The Knee Part 2: Exam 3 Flashcards
Where can knee injuries occur?
- ligament
- muscles
- tendons
- cartilage (meniscus and articular)
What does a MCL sprain result from?
Severe blow from the lateral side or a valgus force
Symptoms of a grade 1 MCL sprain
- stability valgus stress test (no laxity)
- little or no swelling
- some joint stiffness and point tenderness on medial aspect
- relatively normal ROM
Grade 1 MCL sprain
Ligament stretching but no tear
Management of grade 1 MCL sprain
- RICE for at least 24 hours
- crutches if necessary
- relatively quick strengthening progression
Limiting factor in strength progression of grade 1 MCL sprain
Pain
How long is the recovery time for grade 1 MCL sprain?
About 2-3 weeks
Grade 2 MCL sprain
Partial tear
Symptoms of grade 2 MCL sprain
- no gross instability (slight laxity)
- slight swelling
- joint tenderness with decreased ROM
- pain along medial side of the knee
Management of Grade 2 MCL sprain
- RICE and modified weight bearing in acute phase
- hinged knee brace
- modalities for pain
- gradual strength progression
What type of strength progression should be used in a grade 2 MCL sprain?
Close chain activities
Grade 3 MCL sprain
Complete tear of supporting ligaments
Symptoms of grade 3 MCL sprain
- complete loss of medial stability
- minimum to moderate swelling
- immediate pain followed by ache
- loss of motion due to effusion and hamstring guarding
- positive valgus stress test
management of grade 3 MCL sprain
- RICE
- Conservative non-operative vs surgical approach
- limited immobilization
- rehab similar to grade 1 and 2 but slower
How long should progressive weight bearing and increased ROM take in grade 3 MCL sprain?
Over 4-6 week period
What causes LCL sprain?
Varus force
Symptoms of LCL sprain
-pain and tenderness over LCL
-Swelling over LCL
Joint laxity with varus testing
Management of LCL sprain
Similar to MCL
What causes a contact ACL sprain?
valgus force with externally rotated tibia or hyperextension
What causes a non-contact ACL sprain?
Deceleration with rotational component
-jump landing strategies
What has there been extensive research on regarding the ACL?
Impact of femoral notch, ACL size and baseline laxity, malalignments, and faulty biomechanics
do males or females have a valgus angle more often?
Female
Symptoms of ACL sprain
- pop with severe pain and disability
- positive anterior drawer and Lachmans
- rapid swelling at the joint line
Management of ACL sprain
- RICE
- crutches
- could lead to major instability
How long is rehab for ACL sprain?
4-6 months
What does ACL surgery involve?
Joint reconstruction with grafts (tendon) transplantation of external structures
What can lack of stability in ACL lead to if not corrected?
Degeneration of cartilage and arthritic changes
When are you most at risk for a PCL sprain?
During 90 degrees of flexion
What causes a PCL sprain?
Fall on bent knee, result of rotational force, car crash
Symptoms or PCL sprain
- feel a pop in back of knee
- tenderness and relatively little swelling in the popliteal fossa
- laxity with posterior sag test
Management of PCL sprain
-RICE
What should non-operative grade 1 and 2 PCL sprain rehab focus on?
Quad strength
Surgical PCL time frame
- 6 week immobilization in extension with full weight bearing on crutch
- ROM after 6 weeks
- progressive resistance exercises at 4 months
What is the most common MOI in meniscal lesions?
Rotary force
Symptoms of meniscus tear
- swelling over 48-72 hours
- joint line pain and loss of motion
- intermittent locking and instability
- pain with squatting
- portions may become detached causing locking giving way or catching within the joint
Meniscal lesions management
- diagnostic testing
- preserve the meniscus
- full healing dependent on location
Menisectomy rehab
-partial weight bearing and quick return to activity
How long will rehab be for repaired meniscus?
Immobilization and gradual return to activity over 12 weeks
Osteochondral Knee fractures
Fractures of cartilage and underlying bone varying in size and depth
What causes osteochondral knee fractures?
Twisting, sudden cutting or direct blow
Symptoms of O knee fracture
- immediate swelling and considerable pain
- diffuse pain along the joint line
What can happen with swelling of O knee fracture?
Can turn chronic that increases following strenuous activity
What causes a patellar fracture?
Direct or indirect trauma
-semi flexed position with forcible contraction
Symptoms of patellar fracture
- swelling
- possible deformity
- little bone separation with direct injury
Management of patellar fracture
- x-ray for confirmation
- RICE and splinting
- refer and immobilize for 2-3 months
What causes patella subluxation or dislocation?
Deceleration with simultaneous cutting in opposite direction (valgus force at knee)
Acute patella subluxation or dislocation
Quad pulls patella out of alignment
Can people be predisposed to patella dislocation?
Yes
Symptoms of patella subluxation
Pain and swelling with restricted ROM and palpable tenderness
Symptoms of patella dislocation
- total loss of function until relocated
- potential articular surface damage to both bony surfaces
What is another name for patellar tendinitis?
Jumper or kickers knee
What causes patellar tendinitis?
Jumping or kicking
-sudden or repetitive extension
Symptoms of patellar tendinitis
-pain and tenderness at inferior pole of patella or insertion of tendon on tibia
What causes patellar tendon rupture?
Sudden, powerful quad contraction
Where does patellar tendon rupture occur?
Point of attachment
When does patellar tendon rupture occur?
-chronic inflammatory condition persists resulting in tissue degeneration
Symptoms of patellar tendon rupture
- palatable defect
- lack of knee extension
- considerable swelling and initial pain
Management of patellar tendon rupture
-surgery
What can minimize chances of patellar tendon rupture?
Proper and conservative care of jumpers knee
What causes knee dislocation?
Extreme force involved including contact or non contact
Why is knee dislocation a medical emergency?
Risk to neurovascualr structures
What structures are involved in knee dislocation?
- ligaments
- cartilage
- soft tissue
management of knee dislocation
- activate EMS
- check neurovascular status distall
- splint and transport
