Knee

Question 1

Patellofemoral joint reaction force is influenced by two things

Answer 1

Quadriceps force & knee angle

Question 2

During knee flexion and extension, the patella is pulled superiorly by ___________ and inferiorly by ____________

Answer 2

Quadriceps tendon / patellar tendon

Question 3

Combination of quadriceps tendon and patellar tendon pulls produces __________ of patella on femur, it varies with knee flexion.

Answer 3

Posterior compressive force

Question 4

In extension, there is small contact area between patella and femur, minimal posterior compressive vectors of __________ and ___________ muscles maintains low joint stress.

Answer 4

Vastus medialis and Vastus lateralis

Question 5

The frontal plane patellofemoral joint stability is unique in its potential for

Answer 5

• frontal plane instability near full extension
• degenerative changes resulting from PFJ stress

Question 6

What are the longitudinal stabilizers of the knee, providing medial & lateral stability of patella during flexion

Answer 6

• quadriceps tendon
• patellar tendon
• patellotibial ligament
• capsule

Question 7

What are the transverse stabilizers of the knee

Answer 7

• superficial portion of extensor retinaculum
• medial and lateral patellofemoral ligament
• large lateral lip of femoral sulcus

Question 8

The medial and lateral patellofemoral ligament attach the patella to the _________ medially and _______ laterally.

Answer 8

Adductor tubercle / IT band

Question 9

An umbrella term used for pain arising from the patellofemoral joint itself or adjacent soft tissue

Answer 9

Patellofemoral pain syndrome

Question 10

Patellofemoral pain syndrome causes posterior knee pain which could be misleading because the pain can be felt in all aspects of the knee including the popliteal fossa. True or false

Answer 10

False, anterior knee pain

Question 11

What are synonyms to PFPS

Answer 11

Patellofemoral joint pain & anterior knee pain

Question 12

What are the muscular etiologies of PFPS

Answer 12

• quadriceps weakness
• hamstring tightness
• calf muscles tightness
• hip muscle weakness or tightness
• tight IT band

Question 13

What are remote factors of PFPS

Answer 13

• femoral internal rotation
• knee valgus
• tibial rotation
• subtalar pronation
• muscle strength & inflexibility

Question 14

What are local factors to PFPS

Answer 14

• patella position
• soft tissue tension
• neuromuscular components of medial and lateral vasti

Question 15

What are other diagnosis that may be used for pain at or around the kneecap

Answer 15

• chondromalacia patallae
• patellar tendonitis
• fat pad irritation

Question 16

Symptoms of chondromalacia patella occur after prolonged 90 degrees of knee flexion sitting position or are aggravated by activity, what are examples of these symptoms

Answer 16

• crepitation
• sense of tightness or “fullness” in knee area
• quadriceps muscle strength may cause the leg to “give out”
• mild swelling

Question 17

Actual fraying and damage to the underlying patellar cartilage is called

Answer 17

Chondromalacia patella

Question 18

also known as jumpers knee, most common in athletes who’s sport involves frequent jumping such as basketball and volleyball, however even people who don’t participate in jumping sports can get it, what is it ?

Answer 18

Patellar tendinitis

Question 19

What is the main symptom of patellar tendinitis and when can it be felt most

Answer 19

Pain (usually between kneecap and tibial tuberosity) / climbing stairs or rising from a chair

Question 20

How do we prevent patellar tendinitis

Answer 20

• don’t play through pain
• strengthen your muscles (eccentric exercises)
• improve your technique

Question 21

What are other names used for fat pad irritation

Answer 21

Hoffa’s syndrome & fat pad impingement

Question 22

Examination test to assess for medial patellar glide, performed in 30 degrees knee flexion, this assesses for what ?

Answer 22

Limitation of mobility in the superficial lateral patellar retinaculum

Question 23

Examination test to assess for superior patellar glide, performed in 30 degrees knee flexion, this assesses for what ?

Answer 23

Limitation of mobility of the inferior patellar tendon and soft tissue structures

Question 24

Examination test to assess for inferior patellar glide, performed in 30 degrees knee flexion, this assesses for what ?

Answer 24

Limitation of mobility of the quadriceps tendon and other quadriceps muscles

Question 25

The moving patellar apprehension test is done with patient supine, the clinician translates patella laterally while moving from extended to flexed position, how do we indicate if it’s a positive test ?

Answer 25

A positive test is indicated by symptoms of instability with the test

Question 26

Examination test to determine patellar tilt for assessment of what ?

Answer 26

Deep patellar retinacular fibers

Question 27

Test for tightness of deep lateral structures is done by attempting to tilt in a medial direction, inability to obtain a neutral position indicates what ?

Answer 27

Tightness of deep lateral structures

Question 28

What are common interventions used for treatment of PFPS

Answer 28

- manual therapy - open vs. closed chain exercises - quadriceps strengthening - patellar taping (kinesio-McConnel) - orthotics - proximal muscle strengthening - modalities

Question 29

when the knee is bent at 30 degrees, just as your foot strikes the ground in running , this region of 30 degrees of knee flexion is called

Answer 29

impingement zone

Question 30

repetitive sliding can create excess friction especially when the knee is bent at 30 degrees, it is the pinching of irritated structures over the outside of the knee, thereby producing

Answer 30

ITB friction syndrome

Question 31

joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow, this bone and cartilage break loose causing pain and possibly hindering joint motion, this is called

Answer 31

osteochondritis dissecans

Question 32

children and adolescents between the ages of _________ who are highly active in sports may be at risk of getting osteochondritis dissecans

Answer 32

10 and 20

Question 33

when a child is active, the quadriceps muscles pull on the patellar tendon which in turn pull on the tibial tubercle, in some children this repetitive traction on the tubercle leads to inflammation of the growth plate and the tibial tubercle may become very pronounced, this is called

Answer 33

osgood-schlatter disease

Question 34

causes of ACL injury

Answer 34

- cutting (rotation) - hyperextension (straight knee landing)

Question 35

what can be associated with ACL injury

Answer 35

- articular cartilage injuries - associated meniscal injury - knee OA

Question 36

unhappy triad consists of

Answer 36

- ACL - medial collateral ligament - medial meniscus

Question 37

what are tests that we can perform to check the ACL

Answer 37

lachman and anterior drawer tests

Question 38

normal knees have a 10mm anterior translation and a soft end point, true or false

Answer 38

False / 4mm & solid end point

Question 39

in the lachman test, we apply a gentle anterior force to the tibia. A translation of more than 4mm (increased translation) and no solid or firm end point (soft end point) indicates an ACL injury. True or false

Answer 39

true

Question 40

what is an example of ACL reconstruction

Answer 40

graft harvest of patellar tendon / hamstring tendon

Question 41

Rehabilitation after ACL reconstruction includes

Answer 41

- PT before surgery (ROM & inflammation) - early WB-ROM to full passive ROM - early quadriceps and hamstring activity - swelling and pain - closed chain to open chain -LE strengthening and stretching -perturbation training (neuromuscular and proprioception)

Question 42

weight bearing protocols in first 2 weeks after ACL reconstruction surgery

Answer 42

- initially brace is locked and crutches are used - may walk without crutches if no pain or effusion - may unlock brace once able to perform SLR without lag - may discontinue use of brace at 6 weeks once adequate quad control is achieved

Question 43

allograft and hamstring autograft continue PWB with crutches for _______ unless instructed otherwise, immediately post ACL op

Answer 43

6 weeks

Question 44

we can use retrograde massage and ankle pumps for swelling management in ACL immediate post op phase, true or false

Answer 44

true

Question 45

criteria for entrance into the return to sport phase include

Answer 45

- min international knee documentation (IKDC) subjective knee score:70 - no post op history or negative pivot shift - minimum baseline strength

Question 46

minimum baseline strength for entrance into the return to sport phase after ACL reconstruction surgery

Answer 46

knee extension peak torque / body mass 300 degrees: 40% M / 30% F 180 degrees: 60% M / 50% F

Question 47

if a PCL injury results in an avulsion fracture, surgery is needed to reattach the ligament, knee function after this surgery is often quite good. True or False

Answer 47

True

Question 48

stage 1 and 2 of medial collateral ligament injuries require stabilization in varus or valgus position, and for how long is conservative management done ?

Answer 48

valgus position / 2-6 weeks

Question 49

for lateral collateral ligament injuries, first _____ weeks are restricted weight bearing

Answer 49

4 weeks

Question 50

what are causes of meniscus tears

Answer 50

- twisting or turning quickly - lifting something heavy or playing sports - age