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OCS Prep > Knee > Flashcards

Knee Flashcards

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1
Q

medial collateral ligament

A

-resists valgus stress
- gr II, III typically involve meniscus

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2
Q

lateral collateral ligament

A
  • resists varus stress
  • stronger than MCL
  • taut from 0-30 degrees
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3
Q

ACL

A
  • restraint for anterior translation of tibia on femur
    -attachments with ant-medial horn of meniscus
  • anterior-media bundle: most taut in flexion
  • posterior-lateral bundle: most taut in extension
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4
Q

PCL

A
  • anterior lateral bundle: most taught in flexion
  • posterior medial bundle: most taut in extension
  • main restraint of posterior tibial translation or anterior femoral translation
  • also limits femoral external rotation or tibial internal rotation
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5
Q

collateral ligament injury s/sx

A
  • varus/valgus trauma
  • varus/valgus stress testing will be positive (MCL may be associated with ACL and meniscal symptoms)
  • swelling, ecchymosis
  • joint effusion if meniscal involved
  • tenderness to palpation of ligament
  • difficulty with pivoting and cutting
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6
Q

MCL exam

A
  • valgus stress test
  • knee flexed to 20-30, + if laxity or pain, SN of .86
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7
Q

LCL exam

A
  • varus stress test, + is presence of laxity or pain
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8
Q

ACL s/sx

A
  • severe pain with joint effusion
  • popping, giving way, buckling
  • continued effusion
  • quad inhibition
  • limited ROM
  • flexed knee gait
  • 80% non-contact injury
  • contact- 20%
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9
Q

ACL exam

A
  • gold standard is lachmans
    — thought to test more of posterior bundle
  • anterior drawer test
    — thought to test more anterior bundle
  • pivot shift test
    — highly specific
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10
Q

PCL s/sx

A
  • posterior knee pain
  • not as much effusion
  • flexion beyond 90 may increase pain
  • difficulty squatting, descending stairs, running
  • not as much problem with quad inhibition
    • sag sign (100 SP), + posterior drawer, reduced palpation of tibial plateau step up

MOI
- hyperflexion
- fall on flexed knee with foot in plantarflexion
- step in pot hole
- dashboard injury

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10
Q

PCL s/sx

A
  • posterior knee pain
  • not as much effusion
  • flexion beyond 90 may increase pain
  • difficulty squatting, descending stairs, running
  • not as much problem with quad inhibition
    • sag sign (100 SP), + posterior drawer, reduced palpation of tibial plateau step up

MOI
- hyperflexion
- fall on flexed knee with foot in plantarflexion
- step in pot hole
- dashboard injury

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11
Q

Knee pain and mobility impairments CPG recommended physical performance measure

A

LVL C- single legged hop tests, that can identify patient’s baseline status relative to pain, function, side to side asymmetries, test return to sport

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12
Q

Knee pain and mobility impairments CPG recommended physical impairment measures

A

Level B- meniscus
- modified stroke test
- knee AROM
- max isometric quad strength
- forced hyper extension
- knee PROM
- McMurray’s
- joint-line tenderness

Level D- articular cartilage
- modified stroke test
- knee AROM
- max quad strength
- joint line tenderness

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13
Q

Knee pain and mobility impairments CPG recommendation for progressive knee motion

A

Level B: early progressive active and passive knee motion following surgery for both meniscus and articular cartilage

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14
Q

Knee pain and mobility impairments CPG recommendation for progressive weightbearing

A

Level C: meniscus, early progressive weightbearing
Level B: stepwise progression of weightbearing to full bearing by 6-8 weeks after MACI for articular cartilage lesion

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15
Q

Knee pain and mobility impairments CPG recommendation for progressive return to activity

A

Level C: may utilize progressive return to activity following meniscal repair
Level E: may need to delay return to activity depending on type of articular cartilage surgery

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16
Q

diagnosis of patellafemoral pain

A
  • presence of retropatellar or peripatelllar pain (LVL A)
  • reproduction of pain with squatting, stairs, prolonged sitting, or other functional activities that load the PFJ in a flexed position (LVL A)
  • exclusion of all other conditions (LVL B)
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17
Q

PFP categories

A
  • overuse/overload without other impairment
  • muscle performance deficits
  • movement coordination deficits
  • mobility impairments
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18
Q

Overuse/overload without other impairment PFP

A
  • pain primarily due to overuse/overload
  • patient presents with history suggesting an increase in magnitude or frequency of PFJ loading at a rate that surpasses the ability of his tissues to recover
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19
Q

muscle performance deficits PFP

A
  • may respond favorably to hip and knee resistance exercises
  • patient presents with lower extremity muscle performance deficits in hip and quad
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20
Q

Movement coordination deficits PFP

A
  • may respond favorably to gait training and movement re-education interventions leading to improvements in kinematics and pain
  • patient presents with with excessive or poorly controlled knee valgus during a dynamic task, but not due to weakness
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21
Q

Mobility impairments PFP

A
  • hypermobile or hypomobile structures
  • higher than normal foot mobility or flexibility deficits of 1 or more of the following (hamstrings, quad, GS complex, lateral retinaculum, ITB
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22
Q

Meniscus hx and MOI

A
  • twisting injury
  • pain worse with movement, better with rest
  • may complain of locking
  • joint line tenderness
  • acute effusion (within 2 hours)
  • acute: sudden onset in people <40
  • chronic: no specific MOI in people >50
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23
Q

good prognosis for meniscus

Study These Flashcards
A
  • age <35
  • peripheral damage
  • longitudinal tear
  • short tear
  • acute injury
  • stable knee
24
poor prognosis for meniscus
- older patient - central damage - complete tear - bucket handle tear - chronic injury - unstable knee
25
meniscus hallmark findings
- joint line tenderness: good SN - effusion: mild to mod over 1-2 days - positive entrapment test: mcMurray's, apley's, squat - quad inhibition: atrophy over first week or two following injury
26
microfractures for articular cartilage
- encourage blood flow - replaced with fibrocartilage (not the same as hyaline cartilage) - WB is controlled - not great for active people - good short term outcomes
27
ACI (autologous chondrocyte implantation
- small biopsy of autologous cartilage is harvested - cartilage is enzymatically digested in lab to release chondrocytes - chondrocytes cultured and implanted in second surgery
28
Osteochondral autograft transplantation system
- full thickness defects - remove plug from NWB surface - "press-fit" plugs implanted into lesion - need CPM if mosiac is done to smooth out surface
29
outcome measures for PFP
Lvl A: - AKPS - KOOS - visual analog scale - EPQ
30
exercise for PFP
LVL A - hip and knee targeted exercises - hip before knee in early stages
31
paterllar taping for PFP
LVL B - may use taping with exercise to reduce pain and enhance outcomes in short term
32
Bracing for PFP
LVL B - should not use orthoses for PFP
33
foot orthoses for PFP
LVL A - for patients with greater than normal pronation to reduce pain but only for short term - should be combined with exercise - no evidence on custom versus prefabricated
34
biofeedback for PHP
LVL B - should not use EMG based feedback for quad LVL B - should not use visual biofeedback for lower extremity alignment
35
running gait retraining PFP
LVL C - forefoot strike pattern - cueing to increase running cadence - cueing to reduce peak hip adduction while running
36
BFR + high rep knee exercise PFP
LVL F - may use for those with limiting painful resisted knee extension
37
needling PFP
LVL A - should not use TPDN LVL C - may use acupuncture
38
manual therapy PFP
LVL A - should not use manual therapy alone
39
biophysical agents PFP
LVL B - should not use biophysical agents (ultrasound, cryotherapy, phono/ionto, estim, laser)
40
patient education PFP
LVL F - may educate on load management, body weight, adherence to active treatments
41
combined interventions PFP
LVL A - should combine physical therapy interventions
42
Anteromedial rotary instability test
- slocum test (PMC)
43
anterolateral rotary instability tests
-jerk test of hughston - losee test - side-lying test of slocum - flexion rotation drawer test
44
posterolateral rotary instability tests
- dial test at 30 and 90 (prone external rotation test) - reverse pivot shift test - posterolateral drawer test - external rotation recurvartum test - posterolateral external rotation test
45
J sign
for patellar tracking
46
ottowa knee rules
- 55 years or older - isolated tenderness of patella - tenderness at head of fibula - inability to flex 90 degrees - inability to bear weight both immediately and in ED for 4 steps (unable to transfer weight twice onto each lower limb
47
CPM knee ligament sprain
LVL C - may use cpm immediately postop to decrease pain for ACL
48
early weightbearing knee ligament sprain
LVL C - may implement early weightbearing within 1 week for ACL
49
knee bracing knee ligament sprain
LVL C - may use functional knee bracing for ACL deficiency LVL D - should document patient preference in decision to use knee bracing following ACL reconstruction LVL F - may use appropriate knee bracing for acute PCL, severe MCL, or PLC injuries
50
immediate versus delayed mobilization knee ligament sprain
LVL B - should use mobilization within 1 week after ACL reconstruction to increase joint ROM, reduce joint pain, reduce risk of adverse responses of surrounding soft tissue structures
51
cryotherapy knee ligament sprain
LVL B - should use cryotherapy immediately following ACLR to reduce postop knee pain
52
supervised rehab knee ligament sprain
LVL B - should use exercises and proved and supervises HEP
53
therapeutic exercises knee ligament sprain
LVL A - WB and NWB concentric and eccentric should be implemented within 4-6 weeks, 2-3 times per week for 6-10 months
54
NMES knee ligament sprain
LVL A - should be used for 6-8 weeks following ACLR to augment muscle strength to enhance short term functional outcomes
55
neuro re-ed knee ligament sprain
LVL A - should be incorporated with muscle strengthening exercises in patients with knee stability and movement coordination impairments
56
risk factors for osgood schlatters
- male gender - male: 12-15 - female: 8-12 - sudden skeletal growth - repetitive activities like jumping and sprinting
57
osgood schlatters presentation
- anterior knee pain with or without swelling which can be bilateral or unilateral - starts as dull ache over tibial tubercle - insidious - improves with rest and subsides minutes to hours after stopping activity - worse with running, jumping, knee trauma, kneeling, squatting - enlarged prominence - poor flexibility of quad and hamstrings
58
treatment of osgood schlatters
- may last for 2 years until apophysis fuses - relative rest, activity modification - ice and NSAIDS for pain relief - can use knee pad to protect tibial tubercle - quad and hamstring stretching and strengthening

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