S3_L3: Knee Flashcards
What is the action of the piriformis muscle beyond 90
degrees of hip flexion?
internal rotation
What is the arthrokinematics of the knee during OKC knee extension?
glides anteriorly
What is the direction of tibial rotation during
OKC knee extension?
Tibia goes to ER
TRUE or FALSE: Foot overpronation will lead to increase in Q-angle
TRUE
TRUE or FALSE: Weakness of the Hip Abductors does not affect the knee.
FALSE.
Forcibly rotating medially on a planted foot will injure the what structure?
Femur
TRUE OR FALSE: During resisted Open-Kinematic Chain (OKC) knee extension, tibial anterior translation increases during the terminal knee extension.
TRUE.
Which knee motion has a greater amount of LOM in knee OA?
Flexion
An abnormal Q-angle is also known as ____
knocked knee
What is the resting position of the knee?
25-30Β°
Clinical Practice: 20-30Β°
What is the unhappy triad?
anterior cruciate ligament (ACL), medial meniscus and tibial (medial) collateral ligament
the following are problems within the kinetic chain that may result to anterior knee pain, EXCEPT:
A. Femoral Anteversion
B. External Tibial Torsion
C. Foot Hypersupination
D. Genu Valgum
E. None
C. Foot Hypersupination
TRUE OR FALSE: PTs may use dry needling as an intervention for PFP.
FALSE
Clinicians should not use dry needling for the
treatment of patients with PFP.
How many weeks until pts with central zone repair can have FWB?
6-8 Weeks
After meniscal repair, which kind of zone repair does not need protective bracing?
Peripheral Zone Repair
What is the passive insufficiency of the rectus femoris?
rotate pelvis posterior, extend the hip, and flex the knee
When the hip internally rotates, what motion will the knee have?
external rotation
TRUE OR FALSE: MAI may be done in the protection phase of knee OA.
True.
This is allowed as long as patient can tolerate it and has a wide range of movement.
Scenario: You asked your patient to perform a figure of 4 (dekwatro) position using his (L) leg and you noticed that the (L) leg was going upwards.
Using your knowledge in anatomy, what muscle is tight? Consider the laterality.
(L) Piriformis
TRUE OR FALSE: Active insufficiency uses the principle of stretching.
False.
Passive insufficiency uses the principle of stretching.
What is the passive insufficiency of the quadriceps muscle?
Knee Flexion
TRUE OR FALSE: It is easier to reach passive insufficient for 2-jointed muscles as lesser range is needed, but it can be also weakened because of this.
True
To maximize force production, do not place a muscle in an _____ position
active insufficiency
What is the passive insufficiency of the iliopsoas muscle?
posterior tilt of pelvis & extend the hip
This muscle is the first to become weak or first to atrophy during injury
Vastus Medialis Obliquus (VMO)
TRUE OR FALSE: Transcutaneous electrical stimulation (TENS) is recommended for patients with knee and/or hip OA.
FALSE
TENS is strongly recommended against patients with knee and/or hip OA.
This implant design is used in bicompartmental replacement
Semi-constrained
When a pt has ACL tear, what muscle must be strengthened to provide anterior stability?
Hamstring
NOTE: In PCL tear, the Quadriceps must be strengthened.
TRUE OR FALSE: When dealing with a knee injury, a PT must also give interventions for the hip, ankle, and foot.
True
This is when one or both trochlea are flat
Dysplastic Trochlea
The bones of the knee joint consist of the (1)______ with its two condyles, the (2)_____ with its two tibial plateaus,
and the large sesamoid bone in the quadriceps tendon, the (3)_____.
- distal femur
- proximal tibia
- patella
Source: Kisner & Colby 7th ed., page 770
What type of joint is the knee?
biaxial, modified hinge joint
Source: Kisner & Colby 7th ed., page 770
In general, anteroposterior stability is provided by the (1)_____ while mediolateral stability is provided by the (2)_____
- cruciate ligaments
- collateral ligaments
Source: Kisner & Colby 7th ed., page 770
What condyle contributes to the locking mechanism at the knee?
Medial Condyle
Source: Kisner & Colby 7th ed., page 770
In OKC movements of the knee, which direction does gliding happen?
Concave plateaus slide in the same direction
Source: Kisner & Colby 7th ed., page 771
In non-weight bearing extension the tibia rotates (1)____ on the femur, and with flexion it rotates (2)____.
- laterally
- medially
Source: Kisner & Colby 7th ed., page 771
This is the axial rotation that occurs between the femoral condyles and the tibia during the final degrees of extension is called the
Locking or screw-home mechanism
Source: Kisner & Colby 7th ed., page 771
What muscle unlocks the knee?
Popliteus
Source: Kisner & Colby 7th ed., page 771
TRUE OR FALSE: The patella is not associated with extensor lag as the patellofemoral joint is not responsible in extending the knee
False
If patellar movement is restricted, it interferes with the range of knee flexion and may contribute to an extensor lag with active knee extension.
Source: Kisner & Colby 7th ed., page 771
The primary function of the patella is to increase the moment arm of the _____muscle in its function to extend the knee.
quadriceps
Source: Kisner & Colby 7th ed., page 771
The Q-angle is the angle formed by two intersecting lines: one from the (1)____ to the midpatella and the other from the (2)____ through the midpatella
- anterior superior iliac spine (ASIS)
- tibial tubercle
Source: Kisner & Colby 7th ed., page 771
TRUE OR FALSE: A normal Q-angle which tends to be greater in me and has a value of 15Β° to 20Β°.
False
A normal Q-angle tends to be greater in women than men and is between 10Β° to 15Β°.
Source: Kisner & Colby 7th ed., page 771
This is the prime mover for knee extension
quadriceps femoris
Source: Kisner & Colby 7th ed., page 773
What are the major nerves subject to knee injury?
- common fibular (peroneal) nerve (L2βL4)
- saphenous nerve (L2βL4)
Source: Kisner & Colby 7th ed., page 775
TRUE OR FALSE: In the knee, articular cartilage destruction is more often apparent on the medial joint compartment than the lateral compartment.
TRUE
Source: Kisner & Colby 7th ed., page 775
What is the deformity commonly seen in the presence of OA?
Genu varum
Source: Kisner & Colby 7th ed., page 775
When there is effusion (swelling within the joint), what is often most comfortable for the patient?
near 25Β° of flexion
Source: Kisner & Colby 7th ed., page 776
TRUE OR FALSE: Do not increase ROM unless the patient has sufficient strength to control the motion already available.
True
A mobile weight-bearing joint with inadequate muscle control causes impaired stability and makes lower extremity weight-bearing function difficult.
Source: Kisner & Colby 7th ed., page 777
A mobile-bearing knee design is recommended for
(1)____ patients , younger than (2)____ years of age.
- active
- 55 to 65
Source: Kisner & Colby 7th ed., page 783
The position of immobilization after primary TKA is in ____.
extension
NOTE: Although uncommon, an alternative approach is to immobilize the knee in a 90Β° flexion splint immediately after surgery
Source: Kisner & Colby 7th ed., page 786
In Post-op TKA, the ROM goal is to attain (1)____ for knee flexion and (2)____ for knee extension by the end of this first phase of rehabilitation.
- 90Β°
- full ROM for
Source: Kisner & Colby 7th ed., page 787
TRUE OR FALSE: Full knee extension is not possible until joint swelling has subsided.
TRUE
Source: Kisner & Colby 7th ed., page 787
TRUE OR FALSE: Avoid placing a pillow or rolled towel under the knee while lying supine or while seated with the operated leg elevated to reduce the risk of developing a knee flexion contracture.
TRUE
Source: Kisner & Colby 7th ed., page 788
Patellar instability is most often in what direction?
lateral
Source: Kisner & Colby 7th ed., page 792
This condition is when an embryological synovial tissue remnants or bands around the patella cause joint irritation during motion.
Plica syndrome
Source: Kisner & Colby 7th ed., page 793
______, also known as housemaidβs knee, can result from prolonged kneeling or recurrent minor trauma to the anterior knee.
Prepatellar bursitis
Source: Kisner & Colby 7th ed., page 793
TRUE OR FALSE: Quadriceps inhibition is common with pain and joint effusion
TRUE
Source: Kisner & Colby 7th ed., page 795
Ligament injuries occur most frequently in individuals between ____ years of age during sport participation
20 and 40
Source: Kisner & Colby 7th ed., page 805
The _____ is the most commonly injured knee ligament.
ACL
Source: Kisner & Colby 7th ed., page 805
TRUE OR FALSE: More than one knee ligament is often damaged during a single injury episode.
TRUE
Source: Kisner & Colby 7th ed., page 805
This knee ligament is usually managed with only a conservative (nonsurgical) approach when injured.
MCL
Source: Kisner & Colby 7th ed., page 808
Define auto-graft
It is when the tissue used for intra-articular reconstructions is from the patientβs own tissue
Source: Kisner & Colby 7th ed., page 811
TRUE OR FALSE: A semitendinosus-gracilis
tendon graftβs strength and stiffness are greater than that of the native ACL.
TRUE
Source: Kisner & Colby 7th ed., page 811
TRUE OR FALSE: When a ptβs ACL is injured or torned, surgery is immediately indicated and performed.
False.
Surgery is typically delayed until acute symptoms have subsided.
Source: Kisner & Colby 7th ed., page 817
TRUE OR FALSE: Simple squatting may cause a meniscus tear.
TRUE
Source: Kisner & Colby 7th ed., page 824
What special test may be positive in meniscal tear?
McMurray test or Apleyβs compression/distraction test
Source: Kisner & Colby 7th ed., page 824
Determine whether the MOI presented is for what ligament:
- Dashboard injury
- Varus force on the knee
- Kick in the front of the knee
- Valgus moments
- Kick on the lateral part of the knee
A. Anterior Cruciate Ligament
B. Posterior Cruciate Ligament
C. Medial Collateral Ligament
D. Lateral Collateral Ligament
- B
- D
- B
- C
- A
In terms of ROM, what is the criteria to progress from maximum to moderate protection phase?
β ~100-110 degrees of flexion
β Full active extension (no extensor lag)
TRUE OR FALSE: Clinicians should not prescribe patellofemoral knee orthoses, including braces, sleeves, or straps, for patients with PFP.
True
3 common MOI of PCL injury?
- Dashboard/ anterior injury mechanism
- Fall on flexed knee c PF foot
- Sudden violent hyperflexion