Acute Knee Injuries

Question 1

List common injuries to the knee

Answer 1

• Medial meniscus tear.
• MCL sprain.
• ACL sprain.
• Lateral meniscal tear.
• Articular cartilage injury.
• PCL injury.
• Patellar dislocation.

Question 2

Time relation to onset of injury (intermediate hemarthrosis)

Answer 2

• 0-2 hrs. Degree and time of onset can reflect either intra articular of extra articular injury.
• Patellar dislocation.
• Major chondral lesion.
• MCL sprain (deep)

Question 3

Time relation to onset of injury (Delayed effusion)

Answer 3

• 6-24 hrs. Degree and time of onset can reflect either intra articular of extra articular injury.
• Meniscus.
• Smaller chondral lesion.
• May represent synovitis and is a feature of meniscal and chondral injury.

Question 4

Time relation to onset of injury (no swelling)

Answer 4

• Degree and time of onset can reflect either intra articular of extra articular injury.
• MCL sprain (superficial).
• May represent synovitis and is a feature of meniscal and chondral injury.

Question 5

Why is the time of injury vs. time of onset of swelling important

Answer 5

Degree and time of onset can reflect either intra articular of extra articular injury.

Question 6

List special tests that indicate ACL injury

Answer 6

• Lachman’s test. (30 deg. knees flexion + tibia ext. rotation then ant. drawers test)
• Anterior drawer test.
• Pivot shift test.(int. rot. valgus stress and knee flexion)

Question 7

List special tests that indicate PCL injury

Answer 7

• Posterior drawer test.
• Posterior sag sign.
• Reverse Lachman’s test.(30 deg. knees flexion + tibia int. rotation then post. drawers test)

Question 8

List special tests that indicate Meniscal injury

Answer 8

• McMurrays’s test. (knee fully flexed, internal rotation(for lateral) or medial rotation(for medial) and move into extension)
• Joint line tenderness.
• Apley’s test.

Question 9

List special tests that indicate MCL injury

Answer 9

• Valgus stress test.

Question 10

List special tests that indicate LCL injury

Answer 10

• Varus stress test.

Question 11

List some key outcome measures to assess functional activity level

Answer 11

• International knee documentation committee (IKDC) Subjective evaluation form.
• Knee injury and osteoarthritis score (KOOS).
• Lysholm knee scoring scale.
• Tehner activity scale.
• Activity rating scale.

Question 12

List the 6 types of meniscal tear injuries

Answer 12

Longitudinal tear (progress to Bucket handle tear).
Horizontal tear (progress to Flap tear).
Radial tear (progress to Parrot Beak tear).

Question 13

Meniscal rehab goals Phase 1
(Time and 5 points)

Answer 13

• 0-1 week.
• control swelling.
• maintain knee ext.
• knee flexion to 100 deg.
• 4/5 quad strength.
• 4/5 hamstring strength.

Question 14

Meniscal rehab goals Phase 2
(Time and 5 points)

Answer 14

• 1-2 weeks.
• Full ROM.
• 4+/5 quadricep strength.
• 5/5 hamstring strength.

Question 15

Meniscal rehab goals Phase 3
(Time and 5 points)

Answer 15

• 2-3 weeks.
• Full ROM.
• Full strength.
• Full squat.
• Dynamic proprioceptive training.
• Return to running and restricted sport specific drills.

Question 16

Meniscal rehab goals Phase 4
(Time and 5 points)

Answer 16

• 3-5 weeks.
• Full ROM.
• Full Strength.
• Full endurance.
• Return to sport specific drills and restricted training and match play.

Question 17

Mild MCL rehab goals Phase 1
(Time and 5 points)

Answer 17

• 0-1 week.
• Control swelling.
• Knee flexion to 100.
• Allow +20 extension.
• 4/5 quadriceps strength.
• 4/5 hamstring strength.

Question 18

Mild MCL rehab goals Phase 2
(Time and 6 points)

Answer 18

• 1-2 weeks.
• Eliminate swelling.
• Full ROM.
• Allow +10 extension.
• 4+/5 quadriceps strength.
• 5/5 hamstring strength.
• Return to light jogging.

Question 19

Mild MCL rehab goals Phase 3
(Time and 5 points)

Answer 19

• 2-4 weeks.
• Full ROM.
• Full strength.
• Full squat.
• Dynamic proprioceptive training.
• Return to running and restricted sports specific drills.

Question 20

Mild MCL rehab goals Phase 4
(Time and 4 points)

Answer 20

• 3-6 weeks.
• Full ROM
• Full strength
• Full endurance
• Return to sports specific drills and restricted training and match play.

Question 21

Moderate MCL rehab goals Phase 1
(Time and 5 points)

Answer 21

• 0-4 weeks.
• Control swelling.
• Knee flexion to 90.
• Allow +30 extension.
• 4/5 quadriceps strength.
• 4/5 hamstring strength.

Question 22

Moderate MCL rehab goals Phase 2
(Time and 5 points)

Answer 22

• 4-6 weeks.
• Eliminate swelling.
• Full ROM.
• FWB.
• 4+/5 quadriceps strength.
• 5/5 hamstring strength.

Question 23

Moderate MCL rehab goals Phase 3
(Time and 5 points)

Answer 23

• 6-10 weeks.
• Full ROM.
• Full strength.
• Full squat.
• Dynamic proprioceptive training.
• Return to light jogging.
• Return to running and restricted sports specific drills.

Question 24

Moderate MCL rehab goals Phase 4
(Time and 5 points)

Answer 24

• 8-10/12 weeks.
• Full ROM.
• Full strength.
• Full endurance.
• Return to sports specific drills and restricted training and match play.

Question 25

ACL prehab goals (4 points)

Answer 25

- N/minimal swelling. - Restore FROM particularly extension. - General 4+/5 lower limb strength or better. - Education.

Question 26

ACL rehab goals Phase 1 (Time and 5 points)

Answer 26

- 0-2 weeks. - PWB FWB. - Eliminate swelling. - 0 -100 ROM. - 4+/5 quadriceps strength. - 5/5 hamstring strength.

Question 27

ACL rehab goals Phase 2 (Time and 6 points)

Answer 27

- 2-12 weeks. - No swelling. - Full knee extension. - Knee flexion to 130 +. - Full squat. - Good balance and control. - Unrestricted walking.

Question 28

ACL rehab goals Phase 3 (Time and 4 points)

Answer 28

- 3-6 months. - Full ROM. - Full strength and power. - Return to jogging, running, and agility. - Return to restricted sport specific drills.

Question 29

ACL rehab goals Phase 4 (Time and 1 point)

Answer 29

- 6 -12 months. - Return to sports.

Question 30

List problems that are unaccounted for during ACL rehab (non treatment and non surgical)

Answer 30

- Lower back pain. - Instability. - Symptomatic meniscus tears.

Question 31

List problems that are unaccounted for during ACL rehab (surgical treated)

Answer 31

- Patellar region pain. - Soft tissue stiffness. - Soft tissue laxity. - Muscle weakness. - Poor proprioception. - Psychosocial problems.

Question 32

Outcomes after ACL Rx. (4 points)

Answer 32

1. Patient’s own perception of knee function. 2. Return to pre injury sporting activity. 3. Re injury rate. 4. Prevalence of osteoarthritis.

Question 33

PCL rehab goals Phase 1 (Time and 5 points)

Answer 33

- 0 - 2 weeks. - PWB. - Eliminate swelling. - 0 - 100 ROM. - 4+/5 quadriceps strength. - 5/5 hamstring strength.

Question 34

PCL rehab goals Phase 2 (Time and 4 points)

Answer 34

- 2 - 4 weeks. - No swelling. - Full ROM. - 4+/5 quadriceps strength. - 5/5 hamstring strength.

Question 35

PCL rehab goals Phase 3 (Time and 4 points)

Answer 35

- 4 - 6 weeks. - Full ROM. - Full strength & power. - Return to jogging, running, and agility. - Return to restricted sports specific drills.

Question 36

PCL rehab goals Phase 4 (Time and 1 point)

Answer 36

- 6 -10 weeks. - Return to sports

Question 37

Explain four functions of the meniscus

Answer 37

- Increase stability of the femorotibial joint. - Distribute axial load. - Absorb shock. - Provides lubrication and nutrition to the knee joint.