acute soft tissue injury- knee

Question 0

second degree lig injury

Answer 0

joint opens on stress

definite palpable endpoint

Question 1

first degree ligament classification

Answer 1

local tenderness

no instability on stress

Question 2

third degree ligament injury

Answer 2

joint opens on stress

no endpoint

Question 3

what is the most common lateral injury

Answer 3

MCL injury

Question 4

how does MCL injury happy

Answer 4

direct blow to lateral aspect of knee

valgus stress

Question 5

physical exam with MCL injury

Answer 5

plain on valgus

laxity of medial structures

Question 6

Tx of 3 grades for LCL and MCL

Answer 6

1- symptoms- stay off 2 weeks
2- knee brace- 4 weeks off
3- nonoperative brace or surgery- 6 weeks off

Question 7

pe of LCL injury

Answer 7

pain on vargus

lateral laxity

Question 8

what do you have to check for with LCL injury

Answer 8

peroneal nerve dysfunction (runs under biceps femoris and wraps around head of fibula)

Question 9

ACL mech of injury

Answer 9

rapid deceleration, hyperextension with rotation on a planted foot

Question 10

gender in ACL tears

Answer 10

m>f in tear risk, but F>m x4 of rupture risk

Question 11

hx of ACL injury

Answer 11

audible pop followed by immediate pain and swelling after injury

Question 12

PE of ACL injury

Answer 12

hemarthrosis (bleeding into joint) and limited ROM

Question 13

tests to exam ACL

Answer 13

Lachman (hard to do but most sensitive)
anterior drawer
pivot shift tests

Question 14

tx of acl injury depends on the

Answer 14

pathogenesis

ACl tear–>instability–>stress on secondary restrainign structures–>meniscal tears–>arthritis

Question 15

osteoarthritis risk with ACL tear

Answer 15

surgery does not decrease the risk; remains high after the tear

Question 16

decision whether or not to operate on ACL depends on

Answer 16

age, athletciism, rehab, motivation, ass injuries, failed no op tx

Question 17

what are PCL injuries usually from

Answer 17

vehicular injuries

Question 18

dx PCL injury

Answer 18

difficult and often missed

-hyperextension, + drawer test, MRI

Question 19

tx PCL injury

Answer 19

non-operative if isolated (need to avoid popiteal artery)

operative if complex

Question 20

knee dislocation

Answer 20

grossly unstable knee that has disruption of both cruciate ligaments and at least one collateral ligaments

Question 21

natural history of knee dislocation

Answer 21

usually decreases spontaneously by patient or caregiver

Question 22

what is always recommended for a knee dislocation?

Answer 22

arteriogram –>popiteal artery or peroneal nerve injury–>if disrupted emergency surgery necessary

Question 23

knee dislocation tx options

Answer 23

cast immobilization for 6-8 weeks

surgical ligament reconstruction and early motion

Question 24

vasculization and menisci

Answer 24

peripheral 1/3 is vascularized

Question 25

job of menisci

Answer 25

shock absorbers increase stability by cupping femoral condyles decrease chrondral stress

Question 26

dx of menisci injury

Answer 26

joint line tenderness, effusion, incomplete extension, positive mcmurray sign

Question 27

how do you really dx an menisci tear

Answer 27

mRI

Question 28

tx of menisci

Answer 28

usually just observe (not everyone needs a surgery)p | you can also do arthroscopic partial excision/repair

Question 29

paterallar femoral disorder vascular supply

Answer 29

geniculate arteries

Question 30

what is fx of patella

Answer 30

increase force of extension

Question 31

contact stresses of patella increase with

Answer 31

flexion

Question 32

hx of patellar-gemoral disorder

Answer 32

``` knee "giving way" pain on inclines pain associated with prolonged flexion crepitation swelling ```

Question 33

PE of patello femoral dx

Answer 33

peri-patellar tenderness, pain w/ compression (quadriceps atrophy, exam aprehension)

Question 34

patello0femoral syndrome is commonly seen in

Answer 34

adolescent females

Question 35

signs of patelllo-femoral syndrome

Answer 35

pain or crepitation in knee at PF joint positive effusion positive patellar compression test

Question 36

tx of patello-femoral syndrome

Answer 36

non-operative quadriceps strengthing

Question 37

patellar dislocation often presents as

Answer 37

ACL tear

Question 38

patellar dislocation occurs from

Answer 38

direct or indirect trauma-->patella dislocated laterally

Question 39

inital tx of patellar dislocation

Answer 39

decrease dislocation acutely if locked by applying gental medial pressure with knee extended if dislocation reduced spontaenously, check for signs of medial tenderness, effusion and apprehension

Question 40

later tx of patellar dislocation

Answer 40

if first time an dno fx, immobilze | if recurrent, operative repair

Question 41

patellar tendininitis

Answer 41

jumper's knee | stress at insertion site of patellar tendon