The Knee - Ch. 20

Question 1

which part of the menisci has the most adequate blood supply? minimal? and nothing?

Answer 1

adequate: red-red zone
minimal: red-white
na da: white-white

Question 2

what mvmnts does the ACL prevent?

Answer 2

posterior translation of femur in wt bearing 
anterior trans. of tibia in non-wt bear 
tibial IR 
hyperextenion 
to a degree of valgus and varus

Question 3

what mvmnts does the PCL prevent?

Answer 3

anterior trans of femur in wt bear
posterior trans of tibia in non wt bear
hyperextension
tibial IR

Question 4

attachment of superficial MCL?

which angle is it isolated?

Answer 4

medial condyle and just underneath pes anserine attachment

20-30 degress of knee flexion

Question 5

when is the deep medial capsular ligament taut? slack?

Answer 5

taut: extension
slack: flexion

Question 6

what aspects of the deep medial capsular ligament attach to the medial meniscus?

Answer 6

medial and posterior deep capsule

Question 7

describe the 4 ‘corners’ of the knee joint capsule? what other structures protect each ‘corner’

Answer 7

postlat: ITB, popliteus, biceps fem, LCL
postmed: pes anserine, semitmemb tendon, post lig.
antlat. : ITB, lateral retinaculum, patellar tendon
antmed: medial retinaculum, MCL

Question 8

what muscles are innervated by the femoral nn?

Answer 8

sartorious

all quadricep mm

Question 9

what mm are innervated by the sciatic nn?

Answer 9

biceps femoris

Question 10

what mm are innervated by the obturator nn?

Answer 10

gracilis

Question 11

what mm are innervated by the tibial nn?

Answer 11

semimemb.
semitend. 
gastroc
soleus 
popliteus
plantaris

Question 12

describe the screw home mx

Answer 12

femur must IN ROT for full extension
last 15 degress - tibial ER and ACL unwinds

popliteus must unlock knee into flexion by internally rotating the tibia after full extension

Question 13

how do you measure tibial torsion?

Answer 13

have pt kneel on stool

make a staight line from thigh to middle of heel and another line from middle of foot to centre of heel

**if angle is >15 than likely a tibial torsion

Question 14

4 components to assess for patellar orientation?

Answer 14

glide, (M-L) & (A-P) tilt, rotation

Question 15

measuring structural leg length vs. functional leg length

Answer 15

structural: ASIS - med mall
functional: umbilius - med mall

Question 16

what does a (+) test indicate for apley’s distraction test?

Answer 16

joint capsule ligament sprain

meniscus should not be painful

Question 17

describe slocum’s test (anterior drawer remix)

Answer 17

knee flexed to 90
internally rotated 15 - (+) laxity ACL, postlat. capsule
externally rotated 30 - (+) laxity ACL, post med, MCL

Question 18

what to look for in a pivot shift test?

Answer 18

tibia subluxes in extension and reduces itself after 20-30 of knee flexion - indicates anterolateral instability

Question 19

what to look for in jerk test?

Answer 19

reverse-pivot:

same as pivot shift but start in flexion and tibial will sublux as you bring it into extension

Question 20

describe the external rotation recurvatum test

Answer 20

grab big toe and patient’s straight leg

watch for tibia externally rotating and sagging down - indicates torn PCL

Question 21

which menisci are you testing for during int/ext rot in a Mcmurrey’s?

Answer 21

int rot. - lateral meniscus
ext. rot - medial meniscus

same as apley’s compression

Question 22

q-angle, normal and abnormal

Answer 22

M - 10
F - 15
abnormal: > 20

Question 23

A-angle, abnormal

Answer 23

from patellar line to tib tub line

> 35 is pathological

Question 24

what’s the typical % one needs for adequate quad to hamstring strength?

Answer 24

60-70%

Question 25

after a grade 3 MCL tear, what are the typical ranges one is allowed to have post injury - in a brace?

Answer 25

1st 2-3 wks: 0-30

2nd 2-3 wks: 0-90

Question 26

mx of a ACL tear

Answer 26

non-contact - decel/ stop to change direction - int rot of tibia and planted foot with eccentric contraction of quads
direct- direct valgus force (lat/post)
indirect - pertubations to shift COM

Question 27

mx of PCL aka ?

Answer 27

dashboard injury

falling or getting hit on a hyperflexed knee w/ PF foot

Question 28

what’s the mx of drop foot? and what structure is primarily affected?

mng?

Answer 28

direct blow

common peroneal nerve - affects the deep peroneal branch (dorsiflexors)

no RTP until weakness and radiating pain cease
protective padding

Question 29

true reason why a baker’s cyst occurs and where it’s located?

mng?

Answer 29

cyst swells due to a problem in the joint itself and not from bursitis - located behind the medial gastroc

mng: compression wraps and NSAIDs

Question 30

mng of infrapatellar fat pad syndrome?

Answer 30

decrease hyperextension with use of tape or heel lift

Question 31

difference between larson-johansen vs osgood schlatter

Answer 31

same condition but larson-johan is at the inferior pole of patella

osgood schlatter’s is a tib tub