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KNEE 1 Flashcards

Knee 1: ACL, MCL, LCL, meniscus

1
Q

ACL sprains/tears are defined as

A

sudden/violent twist of tibiofemoral joint, which stretches/tears ACL

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2
Q

Grade I knee sprains

A

MILD: stretched ligament with micro tears. Can still WB

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3
Q

Grade II knee sprain

A

MODERATE: partial tear
mild to mod instability, knee giving out while standing/walking

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4
Q

Grade III knee sprain

A

SEVERE: complete tear, unstable

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5
Q

Most ACL injuries occur (with/without) contact?

A

WITHOUT CONTACT, mostly landing a jump. No single cause (combo of intrinsic and extrinsic factors)

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6
Q

ACL injury intrinsic factors

A

joint laxity
larger Q angle (women)
narrow intercondylar notch

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7
Q

ACL injury extrinsic factors

A

muscle strength! SPECIFICALLY HAMSTRINGS (ACL agonist to prevent anterior tibial translation)
-usually quad is stronger, so there is imbalance

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8
Q

ACL common demographics

A

female athletes
14-29 years (highly athletic)
*differences due to muscle stuff, joint laxity, narrower notch width index

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9
Q

ACL provides 85% of total restraining force of ____ translation of tibia

A

anterior

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10
Q

ACL strains can occur due to what 3 things?

A
  1. sudden stop/twist/pivot
  2. hyperextension/extreme straightening
  3. direct impact to outside of knee/lower leg
    *usually during sudden cut/deceleration NONCONTACT
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11
Q

ACL is frequently injured along with what structures?

A

MCL and medial meniscus

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12
Q

There is a 100 fold increase in ACL injury in ____ players compared to general pop.

A

college football players

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13
Q

Are male or female athletes more susceptible to ACL injuries?

A

female

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14
Q

What are three contributing factors to ACL injuries? hint* sports related, gender, NWI

A
  1. sports related (football, baseball, soccer, skiing, basketball)
  2. female athletes
  3. femoral notch stenosis (NWI<0.2)
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15
Q

What are the common signs of ACL tears?

A

pain
AUDIBLE/FELT POP**
feeling knee give out
inability to continue sport
swelling, large hemarthrosis
instability
loss of knee ROM

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16
Q

What hurts ACL tears?

A

walking, stairs up or down, sport
change of direction
cutting, pivot, jump

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17
Q

What makes ACL tears better?

A

elevation
NSAIDS
muscle relaxants
ice
rest

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18
Q

surgical options of ACL tears

A

intraarticular reconstruction:
1. bone-patella-bone autografts
2. hamstring tendon grafts
3. allografts

surgical reconstruction:
1. autografts (patellar tendon, quad tendon, hamstring, medial head of gastroc)
2. allografts (donor achilles, patellar, quad, hamstring tendon)

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19
Q

Why would you use an allograft for ACL tear?

A

less invasive, quicker return to function
cons: disease, infection, weaker than autografts

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20
Q

Rehab of ACL depends on if they had surgery or not.
If they had surgery, take into mind that…

A

autographs undergo ligamentation (strong at implantation)
collagen matures for 1-2 years after surgery
transplanted graft does not ever get to normal ACL tissue level

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21
Q

Can you test meniscal tears through palpation?

A

very low validity. rely on X-rays

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22
Q

When does collagen mature in ACL autograft?

A

1-2 years after surgery (never obtains all cellular features of normal ACL tissue)

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23
Q

What are the stages of ligamentation? (ACL surgery)

A
  1. necrosis (1-3 weeks)
  2. revascularization (6-8 weeks): peripheral to central
  3. cellular proliferation (8+ weeks)
  4. collagen formation, remodeling, maturation (8+ weeks)
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24
Q

Phase I of ACL rehab (0-14 days)

A

ACUTE INFLAMMATORY PHASE
goals: maintain ROM, decrease inflammation
*basically all interventions for all the phases include meds, modalities like e-stim on quads, ultrasound, ice, myofascial release, LE flexibility of hamstrings, ITB, hip flexors, and a HEP

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25
Q

Phase 2 of ACL rehab (15-21 days)

A

Reparative Phase: progress as pain allows
gals: return ROM (FULL EXTENSION), MINIMIZE SWELLING

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26
Q

Phase 3 of ACL rehab (22-60)

A

Remodeling phase
progress when PAIN FREE ROM and NO FUNCTIONAL LIMITATIONS
goals: increase agility, progress to return to sports, address contributing factors

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27
Q

Phase 4 of ACL rehab (day 60-1 year)

A

Remodeling Phase
Progress to this phase when NO FUNCTIONAL LIMITATIONS
goals: correct contributing factors to injury, retrain muscles

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28
Q

MCL tears are defined as:

A

sudden twist of tibiofemoral joint, stretching MCL.

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29
Q

what is the unhappy triad?

A

MCL, ACL, medial meniscal tears together

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30
Q

What is the most common of all ligament injuries?

A

MCL sprain

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31
Q

What contributes to MCL injuries?

A
  1. sports related injuries (similar to ACL)
  2. long term corticosteroid use (weakens ligaments)
  3. systemic diseases=joint laxity, like RA/lupus
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32
Q

What is the most common cause of MCL injury?

A

valgus stress/external tibial rotation
*direct blow to outside of knee
(combo of intrinsic/extrinsic factors)
occurs most commonly at femoral attachment

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33
Q

Partial MCL tears due to noncontact injuries are due to ____, ____, ____ motions

A

deceleration, cutting, pivoting

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34
Q

overuse injuries of MCL are found in ______(which kind of athlete/sport?)

A

swimmers
(whip-kick technique)
*also caused by severe knee twist in skiing/wrestling, fall twisting lower leg outward

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35
Q

common signs of MCL tears

A

-TEARING, NOT POP
-bruising of medial knee (MCL is extraarticular)
-swelling
-limp/pain with knee extension
-instability
-loss of ROM, stiffness
-medial joint line pain

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36
Q

What makes MCL injuries hurt more?

A

-extension of knee
-initial contact in gait
-stairs up or down
walking downhill
-starting run
-uneven ground=instability
-changing directions (turning contralaterally)

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37
Q

what makes MCL injuries feel better?

A

elevation
NSAIDS, muscle relaxants, pain meds
ice
rest

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38
Q

is the MCL well or poorly vascularized?

A

well vascularized!
surgery is rarely required.

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39
Q

In first 72 hours, the knee is ____ to prevent valgus stresses to knee in MCL tears

A

braced

40
Q

During first 6 weeks post MCL tear, knee should be protected to avoid excess_______(what position/loading?)

A

valgus loading
*to allow scar tissue to form and reinforce damaged ligament

41
Q

typically, a grade I or II MCL injury will heal within _____ days

A

11-20 days

42
Q

a grade III MCL injury will take around _____to heal

A

6 months-1 year

*in rare cases, surgery performed

43
Q

If patient has MCL surgery, first 3-4 weeks bracing is in what position?
Brace is kept on until 6 weeks post op

A

close to full EXTENSION
*bracing may be removed frequently for AAROM, AROM exercises

44
Q

complete rehab of MCL surgery takes

A

6 months

45
Q

Phase I of MCL injury (0-2 weeks)

A

Acute Inflammatory Phase
goals: maintain ROM, protect joint/ligament, decrease inflammation

46
Q

Phase 2 of MCL injury (15-21 days)

A

Reparative Phase
progress as pain allows (protect full extension bc it stretches MCL)
-return ROM, minimize swelling

47
Q

Phase 3 of MCL injury (22-60 dyas)

A

Remodeling Phase
-pain-free ROM
-no functional limitations
goals: increase agility, progress return to sports, address contributing factors

48
Q

Phase 4 of MCL tear (2 months-1 year)

A

when to progress: no functional limitations

goals: correct contributing factors, retrain muscle activity

49
Q

LCL sprains are defined as

A

sudden twist of tibiofemoral or tibiofibular joint, stretching LCL

50
Q

LCL injury most commonly occurs at what attachment?

A

fibular attachment (75% of the time)

51
Q

overstressing LCL occurs with a ____force at knee

A

varus (ligament failure due to excessive loading)

52
Q

LCL sprain is the most/least common?

A

LEAST COMMON (2% of all knee injuries)

53
Q

LCL controls varus loading and external rotation of tibia. LCL contact injuries are caused by _____ load to the knee

A

direct varus load=complete tear
Most common method of injury: direct varus force, foot pointed and knee extended

54
Q

What are related injuries with LCL injuries?

A

common fibular nerve, posterolateral capsule damage, PCL damage

55
Q

The much less common mechanism of injury to LCL is knee (add/abd), (flex/ext), (int/ext rotation of femur)

A

knee adduction, flexion, external rotation of femur

56
Q

What are common signs of LCL injury?

A

-pain
-pop to knee (MCL is tearing, not pop)
-bruising to lateral knee (LCL is extraarticular)
-swelling building for several days
-instability
-loss of ROM and mod stiffness
-lateral joint line pain

57
Q

what makes LCL tears hurt more?

A

-starting run
-walking long distances
-uneven ground: instability feeling
-changing directions (ipsilateral turn)

58
Q

what makes LCL injuries feel better?

A

elevation
NSAIDS, muscle relaxants, pain meds
ice
rest

59
Q

LCL rehab recommendations: after repair, patients are instructed to put ____ weight on their foot when standing/walking for up to 6 weeks

A

little to no weight for 6 WEEKS

60
Q

after LCL repair, weight bearing precautions last up to ___ weeks

A

12 weeks (following ligament reconstruction)

61
Q

After LCL surgery, knee is braced into ______ for 3-4 weeks

A

full extension for 3-4 weeks
*some surgeons use contin passive motion machine-pt can come out of brace to use it

62
Q

at 5-6 weeks, LCL repair patient will wear ______

A

knee brace with hinge
protect during walking

63
Q

complete LCL recovery takes how long?

A

6 months to 1 year

64
Q

Phase I of LCL injury (day 0-2 weeks) is called

A

acute inflammatory phase
-initial injury
-goals: maintain ROM, protect, decrease inflammation

65
Q

What are interventions for all ligament injuries?

A

▪ Medications: Antiinflammatories/muscle relaxants
▪ Modalities: E-stim for quadriceps contraction, ultrasound, ice after activity ▪ Myofascial release to global muscles as needed
▪ LE flexibility: Hamstrings, ITB, and hip flexors
▪ HEP: ROM exercises, lower extremity flexibility, hip strengthening, RICE

66
Q

Phase 2 of LCL injury (day 15-21) is called:

A

Reparative phase
Progress to phase 2 as pain allows

goals: restore normal ROM, minimize swelling
interventions: walking program as needed

67
Q

Phase 3 of LCL injury is (day 22-60)

A

REMODELING PHASE
when to progress: when ROM is PAIN FREE, no functional limits
goals: increase agility, progress to return to sports, address contributing factors

68
Q

Phase 4 of LCL injury is known as (day 60-1 year)

A

Remodeling phase
when to progress to this phase: no functional limits
goals: correct contributing factors, retrain muscles

69
Q

Meniscal injury is defined as

A

tear/degeneration of semilunar, fibrous cartilage in knee joint

70
Q

Meniscal injury is diagnosed by palpation or arthroscopically/MRI?

A

arthroscopically (gold standard) or MRI
can be medial, lateral meniscus, or both

71
Q

for degenerative meniscal tears, what is a risk factor?

A

age (60% of people older than 65 have degenerative tears)

72
Q

young, active, athletic people are more susceptible to _____ meniscal tears

A

acute, traumatic

73
Q

true or false: meniscal tears result from minor or major trauma to knee OR from degeneration

A

TRUE
trauma: young
degeneration: old

74
Q

degenerative tears can be age related or result from repetitive _________

A

squatting/kneeling

75
Q

medial meniscus is more commonly injured than lateral (true or false)

A

true! bc of its attachment to the joint capsule, it is less mobile than the lateral meniscus

76
Q

meniscal tears are often associated with ____tears

A

ACL (think unhappy triad)

77
Q

bucket handle tears are _____

A

vertical tear with displacement of inner margin
most often associated with ACL tear
more common in medial meniscus

78
Q

radial tears are most often found in ____aspect of ____meniscus

A

found in medial aspect of LATERAL MENISCUS
can be associated with ACL tear
commonly from TRAUMA, often in young, active individuals

79
Q

horizontal meniscal tears are (traumatic/degenerative)?

A

degenerative: found in older people with OA

*think older people with OA are tired and need to be horizontal (lie down)

80
Q

longitudinal tears involve _____of meniscus

A

posterior portion of meniscus
typically associated with ACL tear

81
Q

Flap tear is a displaced flap secondary result from _____, ____, ____ tear

A

radial
bucket handle
horizontal

82
Q

what is the mot common type of meniscal tear?

A

LONGITUDINAL TEAR
*posterior part of meniscus, typically associated with ACL tear

83
Q

oblique tears are a ____ tear running obliquely from inner edge of meniscus out into body of meniscus

A

FULL THICKNESS TEAR

84
Q

degeneration of meniscus is always pathological (true or false)

A

false: degenerative tears occur as natural part of aging (collagen fibers break down)

85
Q

how do traumatic meniscal tears happen?

A

compressive force coupled with rotation while knee is flexed
*most from NONCONTACT (landing from jump, pivoting, decelerating, cutting)

86
Q

degenerative tears are found in what age group?

A

older than 65
nontraumatic from repetitive activities or history of trauma like ACL tear or knee surgery

87
Q

4 contributing factors to meniscal tears

A

age (degenerative tears)
weight
previous surgical history
previous knee trauma

88
Q

do meniscal injuries have a referral pattern?

A

no

89
Q

common signs of meniscal tears

A

clicking, popping, locking, giving way, catching
pain with WB
joint line tenderness/pain
swelling, decreased, painful ROM

90
Q

any position of non weight bearing will make meniscal injuries feel better or worse?

A

better (only easing activity)

91
Q

meniscal repairs are recommended for who?

A

active young people (younger than 50) OR older athletic people

92
Q

meniscal repairs are recommended for tears to the inside or outside edges of mensicus?

A

outer edges (vascular region)

93
Q

partial meniscetomy is recommended for tears in the _____ region of meniscus

A

avascular region/complex tears that cant be repaired

94
Q

surgical options for meniscus repairs

A

arthroscopy: partial meniscectomy or meniscal repair
meniscal transplantation

95
Q

Goals for meniscal tear rehab include LE strength and ROM exercises with _____ (open or closed chain?)

A

limited weight bearing (open chain like heel slides, quad sets, straight leg raises, stationary bike, hip abduction)

96
Q

what else is involved with meniscal rehab?

A

limit high compressive shear forces (control excess WB)
modalities to decrease pain/inflammation
stretching and soft tissue mob for hams, quads, calf to improve knee ROM
gait train with assistive device
patellar mob

MSK (8 decks)

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