Knee

Question 1

Observation for the knee

Answer 1

• Gait analysis –> knee valgus or varus
• Squat –> depth

Question 2

AROM/PROM for knee

Answer 2

• Knee flexion (laying on stomach)
• Knee extension

Question 3

Strength Testing for knee

Answer 3

• Knee flexion (hamstrings)
• Knee extension (quad)

Question 4

Ligament stress tests for knee

Answer 4

• Posterior sag –> PCL
• Posterior drawer –> PCL
• Lachman test –> ACL
• Anterior drawer –> ACL
• Valgus stress test –> MCL
• Varus stress test –> LCL

Question 5

Posterior Sag

Answer 5

• Knee flexed 90 degrees
• Looking if PCL stays intact

Question 6

Posterior drawer

Answer 6

• Hip flexed 45 degress knee flexed 90 degrees
• Hands resting on the depression in the knee
• Push forward
• Observe posterior translation

Question 7

Lachman Test

Answer 7

• 30 degree flexion of knee
• Bring tibia into slight external rotation
• One hand on femur other hand below the knee
• Hand on femur pushes down while hand below the knee pulls up

Question 8

Anterior drawer test

Answer 8

• Hip flexed 45 degress knee flexed 90 degrees
• Hands resting on the depression in the knee
• Pull
• Observe anterior translation

Question 9

Valgus stress test

Answer 9

• 30 degree knee flexion
• One hand grabbing end of lower leg other hand grabbing femur
• External rotate the tibia
• Hand on lower leg outwards (laterally) while hand on knee is inwards (medially)
• Observe for laxity for MCL

Question 10

Varus stress test

Answer 10

• 30 degree knee flexion
• One hand grabbing end of lower leg other hand grabbing femur
• External rotate the tibia
• Lower leg is pulled (medially) while knee is outwards (laterally)
• Observe for laxity for LCL

Question 11

Special test for the knee

Answer 11

• Intracapsular swelling test
• McMurray’s test for meniscus
• Apley’s compression test for meniscus
• Lateral patellar glide
• Patellar grind
• VMO contraction

Question 12

Intracapsular swelling test

Answer 12

• Patellar compression –> push down on the top of patellar
• Swipe Test –> swipe up on medial side, down on lateral side

Question 13

McMurray test

Answer 13

• Knee flexed 90 degrees
• One arm on lower leg, other one femur
• Internally rotate knee for lateral meniscus, externally rotate knee for medial meniscus
• Bring knee to flexion and extension

Question 14

Apley’s compression test

Answer 14

• Lay on stomach with knee flexed 90 degrees
• One hand on heel other hand on ankle
• Push down on leg while turning
• Internal rotation of knee for lateral meniscus, external rotation of knee for medial meniscus

Question 15

Lateral patellar glide

Answer 15

• Stand on opposite side of knee
• Use both hands to apply a lateral force to patella
• Examine for laxity

Question 16

Patellar grind test

Answer 16

• Press down on the top of the patella
• Patient contracts quadriceps
• Observe for pain, clicking or grinding

Question 17

VMO contraction

Answer 17

• Have patient contract quad
• Observe if contraction is weak or absent

Question 18

Palpation for knee

Answer 18

• Medial meniscus
• Lateral meniscus
• MCL
• LCL
• Medial retinaculum
• Underside of patella

Question 19

Injuries for the knee

Answer 19

• ACL sprain
• PCL sprain
• MCL sprain
• LCL sprain
• Meniscus tears
• Patellar dislocation
• Patellofemoral Pain Syndrome

Question 20

History for ACL sprain

Answer 20

• Impact from the lateral side
• Athlete will report a pop
• Knee buckles into valgus
• Sometimes pain sometimes no pain
• Instability

Question 21

Assessment for ACL sprain

Answer 21

• Laxity or pain with anterior drawer and Lachman
• Positive swipe test
• Positive patellar compression test for swelling
• Restricted knee flexion and extension

Question 22

Treatment for ACL sprain

Answer 22

• POLICE
• Strengthening specific to hamstring –> hamstring curl bodyweight then machine
• Bracing
• Possible surgery if ACL ruptured

Question 23

History for PCL sprain

Answer 23

• Impact with dashboard in car accident
• Falling on another athlete
• Tibia translating posteriorly
• Direct impact, may report pop

Question 24

Assessment for PCL sprain

Answer 24

• Positive posterior sag
• Laxity with posterior drawer test
• Positive intracapsular swelling tests
• Possible limitation into knee flexion and extension

Question 25

Treatment for PCL sprain

Answer 25

- POLICE - Strengthening specific to quad --> step ups on an elevated platform, body weight then can carry weighted items - Bracing - No surgery

Question 26

History for MCL sprain

Answer 26

- Lateral impact from side - Reports a pop - Valgus force applied to knee

Question 27

Assessment for MCL sprain

Answer 27

- Swelling - Laxity with either or both valgus stress - Limited ROM KF/KE - Pain over MCL

Question 28

Treatment for MCL sprain

Answer 28

- Avoid valgus forces during daily activities - ROM exercises --> heel slides - Deep transverse friction massage - Brace - Surgery very rare

Question 29

History for LCL sprain

Answer 29

- Impact from medial side - Might report pop - Varus force applied - Often from a fall, not common injury

Question 30

Assessment for LCL sprain

Answer 30

- Swelling - Laxity with either or both varus stress tests - Limited ROM KF/KE - Pain over LCL

Question 31

Treatment for LCL sprain

Answer 31

- Avoid varus forces during daily activities - ROM exercises --> heel slides - Deep transverse friction massage - Brace - Surgery very rare

Question 32

History for meniscus tears

Answer 32

- Planted foot with rotary force - Clicking, popping - Present as chronic in older athletes - Knee can feel unstable

Question 33

Assessment for meniscus tears

Answer 33

- Positive apley's and mcmurray's test - Internal rotation stresses later meniscus - External rotation stresses medial meniscus - Positive intra-capsular swelling - Pain over medial or later joint line

Question 34

Treatment for meniscus tears

Answer 34

- POLICE - AROM --> heel slide - Strengthening exercises --> step ups on an elevated platform, body weight then can carry, hamstring curl bodyweight then machine - Possible surgery

Question 35

History for patellar dislocation/subluxation

Answer 35

- Dislocation --> kneecap completely comes out of groove - Subluxation --> patellae slipped out of groove - Patellae dislocates almost exclusively laterally - Can be impact or non-contact - Extremely painful

Question 36

Assessment for patellar dislocation/subluxation

Answer 36

- Limited ROM KF/KE - Weakness KE - Swelling - Positive lateral apprehension test - Pain over medial retinaculum

Question 37

Treatment for patellar dislocation/subluxation

Answer 37

- If dislocated immobilize, don't move athlete call 911 - Strengthen quads --> Lie on back and extend knee and raise affected leg while keeping leg straight - Use a brace - Restore squat pattern

Question 38

History for Patellofemoral Pain Syndrome

Answer 38

- Chronic injury - Repetitive KF/KE - Common in running - Pain behind knee cap - Pain worse with sitting knee bent or exercising - Getting progressively worse

Question 39

Assessment for Patellofemoral Pain Syndrome

Answer 39

- Poor squat pattern - VMO contraction test positive - Positive patellofemoral grind test - Pain over dorsal patellae

Question 40

Treatment for Patellofemoral Pain Syndrome

Answer 40

- Rest, ice - Biomechanical correction - Squat pattern education - Patellar taping or strap - Stretch and strengthen quads --> straight leg raises, hip flexors --> high kicks , hip abductors --> open the gate