Knee CPG and SR

Question 1

Risk factors

chondral lesion / mensical injury

after ACL injury

Answer 1

• age
• longer time from injury

Question 2

Ottawa knee rules

Answer 2

• >55yo
• isolated TTP patella (no other)
• TTP head of fibula
• inabilty to flex to 90^o
• inability to bear weight 4 steps regardless of limping

Question 3

Mensical tear diagnosis (hx & obj)

Answer 3

• Hx
  
  • twisting injury
  • tearing sensation at time of injury
  • delayed effusion
  • “catching” or “locking”
• Obj
  
  • pain with forced hyperextension
  • pain with max flexion
  • pain/audible click with McMurray
  • joint line tenderness
  • discomfort/locking/catching over MJL/LJL during THessaly at 5^o/20^o flexion

Question 4

Knee outcome measures

Answer 4

• SF36
• KOS-ADLS
• KOOS
• IKDC
  
  • MDC 12.8 (8.8 for meniscus)
  • MCID 20.5
• Cincinnati
  *

Question 5

Meniscal CPR

Answer 5

• hx mechanical catching/locking
• joint line tenderness
• pain w/ forced knee hyperextension
• pain w/ maximum passive knee flexion
• pain/audible click with McMurray

5/5 –> Sn .11 Sp .99 +LR 11.2, -LR .90

4/5 –> Sn .16 Sp .96 +LR 4.3 -LR .87

for medial: JLT (rules in / out)

for lateral: Thessaly at 5^o (rules out) + JLT (rules in)

Question 6

Coper criteria

Answer 6

ALL criteria

• # of giving-way episodes <= 1
• single limb 6-m timed hop >= 80%
• KOS-ADLS >=80%
• GRS >=60%

Question 7

knee ligament sprain interventions

Answer 7

• STRONG
  
  • therex (CKC & OKC)
• Moderate
  
  • post-op bracing MEH
  • immediate (vs. delayed) immobilization
  • supervised rehab
  • neuromuscular e-stim
• weak
  
  • early WB
  • functional knee bracing (ACL deficiency)
  • continuous passive motion
  • cryotherapy
    *

Question 8

factors female ACL injury

Answer 8

1. ligament dominance
2. quadriceps dominance
3. leg dominance
4. trunk core dominance

Question 9

mensical & chondral lesion interventions

Answer 9

• Moderate
  
  • Therex
  • _neuromuscular stimulatio_n
• weak
  
  • progressive knee motion
  • progressive return to activity (meniscus)
• expert opinion
  
  • progressive return to actity (chondral)
• conflicting
  
  • supervised rehab
  • progressive weight bearing

Question 10

articular cartilage lesion diagnosis

Answer 10

• Hx
  
  • acute trauma with hemarthrosis (0-2 hr)
  • insidious onset aggravated by repetitive impact
  • intermittent pain & swelling
  • hx of “locking/catching”
• OBJ
  
  • joint line tenderness

Question 11

Knee OA diagnosis

Answer 11

• Category 1
  
  • knee pain & crepitus w/ active motion
  • morning stiffness < 30 min
  • age >38
• Category 2
  
  • knee pain & crepitus with active motion
  • morning stiffness > 30 min
  • bony enlargement
• Category 3
  
  • knee pain
  • bony enlargement

Sn 89%

Sp 88%

Question 12

Knee OA interventions

Answer 12

• STRONG
  
  • low-intensity resistance program
• Moderate
  
  • high-intesnsity resistance program
  • aquatic exercise not better/worse than other
  • adding MT to exercise = moderate effect on pain

Question 13

PFPS diagnosis

Answer 13

• Squatting with pain -LR 0.2
• Patella tilt test +LR 5.4

Question 14

PFPS rehabilitation

(2016 consensus statement)

Answer 14

• Exercise
  
  • combining hip & knee
• Foot orthoses
• Electrophysical agents & Mobes (PF, knee, lumbar) may not improve outcomes