Knee

Question 1

ACL Sprain

Answer 1

-tear of ACL (85% of resistting ant. translation)
-females more likely
-athletic ppl

S/S: pop or tearing sensation, pain, knee giving out

Cause: violent twist w/o contact, joint laxity, large q angle, weak hamstrings

Better: elevation

Worse: walking, pivoting, stairs, cutting

Treatment:
Surgery: Hamstring, quad, gastroc, patellar tendon grafts
-1-2 years
-necrosis, revascularization, cellerular proliferation, collagen formation

PT:
Stage 1: Inflammatory 0-14d
-ROM, inflammation

Stage 2: Reparative 15-21d
-ROM, full extension, swelling, flexibility, walking

Stage 3: Remodeling 22-60 60-360d
-pain free ROM, no limitations, return to sport

Question 2

MCL Sprain

Answer 2

-tearing of MCL by valgus force at femoral attachment
-combined wiith ACL and med meniscus
-most common lig injury
-well vascularized

S/S: tearing sensation, medial knee brusing, instability

Cause: valgua stress, non contact decceleratioono andc utting

Better: elevation

Worse: running, extension of knee, downhill

Treatment:
-Surgery: rare due to vascularity, bracing instead

-PT:
Phase 1: Acute inflammatory 0-14d
- ROM, protect joint

Phase 2: Reparative 15-21d
-ROM, full extension

Phase 3: Remodeling 22-60 60-360
-pain free ROM, no limitations, return to sport

Question 3

LCL Sprain

Answer 3

-tearing of LCL by varus force at fibular attachment
-combined wiith fibular n, PCL
-least common knee lig injury

S/S: pop sensation, lateral knee pain, instability

Cause: varus stress, add flx and ER

Better: elevation

Worse: running, extension of knee, uneven ground

Treatment:
-Surgery: rare due to vascularity, bracing instead

-PT:
Phase 1: Acute inflammatory 0-14d
- ROM, protect joint

Phase 2: Reparative 15-21d
-ROM, full extension

Phase 3: Remodeling 22-60 60-360
-pain free ROM, no limitations, return to sport

Question 4

Meniscal Injury

Answer 4

-tearing of meniscus by arthroscopy
-often with ACL
-Medial more common (less mobile)
-Longitudinal tear MC
-Bucket Handle Tear with ACL
-Radial Tear with trauma
-Horizonatal with OA

S/S: popping, clicking, giving away, joint line tenderness

Cause: degeneration, trauma (compressive twisting)

Better: non weight bearing

Worse: weightbearing

Treatment:
-Surgery:
-younger or older and physically active
Meniscectomy: avsacular region
Repair: vascular region

-PT:
-ROM, LE strength, limit compressive forces

Question 5

Patellofemoral Pain Syndrome

Answer 5

-pain around or behind patella
-most common knee injury

S/S: pain during flexion and extension behind or around knee, swelling, pain with activity

Cause: overuse with force at patellofemoral, hip/foot/knee issues

Better: avoidance of knee flexion

Worse: prolonged sitting, running, walking

Treatment:
-PT: contributing factors, avoid flexion based things, avoid last 30 of extension

Question 6

Patellar Tendinopathy

Answer 6

-Tendinitis: acute inflammation of the patella
-Tendinosis: chronic degeneration
-low metabolic rate

S/S: localized pain around patellar tendon, swelling, pain with activity, no referral

Cause: overuse activity (3-8%) of load applied, repetitive jumping and running, eccentric

Better: rest, bracing

Worse: squatting, running, squatting

Treatment:
-PT: correction of other factors, activity mod, flexibility, abnormalities
-Surgery: if PT fails after 6mon

Question 7

Patellar Dislocation/Subluxation

Answer 7

-no contact btwn patella and trochlear groove
-usually young

S/S: pain during flexion and extension behind or around knee, swelling, pain with activity

Cause: trauma, non contact IR and valgus stress

Better: inactivity

Worse: jumping, running, quick stops

Treatment:
-PT: bracing, quad strength, footwear
-Surgery: recommended for recurrent dis/sub