Articular pathology of the Knee

Question 1

T or F: knee OA is common and arthritis is strongly associate with major depression

Answer 1

T

Question 2

what is the most common cause of disability in the US?

Answer 2

arthritis

Question 3

are males or females more at risk for articular knee injuries

Answer 3

female

Question 4

does the medial or lateral compartment of the knee experience more wear and tear? why?

Answer 4

medial b/c we load in extension and create a varus moment

Question 5

if your pt has a medial compartment knee injury what kind of exercises may you need to avoid for a time?

Answer 5

weight bearing exercises close to full extension

Question 6

if your pt has an injury to their patella where should you have them do exercises at first?

Answer 6

close to full extension because the patella isn’t making contact

Question 7

what part of the meniscus is innervated

Answer 7

outer 2/3

Question 8

during flexion and extension the meniscus moves with the ______

Answer 8

tibia
(ant with ext, post with flexion)

Question 9

during rotation the meniscus moves with the _____

Answer 9

femur
(during tibial IR, medial meniscus goes anterior and lateral meniscus goes posterior)

Question 10

meniscus cluster testing

Answer 10

1 - catching/locking
2 - joint line tenderness
3 - pain with forced hyperextension
4 - pain with max passive knee flexion
5 - pain or clock with McMurray’s

4/5 = 96% specificity, 5/5 = 99%

Question 11

what kind of MOI do pts typically have with a traumatic meniscus injury

Answer 11

twisting

Question 12

T or F: degenerative and traumatic meniscal tears are examined and treated the same

Answer 12

F: examined the same but degenerative tend to be treated much more conservatively because their outcomes are the same as surgery long term

Question 13

special tests for meniscus (3)

Answer 13

McMurray
Apley’s
Thessaly’s

Question 14

T or F: no single test accurately identifies meniscal injuries

Answer 14

T

Question 15

what is the gold standard imaging for meniscus injuries

Answer 15

MRI

Question 16

with a meniscectomy you get flattening of the ______

Answer 16

condyles

Question 17

4 surgical treatments for meniscus injury

Answer 17

1) in situ - flap the tear back over and leave it
2) debridement - cut out torn parts or entire thing
3) repair - fix tear
4) allograft - transplant meniscus from cadaver (not common)

Question 18

are repairs usually completed on the lateral or medial meniscus? why?

Answer 18

lateral - b/c better blood flow

Question 19

what is one of the most critical parts of rehabbing meniscal repairs?

Answer 19

getting full knee extension

Question 20

the first 4 weeks after meniscal repair, keep knee flexion ROM below ___- degrees

Answer 20

90

Question 21

therex progression post meniscal repair

Answer 21

0-4 wks = unloaded knee exercise
4-8 wks = closed kinetic chain
8-12 wks = strength training

Question 22

functional progression post meniscal repair

Answer 22

0-2 weeks = weight bearing progression
2-4 weeks = walking progression
4-12 weeks = functional progression

Question 23

what is the main difference rehab wise between an allograft and meniscal repair

Answer 23

allografts are normally NWB for a longer periods of time and need radiographic evidence of healing

Question 24

articular cartilage loss s/s

Answer 24

• ROM loss
• joint line tenderness
• crepitus

Question 25

how many grades of articular cartilage defects? is higher better or worse?

Answer 25

5 (0,1,2a, 2b,3) the higher the grade the worse the damage

Question 26

what are some traumatic MOIs for articular cartilage pathologies

Answer 26

1 - superficial lesions 2 - blunt trauma 3 - deep penetrating wound

Question 27

as you get older, articular cartilage gets _________

Answer 27

softer

Question 28

T or F: genetics can play a role in how quickly articular cartilage wears down

Answer 28

T

Question 29

pigmented villonodular synovitis

Answer 29

- idiopathic synovial overgrowth - hemarthrosis

Question 30

most common joint for pigmented villonodular synovitis

Answer 30

knee

Question 31

T or F: pigmented villonodular synovitis may spontaneously resolve or take years

Answer 31

T

Question 32

medial unloader braces are designed to put a _____ stress on the knee while lateral braces put a ______ stress

Answer 32

valgus varus

Question 33

what are 3 things that have proven to have positive effects on knee OA

Answer 33

weight loss exercise PT

Question 34

For knee OA what kind of exercises should you start with

Answer 34

non-weight bearing

Question 35

what intervention could be useful for pain control in knee OA

Answer 35

joint mobilizations

Question 36

did research show a difference in WOMAC scores between pts who had arthroscopic debridement and those who had PT and conservative medical management

Answer 36

no

Question 37

debridement for knee OA usually leads to a ...

Answer 37

joint replacement

Question 38

are autografts (OATS) or allograft articular cartilage surgeries more common

Answer 38

autografts

Question 39

two parts of autologous chondrocyte implantation (MACI)

Answer 39

1 - harvest cells 2 - debride and implant

Question 40

do most athletes return to "high level" activity after MACI procedures

Answer 40

yes

Question 41

MACI post-op rehab phases

Answer 41

0-6 wks = early protection (control effusion, ROM within limits) 6-12 wks = transition (full ROM, increase WB) 12-26 wks = remodeling (strength and function) 6 months-3 years = maturation

Question 42

T or F: early WB is proven to be superior to later WB in MACI rehabilitation

Answer 42

F: WB restrictions are highly dependent on surgeon preference

Question 43

do athletes tend to do better with an OATS or MACI procedure

Answer 43

OATS

Question 44

salter-harris fracture

Answer 44

a fracture on the epiphyseal plate in children

Question 45

salter-harris classification

Answer 45

type 1 & 2 = no surgery type 3 = sometimes surgery type 4&5 = need surgery *type 2 most common

Question 46

what are kids with type 4&5 salter harris fractures more likely to have

Answer 46

a leg length difference because you damaged the growth plate

Question 47

T or F: you need full knee extension for daily activities

Answer 47

T: knee extension is important