treat acetabular labral tears?
body mechanics
manage forces
avoid pivoting
strengthening through progressive ROM
open/closed, arthrotomy/osteotomy, labral resection, labral repair
what is the post-op intervention for an acetabular labral tear in phase 1 (wk 1-4)?
WB may be none to 50% per surgeon
not more than 90 deg flexion
0 deg ext
25 deg abd
0-25 deg ER (per surgeon)
0-10 deg add (per surgeon)
light PREs
STM
what is the post-op intervention for an acetabular labral tear in phase 2 (wk 4-8)?
progressive WB to full WB
restore full ROM
progress strengthening
initiate CKC (light)
improve neuromuscular control
might have them using 1 crutch for a week or so
what is the post-op intervention for an acetabular labral tear in phase 3 (wk 8-12)?
advance strengthening
improve neuromuscular control
advance CKC strengthening
what is the post-op intervention for an acetabular labral tear in phase 4 (wk 12 to return to sport/fxn)?
progress strengthening
advance to multiplanar hip strengthening
advance to plyometrics bilaterally to unilaterally
sports specific training
order the following from most to least common causes of greater trochanter pain syndrome: glut min tendinopathy, glut med tendinopathy, bursitis
glut med tendinopathy>glut min tendinopathy>bursitis
what is a frequent cause of lateral hip pain?
greater trochanter (GT) pain syndrome
what actions can cause GT pain syndrome?
direct trauma or repeated friction
t/f: pts with GT pain syndrome may be TTP over the GT
true
what are the symptoms of GT pain syndrome?
pain with stretching the ITB into add, ER, and IR (Ober sign)
pain with resisted abd, ext, and IR
tightness of adductors
weakness of abductors and ERs
LBP
t/f: GT pain syndrome is associated with LBP
true
in pts with lateral hip pain what tests will be positive?
(+) GT palpation
(+) resisted abduction
t/f: MRI alone is sufficient to diagnose GT pain syndrome
false
at the pre-clinical/sub-clinical stages of GT pain syndrome, will pts have symptoms?
they may have no/little symptoms and will not be at the level of pain or dysfunction that they feel the need to do anything about it
what is the Trendelenburg sign?
hip drop on the opposite side of glut med weakness
(R weakness=L hip drop, L weakness=R hip drop)
what are the interventions for GT pain syndrome?
stretching the ITB and TFL
TFM
glut med (and max) ER PREs
correct biomechanical causes anywhere along the chain
maybe modalities but not sure about its effectiveness
stretching and manual techniques may have more benefits
t/f: the knee is triplanar
true
what are the shapes of the medial and lateral menisci?
lateral=O
medial=C
is the medial or lateral condyle more posterior?
the lateral condyle
is the med or lat meniscus attached to the popliteus?
lat
is the med or lat meniscus more mobile?
lat
what pulls the lat meniscus back a bit?
the hamstrings and popliteus
is the med or lat meniscus attached via the coronary ligs, tibfib jt capsule, and MCL?
med
t/f: the med meniscus has a larger diameter but covers a smaller % of the knee
true
is there a higher incidence of injury in the med or lat meniscus?
med
is the med or lat condyle more distal and curved?
med
t/f: the knee capsule secretes synovial fluid and has a supracondylar pouch
true
what happens to the synovial fluid in the knee with flexion?
it moves posteriorly
what happens to the synovial fluid in the knee with extension?
it moves anteriorly
does the knee capsule become more taught anteriorly or posteriorly with knee flexion?
anteriorly
does the knee capsule become more taught anteriorly or posteriorly with knee extension?
posteriorly
what is the plica?
a fold in the synovial layer of the knee capsule that wraps around the patella
usually on the medial side
not everyone has it
t/f: the plica can mimic patellofemoral problems
true
do ligs have greater affects at mid or end range?
end range
are the ACL and PCL extra synovial or intraarticular?
both
when are the ACL PCL taught?
with rotation
where does the PCL go from and to?
from the posterior tibia to the lateral aspect of the medial femoral condyle
where does the ACL go from and to?
from the anterior tibia to the posterior aspect of the medial side of the lateral femoral condyle
is the PCL more taught in flexion or extension?
in flexion
does the ACL or PCL prevent posterior translation of the tibia on the femur?
PCL
how is the PCL often injured?
with a fall on the tib tub and a posterior force
does the ACL or PCL prevent anterior translation of the tibia on the femur?
ACL
does the ACL or PCL draw the femur into the skrewhome mechanism when the knee is fully extended?
ACL
what are the 2 bundles of the ACL?
AM and PL
is the ACL most taught in flexion or extension?
extension
does the ACL or PCL control med/lat (valgus/varum) and rotational motion?
ACL
t/f: the MCL inserts onto the medial meniscus
true
are the MCL and LCL most taught in flexion or extension?
extension
do the MCL and LCL play a greater role in controlling varus/valgus in flexion or extension?
extension
what is the “terrible triad”?
ACL, MCL, and medial meniscus injuries together
why are there less LCL injuries than MCL?
it’s not as common to experience a hit from the medial side
what is a bi-partite patella?
extra bone formed off the lateral aspect of the patella that may look like a fx on imaging
can lead to PF problems
is med or lat patellar tracking usually at the heart of many patella problems?
lateral tracking
how does the patella move?
in a C pattern
at the greatest degree of extension, should the patella pull medially or laterally?
medially bc of the pull of the VMO
when is there max contact bw the patella and the femur?
at 45-60 deg of flexion at the knee
where does the knee generate the most forces and can be a problem area for wearing and p!?
45-60 deg of knee flexion
should the patella be more sup or inf with knee ext?
sup
should the patella be more sup or inf with knee flex?
inf
what is patella alta?
patella pulling sup
what is patella Baja?
patella pulling inf
what is the shape of the femoral trochlea?
should be higher laterally to prevent lateral subluxation/dislocation
should we focus more on the “track” or the “train” with PF pain syndrome?
the track
what other things should we look at with PFPS?
the hip and ankle
when the talus moves medially or laterally, what happens with the tibia?
it follows
does overpronation lead to increased medial tibial rotation or lateral tibial rotation?
medial tibial rotation
does medial tibial rotation lead to genu valgus or genu varum?
genu valgus
what can be strengthened in the foot to help with PFPS?
the foot intrinsics
what is chondromalacia patella?
softening of the cartilage on the posterior aspect of the patella that may occur from extra forces
what population is PFPS most common in?
ectomorphic female athletes (tall and slender)
what is blanket term for the following?:
excessive lat compression syndrome
global patella compression syndrome
patella instabilities
biomechanical dysfunction
trauma
suprapatellar plica syndrome
IT band friction syndrome
fat pad syndrome
overuse syndrome
PFPS
what are some causes of PFPS?
muscles imbalances (VMO vs lateralis)
inflammation
instability
anatomic variance
abnormal Q angle
foot contributions (bottom up)
hip contributions (top down)
what are some anatomic variantions that can cause PFPS?
femoral condyle dysplasia (femoral condyle not as high as it should be)
patellar congruence
patellar position
what happens when the femoral condyle is high up than it should be?
higher chance of lateral tracking and subluxation/dislocation
how is the Q angle measured?
ASIS–> mid patella–> tib tub
is the Q angle larger in males or females?
females
is there genu valgus or varum with increased Q angle?
valgus
t/f: the Q angle is usually observed and not measured
true
what are some top down contributions to PFPS?
the hip goes into excessive IR with WB
significant weakness of the hip ERs and abductors often in women
quad overuse
excessive hip adduction
excessive femoral IR
what are top down causes of increased PF rxn forces?
excessive hip adduction
quad overuse
what is a top down cause of decreased PFJ contact area?
excessive femoral IR
is there increased glut work with increased trunk lean or with upright posture?
increased trunk lean
is there more PF compression with increased trunk lean or with upright posture?
with upright posture
in the CKC, does the patella move laterally on the femur or does the femur rotate medially under the patella?
the femur rotates medially under the patella
in the OKC, does the patella move laterally on the femur or does the femur rotate medially under the patella?
the patella moves laterally on the femur
what are some bottom up causes of PFPS?
pronation of the talonavicular and talocalcaneal jts
how does pronation at the mid foot affect PFPS?
increased tibial IR
increased genu valgus
increased lat PFJ contact
lower arch height=ant knee p!
what is the step down test?
looking at the WB limb, have pt take a step down from a platform and see if the patella/knee moves in (dynamic valgus)
what is a (+) step down test?
the knee moves into dynamic valgus
what is the typical intervention for PFPS?
taping/bracing (may be helpful)
PF mobilization (helpful)
ITB stretching (may be helpful)
VMO PREs (not helpful)
what are effective treatment goals for PFPS?
reduce swelling and p!
restore volitional mm control
emphasize quads
control the knee through the hip
emphasize hip and and ER strengthening
enhance soft tissue flexibility
improve soft tissue mobility
enhance proprioception and nm control
normalize gait
shoe/orthotics recommendations
are there better results from strengthening the knee or the knee and hip together for PFPS?
knee w /hip
do pts with PFPS have more problems going up or down stairs? why?
down bc the quads work more in upright posture and we tend to stand more upright when going down stairs
what is movie goers sign?
anterior knee pain from long periods of sitting
does an EMG show increased glut med, max, and TFL in the stance limb or moving limb during sidestepping?
in the stance limb
when squatting in sidestepping, does the glut activity increase or decrease?
increase
when squatting in sidestepping, does the TFL activity increase or decrease?
decrease
in sidestepping, is the abduction increased in the stance limb or moving limb?
the stance limb
does a lateral J brace pull the knee medially or laterally?
medially
is bracing or taping more effective?
bracing
what is the likely reason taping may work for someone?
increased proprioceptive input to the muscle
at 5 years, does surgery with a HEP or the HEP alone provide better results for PFPS?
both provide similar results
what is the Elmslie-Trillat surgery for PFPS?
transverse osteotomy of the tibial tubercle
take off the tib tub and move it medially for better tracking
what is the Maquet-Straight surgery for PFPS?
anterior shift of the tib tub by splitting the tibia and pulling the patella of the femur more
what is the Fulkerson surgery for PFPS?
a combo of the Elmslie-Trillat and Maquet-Straight surgerical methods
med and ant shift of the tib tub w/oblique osteotomy
what is the most common cause of mechanical knee pain?
meniscal injury
what motions cause meniscal injury?
turn/twist/change in direction in WB
med/lat contact with the foot planted
t/f: aging leads to delamination of the menisci
true
t/f: edema produces symptoms in meniscal injuries
true
is there greater med or lat meniscal motion?
lat
what can a longitudinal tear of the meniscus that separates out lead to?
a bucket handle tear
which meniscal tear tends to have the poorest prognosis?
radial tears
what are the symptoms of a meniscal tear?
swelling, popping, clicking, catching at the jt line
no immediate swelling, it’s more delayed
locked in flex position (bucket handle)
p! w/flexion and WB
tender medial jt line (esp with med men injury)
would delayed swelling indicate a meniscal injury or a ligamentous injury?
meniscal
would immediate swelling indicate a meniscal injury or a ligamentous injury?
ligamentous
what are the tests for meniscal injury?
(+) McMurray
(+) Appley
(+) Thessaly
what is the McMurray test for meniscal injury?
varus and valgus stress w/rot at the knee to feel for pop/p!
ER and valgus force moving the knee into flex/ext tests the med meniscus
IR and varus force moving the knee into flex/ext tests the lat meniscus
what is the Appley test for meniscal injury?
prone, knee flexion, and grind on the tibia to see if it produces p!
what is the Thessaly test for meniscal injury?
pt stands on one leg with their arms crossed out in front of them for you to steer them into rot both ways
pt may do this in full ext or squatting position
does a meniscectomy involve the inner third or peripheral third of the meniscus?
inner third
does a meniscal repair involve the inner third or peripheral third of the meniscus?
peripheral third (red red zone)
t/f: the ACL extends superiorly, posteriorly, and laterally
true
does the ACL have vascular supply?
yes, some but not a lot so it will still swell
what muscles works with the ACL?
the hamstrings
what are the intrinsic factors in ACL injury?
narrow intercondylar notch
generalized jt laxity
LE malaignments
hormonal influence (estrogen, estadiol, relaxin)
ACL size
strength and recruitment
do men or women tend to have a more narrow intercondylar notch?
women
t/f: the ACL get impinged on the anterior intercondylar notch in full extension
true
what are the extrinsic factors in ACL injury?
altered neuromuscular control
playing surface
playing style
shoe wear
what sports tend to cause ACL injuries in younger populations?
soccer
football
basketball
what sports tend to cause injuries in older populations?
skiing
trampoline
the risk factors for ACL injury are __ to ___ times higher in ___ basketball and soccer players
4, 8, female
is there an increased rate of ACL injuries in female or male collegiate athletes?
female
is there increased incidence of ACL injury in males or females?
males
is there higher ACL injury exposure in males or females?
males
is there higher ACL injury risk factors in males or females?
females
do men or women have:
smaller intercondylar notch
smaller ACL
wider pelvis
increased hamstring flexibility
generalized jt laxity
quads dominance
increased post tibial slope
females
what is only a female risk factor in ACL injury?
increased tibial slope
why does increased hamstring flexibility put one at risk for ACL injury?
looser hamstrings can’t provide secondary support to the ACL
what is a grade 1 ACL injury?
stretched out (attenuation/attenuated)
what is a grade 2 ACL injury?
partial tear
what is a grade 3 ACL injury?
complete full thickness tear
t/f: almost all complete tears of the ACL are mid-substance
true
what does mid-substance mean in an ACL tear?
the tear is in the middle of the tendon
how much force can the ACL handle before it tears?
2160 N of force
what are some MOI for ACL injury?
strength of the lig (force >2160 N)
deceleration injury (non-contact)
hyperextension
valgus stress
sports related
contact injury (hyperext or foot planted w/rot then contact)
what is the MOI in 70% of ACL injuries?
deceleration (non-contact) injury
in ACL tears, a pop is heard/felt in __% of cases
70
what % of ACL injuries are sports related?
80%
is there immediate or delayed disability and hemarthrosis with ACL injury?
immediate
there is hemarthosis in ACL injuries within __ hours
2-6
how is the ACL injured in non-contact injuries?
hip straight, hip IR, tib rot, straight knee
deceleration/acceleration
valgus moment
feet flat
anterior shear
increased ground rxn force
muscles don’t dissipate the forces so the ligs take the brunt of it
in what zone do ACL injuries usually occur?
in the transformational zone
how is the ACL injured in contact injuries?
hyperextension or foot planted in rotation then contact
what are the s/s of ACL injury?
pop at time of injury
giving away
hemarthrosis
quads atrophy
(+) ant drawer
(+) Lachman
(+) KT-1000 findings
rotary instability
(+) MRI
what are the different rotary instabilities that lead to ACL injury?
AMRI, ALRI, PMRI, and PLRI
t/f: MRI is sensitive for the presence of an ACL tear and MCL or meniscal involvement
true
t/f: an MRI is sensitive for discriminating b/w partial and complete tears
false
in an ACL physical exam, the side to side difference is <___mm in 95% of pts
3
what is the most sensitive test for ACL injury?
Lachman test
what other special test can be used for ACL injury?
pivot test
what is the Lachman test?
hold the pt knee stable and pull forward on the tibia
reverse: in prone pull the tibia down towards the table
what % of acute ACL injuries also have a meniscal tear?
45%
what % of chronic symptomatic ACL tears have meniscal tears?
about 88%
what imaging can be done for ACL injury?
x-ray, MRI
what fx is common assocaited with ACL injury?
Segond fx
what is a Segond fx?
avulsion fx from IR w/varus force
what % of ACL cases have Segond fx?
9-12%
what % of Segond fx are indicative of ACL tears?
75%
what would be found in an MRI for acute ACL injury?
lateral meniscal tear
what indicates bone bruising from an ACL injury on a x-ray?
whiteness on the lateral femoral condyle (central) and lateral tibial plateau (posterior)
what would be found on an MRI for chronic ACL injury?
med meniscal tear due to instability
chondral injury
what is the general non-operative management of complete ACL tears?
progressive rehab program
brace for activities (NM feedback)
what are the 3 outcomes after ACL rehab?
1/3 pursued recreational activities (copers)
1/3 compensated by eliminating activities (partial copers)
1/3 required ACL reconstruction (non-copers)
t/f: choice of treatment affects fxn but not development of arthritis in ACL recovery
true
why do most ppl post ACL injury eventually develop arthritis?
bc the jt is never quite as stable as it was pre-injury
what are typical ACL pre-hab goals?
no flexion contractures or quad lag
quad contraction w/sup patellar slide
normal PF mobility
little to no effusion
walk w/o a limp
what are the benefits of pre-hab in ACL injury
provides platform to guide decisions
may be able to work pt to the point of not needing surgery anymore
what is the preferred surgical intervention for ACL tears?
autografts
what tendons can be used in ACL autografts?
patellar tendon (BPTB)
hamstrings (semiten)
quad tendon
Achilles tendon
t/f: there is a higher incidence of patellar tendinopathy w/BPTB procedures in ACL repair bc of moving the patellar tendon to use as an ACL
true
what is one of the most important factors in good recovery from ACL repair?
good graft positioning
what are the principles of post ACL surgery?
consult the surgeon for updated protocol
understand potential risk factors of graft disruption
control p! and edema
utilize locked brace (0-90 deg) early during some PREs
respect healing contraints
emphasize early restoration of ROM
emphasize closed chain training
emphasize hamstrings recruitment
focus on fxn
what is ligamentization?
when a tendon is used in ACL graft itreorganizes and becomes more dense
becomes weaker at 3-4 months post-op
what is superficial and deep infrapatellar bursitis?
inflammation from mechanical irritation, or direct trauma
what is prepatellar bursitis (housemaid’s knee)?
from recurrent trauma or prolonged kneeling
easily observable
what is superficial pes anserine bursitis?
seen in swimmers, runners
medial knee p!
tibia in ER
what is MCL bursitis?
deep to the MCL
misdiagnosed
palpable mass
tender w/ER/IR of tibia
what is the intervention for bursitis?
correct malalignement
correct mechanics
stretching
strengthening (look at the hip too)
surgical resection
what can cause patellar tendinopathy?
eccentric overload
where is a pt tender with patellar tendinopathy?
at the tibial insertion site or mid-substance
can patellar tendinopathy be self-limiting?
yes
what can be done to help with patellar tendinopathy?
RICE
tendon strap around the patellar tendon(Chopat strap) during activity
TFM
correct malalignement
what is IT band friction syndrome (ITBFS)?
a common overuse injury in runners caused by repeated friction of the ITB at 30 deg of knee flexion
increased with road chamber (curve) downhill
better with faster speeds
where would someone with ITBFS be tender?
over Gerdy’s tubercle
what may cause ITBFS?
structural or functional malalignment
weak abductors/ERs
what tests would be positive with ITBFS?
(+) Ober
(+) Noble
what is Osgood Schlatter Disease?
osteochondritis (patellar tendon pulls small bit of immature bone off the tib tub)
irritation of the growth plate
form of patellar tendonitis (patella tendon pulling on the growth plate)
when does Osgood Schlatter Disease tend to occur in life?
12-15 yo
during growing years when the muscles can’t keep up with bone growth
what are possible cuases of Osgood-Schlatter Disease?
indirect trauma
sudden forceful quad contraction
repetitive stress (knee flexion against a tight quad)
longitudinal traction during bone growth (tension on patellar tendon during growth spurts)
malalignment
rigorous activity in young adults
what malalignment pmay contribute to Osgood Schlatter Disease?
bilateral genu valgus
pes planus
patella alta
what is the presentation of Osgood-Schlatter Disease?
p! at the tib tub
enlarged tib tub
possible swelling and warmth
tenderness
p! w/activities involving forceful quads contraction
potential inflexibility of the quads or hamstrings
how is Osgood-Schlatter Disease managed?
rest/activity modification (2-3 wks to 2-3 months)
NSAIDS and ice
exercise to stretch
possible bracing
patellar tendon strap top reduce quad pull
can Osgood-Schlatter Disease be self-limiting?
yes
what are the primary reasons someone gets TKA?
OA (72.7%) or RA (21.2%)
other than RA and OA, what are reasons for getting a TKA?
fx, AVN, septic arthritis
what are indications for TKA?
DJD on radiograph (not difinitive criteria)
breakdown of tibfib jt area
pt lossing fxning
t/f: higher p! prior to TKA surgery is associated with poorer outcomes
true
is the severity of DJD seen on radiographs predictive of outcomes of TKA?
no
what are TKA prognositic indicators of poor outcomes?
female
older age
low socioeconomic status
> # of comorbidities
poor p! coping strategies
somatization of p!
low social support
unrealistic expectations
BMI >40
what is the most popular TKA surgical approach?
medial parapatellar (paramedian)
what are the pros of the paramedian TKA approach?
familiar
popular
what are the cons of the paramedian TKA approach?
incision through the quad tendon
detaches the VM from the extensor mechanism
reduces blood flow to the patella
what is the general TKA procedure?
ACL, PCL, and menisci are removed (PCL may be spared)
femur and tibia ends are excised using a cutting jig
implanted metal tibial and femoral components
polyethylene tibial spacer bw the metal tibial and femoral components
patellar surface (patellar button)
t/f: PCL substituting implants may give better roll-back kinematics for lunging and step-ups
true
is a unicompartmental TKA usually medial or lateral?
medial
does a bi or tricompartmental TKA involve the patella?
tri
what are the indications for a unicompartmental TKA?
non-inflammatory OA
unicompartmental degernation
low impact sports
job with repetitive squatting
intact cruciate ligs
near normal weight
jt space narrowing is isolated to one side of jt
malalignment is correctable w/o a major tissue release
flexion contracture not >10 deg
adequate flexion
valgus/varus <10-15 deg
are more or less ppl going to a rehab hospital following TKAs?
less
what is the early focus of TKA rehab?
p! control and functional recovery
are pt usually WB following TKA?
yes! and often notes decreased p! w/WB
when beginning ROM post TKA, what exercise may be done?
heel slides in supine or sitting
what strengthening exercises may be done post TKA?
quad activation (QS and SLR)
SAQ
sidelying abd
progressive closed chain strengthening
what is a major LE risk post-op?
DVTs
what is a DVT?
occlusion of deep veins from a thrombus that interrupts blood flow
results in edema and p!
what is done prophylactically post TKA to prevent DVTs?
pts are given blood thinner and monitored regularly so blood isn’t too thin
what are symptoms of a DVT?
p! in the calf or associated muscles
(+) Homan’s sign (passive dorsiflexion-not done anymore)
what does a Wells score of >3 mean?
high probability of DVT risk
what does a Wells score of 1-2 mean?
moderate probability of DVT risk
what does a Wells score of 0 mean?
low probability of DVT risk
how are DVTs treated?
anticoagulant therapy
how is a DVT dx?
US imaging
