Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OCS Exam > Thigh & Knee > Flashcards

Thigh & Knee Flashcards

1
Q

Norms for sulcus angle of femoral condyles

A

132 to 144 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Patellar tilt angle norms

A

medial tilt to 6 degrees is normal
> 16 degrees lateral associated w/ lateral patellar subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tibiofemoral joint angle norms and genu varum/valgum indicators

A

180-185 is normal position for tibiofemoral joint
>185 genu valgum
<175 genu varum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Revised Lysholm Knee Score use and ranges for score

A

used for post-op ligament surgery
-8 items for symptoms and function

95-100= excellent
84-94= good
65-83= fair
<65= poor

MDC is 10 points

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tegner Activity level scale

A

0-10 score participation and function
0= sick leave/disability
10= sport participation at national elite level

MDC is 1 point for meniscal and ACL injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

KOOS intended populations

A

ACL Reconstruction
meniscectomy
tibial osteotomy
posttraumatic OA
post-op TKA

reliable within OA and TKA populations
-validated on post TKA patients in PT
-has a floor effect, may be more difficult to track progress for lower functioning patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

IKDC-subjective form(SF) use

A

good internal consistency, test-retest reliability, content and structural validity, no floor/ceiling effects
-useful for all types of knee injuries

MCID is
11.5 for maximal sensitivity to change
20.5 for maximal specificity to change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cincinnati Knee Rating System use

A

reliable, valid, response to change over time for ACLR

MDC subsets
2.45 for pain
2.86 swelling
2.82 partial giving way
2.30 full giving way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Knee Outcome Survey(KOS)

A

2 separate scales
ADL and sports activity scale

MDC 8.7 points
MCID is 7.1% greater than previous examination

valid, reliable, response for assessing functional limitations of various knee pathologies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

LEFS

A

valid for LE conditions
-knee ligamentous strains
-non specific knee sprain/strain
-meniscal injury
-hip or knee OA
-ankle sprain/fracture
-hip or knee arthroplasty

MDC
9 points for LE condition or TKA
10 points hip and knee OA
8 points anterior knee pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patient Specific Functional Scale

A

pt identifies top 3 activities they ar having difficulty with

MDC for knee conditions
3 points for 1 activity
2 points for average score of 3 activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pain scales

A

VAS(visual analog)
VRS(verbal rating)
NRS(numeric rating)

ALL are responsive to changes

MCID of VAS = 10mm on 100mm scale for post-op patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cluster for meniscus injury

A

History
-reports of catching/locking

Exam
-tibiofemoral joint line tnederness
-pain w/ forced hyperextension
-pain w/ maximal knee passive flexion
-mcmurry test: pain or audible click

5/5 present = 92.3% chance of meniscal tear
3/5 present= 75% chance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Meniscal Pathology composite score findings

A

-subjective knee locking/catching
-tibiofemoral joint line tenderness w/ palpation
-pain w/ forced knee hyperEXT
-pain w/ maximal passive knee FLX
-pain or audible click w/ McMurray test

5/5 PPV
100% for acute patients(<6 weeks)
89% for chronic (>6 weeks)

3/5PPV
75% and 76% respectively

other concurrent pathology decreases impact of this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PFPS subjective reports of pain

A

-squatting 93.7%
-stairs 91.2%
-running 90.8%
-sitting 80.2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PFPS clinical tests

A

pain w/ squatting
hypomobility w/ patellar tilt test

these are the ojnly 2 w/ specific diagnostic qualities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a “sage sign”

A

GREATER displacement than 25-50% of patellar width
-knee in full extension
-indicative of patellar hypermobility
-consistent w/ excessive joint laxity or history of patella sublux/dislocations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Norm values for single hop test (cm)

A

Male College
192+-20
Female College
149+-17

Male High School
181+-20
Female High School
129+-18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Norm values for 6 meter timed hop (sec)

A

Male College
1.74+-0.21
Female College
2.13+-0.20

Male High School
1.91+-0.23
Female High School
2.25+-0.24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Norm values triple hop(cm)

A

Male College
632+-72
Female College
470+-53

Male High School
583+-72
Female High School
428+-54

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Norm values crossover hop(cm)

A

Male College
575+-75
Female College
406+-54

Male High School
522+-77
Female High School
375+-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Bracing recs for ACLR

A

no evidence for long term outcomes
-some form of bracing 4-5 months after surgery beneficial
-bracing may be helpful in low load conditions, especially for those w/ insufficient quad activation/strength

unclear if bracing causes decreased quad strength or not

those who stopped bracing at 3 months had greater quad strength and hop performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bracing recs for PCL injury

A

generally not prescribed
-if used, typically DC by post-op week 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bracing recs for MCL

A

early bracing while MCL heals from grade 2/3 injuries
-locked to avoid full knee extension <30 degrees or flexion > 90 degrees
-this diminishes stress on MCL
-soft tissue healing timeline 4-6 weeks, so no further bracing after this generally

25
Q

NMES for quad strength deficits

A

russian type
-pulse duration 400 microseconds
-75 pulse/sec
-2 sec rap
10 x 10 sec, 50 sec rest time

used if strength is <80% of contralateral

NMES should generate AT LEAST 50% of MVIC
-this must be very strong/painful in my opinion

26
Q

BFR for LE parameteres

A

% of 1RM: 15-30%
Reps per set: 30-15-15-15
Rest between sets: 30 sec
% arterial occlusion: 60-80%(80% preferred)

27
Q

Suggested Hamstring:Quad ratio for RTS

A

Prior to RTS
>66% for males
>75% for females

28
Q

Potential ACL copers screening requirements

A

Required milestones:
-isolated ACL tear(no REPAIRABLE meniscal injury or other ligament injury)
-full pain free ROM
-no knee joint effusion
-MVIC of quads 70% or greater of uninvolved side

29
Q

ACL-R autograft vs allograft

A

allograft incorporation slower than autograft
-slower timeline needed for return to running, agility, plyos, sport

irradiation/chemical cleaning of allograft also likely contributor to increased RE-tear
-5.2x GREATER vs autograft bone-patellar tendon-bone

30
Q

When is ACL graft weakest post-op?

A

Approx 12 weeks
-crucial to have full quad recovery for dynamic stability

31
Q

Open chain or closed chain for ACL rehab?

A

OKC and CKC have similar levels of ACL strain
-peak of 3-5% at 10* knee flexion

normal gait is 3x greater than heavy OKC quad exercise

comprehensive rehab program of OKC and CKC is likely to improve strength and coordinated movement

32
Q

Considerations for ACLR w/ meniscal repair

A

WB flexion > 45* avoided for 4 weeks
-avoid compression w/ movement of healing meniscus repair

33
Q

Considerations for ACLR w/ chonral damage or chondroplasty to WB surface

A

restriction in WB for 3-4 weeks to avoid stressing the healing chondral defect

34
Q

Considerations for ACLR and PCLR

A

follow PCL guidelines
-PCL outcomes typically worse for ACLR and PCL may stretch out, thus needs of PCLR supersede ACLR

35
Q

Re-injury rates

A

return to level 1 sports= 4x likelihood
-young athletes 4x for ipsilateral and 5x/ for contralateral injury

6-19 years old w/ ACLR had second ACL injury rate of 27%
-females had 32% rate

36
Q

Return to sport rates for ACLR and revision ACLR

A

83% for primary reconstruction
67% for revision

37
Q

PCL injury treatment grades 1-3

A

1 and 2 conservatively

grade 3 may be conservative if isolated PCL or surgical if involving other structures or more laxity
-grade 3 may have extension immobilization for 2-4 weeks to reduce subluxation
-avoid knee flexion > 70 degrees and isolated hamstring work

38
Q

When is peak posterior shear force on knee?

A

resisted knee esxtnesion between 100 and 40 degrees
-peak at 85-95*
-forces lower from 0-60

take home message is more flexion leads to greater strain generally

39
Q

How to minimize stress on MCL and LCL after injury

A

tibia in IR decreases MCL stress

tibia in ER decreases LCL stress

this is relevant during resistance exercises

40
Q

Post-op precautions after menisectomy

A

no precautions
-rehab guided by presence of swelling, ROM, quad strength

possible knee immobilizer to reduce stress during WB

typical recovery 2-6 weeks

41
Q

post-op precautions after meniscal repair

A

limited WB to allow for healing
-decreased compression and shear forces
-possible knee brace locked in extension

often WB in full extension x 2 weeks followed by FWB at 4 weeks

loaded knee flexion >45* limited x 4 weeks and >90* for 8 weeks

42
Q

OKC vs CKC after meniscal repair?

A

OKC reduces stress via loading/crompression, so OKC is preferred, also in positions of less knee flexion

43
Q

post-op precautions after meniscal transplant

A

limited WB, w/ brace in full extension for 3-6 weeks
FWB progression at 6-9 weeks

generally limited WB and no flexion >90* for 6 weeks

early PROM ok, limited to < 90*
-goal of 120* by 3-4 weeks and 135* by 5-6 weeks

quad isometrics or AAROM from 90 to 0* started immediately after surgery

44
Q

Rehab differences for chondroplasty vs microfracture procedure

A

chondroplasty may have limited WB for 3-5 days, w/ return to full functional activities and impact activities as early as 4 weeks

microfracture procedure NWB 2-4 weeks
FWB at 8 weeks,
high impact activities at 4-6 months(small lesion)
8 months(large lesion)

45
Q

PFP prevalence

A

25% general population

15-20% incidence in adolescents

46
Q

Best diagnostic indicators of PFP(per CPG)

A

activities that increase PFJ compressive forces
-squatting
-stair climbing/descent
-sitting w/ flexed knee

47
Q

CPG recs for foot orthoses and PFP

A

high quality reviews, RCTs, and moderate quality systematic reviews for prefab foor orthoses for people w/ excessive foot pronation
-short term of 6 weeks
-best combined w/ exercise program

long term use of orthoses yields no additional benefit

48
Q

Osgood-Schlatter disease

A

traction apophysitis of patellar tendon insertion at tibial tubercle

most commonly coincides w/ growth spurt
females 8-13
males 10-15

generally a self limiting condition
-no conlusive evidence over best treatment

49
Q

Sinding-Larson-Johansson syndrome

A

traction apophysitis at inferior pole of patella

typically in active 10-15 year olds

self limiting and also no conclusive evidence for best treatment

50
Q

Best practice for patellar tendinopathy

A

No current gold standard

progressive tendon loading including eccentric loading is considered best practice
-non invasive(tape, brace, US, Laser) and invasive(DN, PRP) treatment options should be considered adjunct to progressive loading

51
Q

Silbernagel et al Pain Monitoring model

A

0-2 safe zone
2-5 acceptable zone
5-10 high risk zone

pain can reach 5/10 during exercise, but must subside to baseline by next morning

baseline pain not allowed to increase week over week

52
Q

Heavy Slow resistance progression

A

Week 1: 4 sets of 15RM
Week 2-3: 4 sets of 12RM
Week 4-5: 4 sets of 10RM
Week 6-8: 4 sets of 8RM
Week 9-12: 4 sets of 6RM

3 sec eccentric and 3 sec concentric phase

53
Q

Extracorporeal shockwave therapy recs for patellar tendinopathy

A

no clear evidence if radial vs focused shock waves

radial = more superficial

focused = reaches deeper soft tissue

no difference between the 2 types when combined w/ eccentric training for chronic patellar tendinopathy
-suggested for recalcitrant cases when surgery is being considered

54
Q

Therapeutic US recs for patellar tendinopathy

A

no additional benefit over eccentric exercise or placebo

55
Q

Low level laser therapy recs for patellar tendinopathy

A

1 small study suggests that LLLT + eccentrics
was superior than LLLT or eccentrics alone
-more research needed

56
Q

PRP and autologous blood injection recs for patellar tendinopathy

A

PRP and autologous injections provided short term pain relief and increased function
-there was no statistical difference between groups
-short term value but unclear long term value
-consider risk of invasive procedure for short term gains

57
Q

Corticosteroid recs for patellar tendinopathy

A

oral or injectable
-risk for decreased tendon strength
-no significant improvement above eccentric or HSR training

58
Q

Summary of recs for patellar tendinopathy

A

address risk factors
-load mgmt, weight, jumping/running mechanics, hip/knee/ankle strength and flexibility

Isometric, eccentric and HSR loading programs
-declined squat training
-pain monitoring model
-education that improvement can take 6+ months

PRP can be considered
-some short term benefit
-long term results unclear

Steroid injection and US not recommended

DN and LLLT may be considered but more research needed

Shockwave therapy positive for pain and function for those who had not responded to non-surgical mgmt,

Surgery can be considered after 6 months of unresponsive non-surgical treatment

59
Q
A

OCS Exam (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions