Knee Flashcards
(57 cards)
What is the return to sport criteria after a hamstring injury?
Full strength without pain:
- tested in prone at 90 deg and 15 deg
- max effort with 4 consecutive efforts
- less than 5% bilateral deficit in eccentric hamstrings
Full ROM without pain
Replication of sport specific movements @ near max speed
- use incremental sprint testing for athletes
allograft ACL reinjury rate
The data point to a very high (>30%) early reinjury or contralateral injury rate seen with the use of allografts.
pros/cons to allografts, artificial graft
-efficient but some issues:
-incorporate less completely and more slowly than autografts
-require sterilization and are expensive.
-Recent studies do not support their use in younger patients, especially in young females
-artificial graft: Short-term results were encouraging, but after one year, issues began, and they all failed over time. Any graft must be biologic if the long-term health of the joint is to be preserved.
biceps femoris
long head- ischial tuberosity
short head- linea aspera/latreal supracondylar line
–> fibular head. tendon split by LCL
long head: tibial nerve
short head: common peroneal nerve
L5-S2
semitendinosus
ischial tuberosity-> medial tibia
tibial nerve L5-S2
semimembranosus
ischial tuberosity->posterior medial tibial condyle, attachment forms oblique popliteal ligament
tibial nerve L5-S2
gastroc
lateral head: lateral femoral condyle
medial head: popliteal surface of femur superior to medial condyle
-> calcaneous via tendon
tibial nerve S1-2
soleus
posterior fibula, soleal line/middle 1/3 of medial border of tibia, tendinous arch –> posterior surface of calcaneus
tibial nerve S1-2
plantaris
inferior end of lateral supracondylar line/oblique popliteal ligament –> calcaneus via tendon
tibial nerve S1-2
popliteus
lateral femoral condyle & lateral meniscus -> posterior surface of tibia/superior to soleal line
tibial nerve L4-S1
sartorius
ASIS/superior part of notch inferior to it–> superior part of medial tibia
femoral nerve L2-3
rectus femoris
AIIS and ilium superior to acetab-> via quad tendon, indirectly via patellar ligament to tibial tuberosity
femoral nerve L2-4
vastus lateralis
greater trochanter & lateral lip of linea aspera–>via quad tendon; also into tibia/patella via lateral patellar retinaculum
femoral nerve L2-4
vastus medialis
intertrochanteric line & medial lip of linea aspera-> quad tendon
femoral nerve L2-4
vastus intermedius
anterior/lateral surface of femur shaft-> via quad tendon
femoral nerve L2-4
knee tibial nerve innervations
L5-S2:
biceps femoris long head
semitendinosus
semimembranosus
S1-2:
gastroc
soleus
plantaris
L4-S1
popliteus
Ottawa Knee Rules
Age >55
Fibular head TTP
isolated tenderness of patella
unable to flex knee to 90
unable to bear weight immediately or in ER
high SN
Pittsburgh Knee Rules
Blunt trauma or fall of MOI
PLUS either of following:
-age >50 or <12
-unable to walk 4 WB steps in ER
high SN
Knee OA Clinical presentation
Knee pain + at least 3/6 of following:
-age >50
-AM stiffness <30 min
-crepitus on active motion
-bony tenderness
-no palpable warmth
-bony enlargement
meniscus CPR - CLinical composite score to accurately detect
-history of catching/locking
-joint line tenderness
-pain with forced hyperext (modified bounce home test)
-pain with maximal passive knee flexion
-pain/click with mcmurray
Low SN
High SP: 3+ .9; 5=.99
CPG for meniscus - risk factors level of evidence
- age, greater time from injury, participated in high level sports or had laxity after ACL injury
-cartilage- age/presence of meniscal tear considered in odds of chondral lesion
^^both evidence C
meniscus CPG - level of evidence for interventions
Progressive WB - D
Progressive Knee motion (following surgery); early return to activity: C
return to activity with chondral lesion- E (delay return)
supervised rehab: D, conflicting evidence
ther ex, NMES: B
ACL clinical presentation
contact or non contact
excess dynamic valgus, anterior tibial translation, posterior femoral translation, or hyperextension
audible pop
feeling of instability, immediate swelling
ACL special testing
Anterior drawer - SP 86-100 (low SN)
Active lachman - SN 99, SP 100
Lachman - SN 80-99, SP 91-100
