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NPTE > Knee > Flashcards

Knee Flashcards

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1
Q

Patellar & Quad Tendinopathy: MOI & risks

A

-Change in training load.
-Inadequate recovery btwn training.
-Improper shoes or surface.
-Quad/Ham tightness.

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2
Q

Patellar & Quad Tendinopathy: presentation

A

Pain at inferior (patellar) or superior (quad) pole of patella.
Gradual onset.
Agg: increased load.

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3
Q

Patellar & Quad Tendon Rupture: MOI & risks

A

High tensile force on a weak tendon.
Sudden quad contraction on a flexed knee.
Patellar usually sport.
Quad usually fall.

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4
Q

Patellar & Quad Tendon Rupture: presentation

A

Unable to extend.
Acute onset.
Palpable gap.

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5
Q

Patellar & Quad Tendon Rupture: post-op treatment

A

Progress knee flexion slowly.
Focus on quad function (risk of long-term quad weakness or inability to contract).

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6
Q

Ligaments associated with medial stability

A

MCL
Posterior Oblique

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7
Q

Ligaments associated with lateral stability

A

LCL
Arcuate

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8
Q

Ligaments associated with anterior stability

A

ACL

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9
Q

Ligaments associated with posterior stability

A

PCL

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10
Q

Ligaments associated with patellofemoral stability

A

MPFL

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11
Q

Grade 1 Ligament Sprain

A

Mild, a few fibers torn.
Integrity maintained.
Pain w/ stretch.
Solid end feel.

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12
Q

Grade 2 Ligament Sprain

A

Moderate, half fibers torn.
Integrity partially lost.
Pain w/ stretch.
Mushy end feel.

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13
Q

Grade 3 Ligament Sprain

A

Severe, complete tear.
No pain.
Empty end feel.
Excessive joint movement.

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14
Q

ACL: MOI

A

Hyperextension + valgus on planted foot

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15
Q

PCL: MOI

A

Hyperflexion (dashboard MVC)

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16
Q

MCL: MOI

A

Valgus on planted leg

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17
Q

LCL: MOI

A

Varus on planted leg

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18
Q

ACL: key sxs

A

Loud pop heard/felt.
Instability w/ stair descend.

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19
Q

PCL: key sxs

A

Mild pop heard/felt.
Instability.
P! with decelerating.

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20
Q

MCL: key sxs & special tests

A

Tenderness over MCL.
(+) Valgus Stress Test.

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21
Q

LCL: key sxs & special tests

A

Tenderness over LCL.
(+) Varus Stress Test.

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22
Q

Anterior Drawer Test

A

ACL instability.
(+) excessive anterior translation.

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23
Q

Lachman’s Test

A

ACL instability.
Knee 20-30 flex.
Stabilize femur laterally.
Move tibia anteriorly (grip medial).
(+) excessive translation.

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24
Q

Posterior Drawer Test

A

PCL instability.
Anterior Drawer procedure, but pushing tibia posteriorly.
(+) excessive posteriior translatoin.

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25
Posterior Sag Test
PCL instability. Observe joint line for posterior sag with knee at 90 flex.
26
ACL: post-op timeline
4-6mo for functional. 9-12mo for return to sport.
27
ACL: return to sport criteria
>90% quad symmetry. >90% SL hop symmetry.
28
ACL: treatment focus
Quad strength! OKC knee ext good bc isolates quads. CKC too early may lead to compensations with other mm.
29
PCL: when is reconstruction indicated?
Grade 3. Most others do well non-op.
30
PCL: potential complication if instability persists?
Meniscus tears
31
MCL: treatment focus
Quad activity. Stabilization (bracing, exercises). Medial immobilization for grades 2-3.
32
MCL: when is reconstruction indicated?
Rarely; good blood supply so usually heals w/ conservative.
33
LCL: when is reconstruction indicated?
Grade 3 + avulsion. Grade 3 midsubstance tear.
34
Common combined ligament injuries
1. Posterolateral Corner: LCL + Popliteus tendon + Popliteo-fibular ligament. 2. Posterolateral Corner + ACL or PCL. 3. ACL + MCL. 4. Unhappy Triad: ACL + MCL + Med Meniscus.
35
Grade 1 Muscle Strain
Pain = none or mild. ROM deficit = mild.
36
Grade 2 Muscle Strain
Pain = moderate. ROM deficit = moderate.
37
Grade 3 Muscle Strain
Pain = none (if complete rupture) or severe. ROM deficit = severe. Palpable defect.
38
HS Strain: MOIs for mid-substance & proximal
Mid-Substance: high speed running, strong eccentric contraction @ terminal swing. Proximal: high hip flex with knee ext (high kick).
39
HS Strain (Mid-Substance): key sxs
Pain: moderate SLR: 40% decreased compared to good side. Knee flex strength: 60% decreased compared to good side.
40
HS Strain (Proximal): key sxs
Pain: minor. SLR: 20% decreased compared to good side. Knee flex strength: 20% decreased compared to good side.
41
HS Strain (Mid-Substance): which muscle typically involved?
Biceps Femoris
42
HS Strain (Proximal): which muscle typically involved?
Semimembranosus tendon
43
Prevention of HS strains
Eccentrics!
44
Meniscus Tear: which is more common in different populations?
Degeneration (older) = medial. Traumatic = either.
45
Meniscus Tear (traumatic): MOI
Medial: valgus, tibial lateral rotation. Lateral: varus, tibial medial rotation.
46
Meniscus Tear: key sxs & presentation
Joint line tenderness. P! with passive max knee flex. P! with hyperext. Delayed swelling (6-24hr post-injury).
47
Meniscus Tear: special tests
-McMurray -Thessaly -Ege -Apley Compression/ Distraction
48
McMurray Test: procedure, purpose, (+)
Meniscus. Max knee flex, then ER/IR. (+) P! w/ ER = medial. (+) P! w/ IR = lateral.
49
Thessaly Test: procedure, purpose, (+)
Meniscus. Twist side to side with knee at 5deg flex, then again at 20 flex. (+) more P! at 20deg; catching, locking.
50
Ege Test: procedure, purpose, (+)
Medial Meniscus: hips ER (feet out), squat then stand. Lateral Meniscus: hips IR (knock-knee position), squat then stand. (+) = P! and clicking.
51
Apley Compression/ Distraction Test: procedure, purpose, (+)
Meniscus. Prone, knee 90 flex. 1. Axial force thru foot while ER/IR. 2. Distract while ER/IR. (+) = P! with compression & relief w/ distraction.
52
Osgood Schlatter: definition & MOI/risks
-apophysis of tibial tub -repetitive loading (running, jumping) in adolescence -male>female
53
Osgood Schlatter: key sxs
-Tender tibial tub. -P! with quad activation. -Agg: squat. -Tight quads, HS, gastroc.
54
Osteochondritis Dessicans: definition & common location
Bone & cartilage detach from underlying bone d/t lack of blood flow. Bone & cartilage fragments float in joint space. Medial epicondyle most common.
55
Osteochondritis Dessicans: treatment
Surgical removal of loose bodies. Focus of post-op PT: muscle recruitment & gradually progress WB.
56
PF Instability: definition
patella subluxes or dislocates out of trochlear groove
57
PF Instability: MOI & risks
-Patella alta -Trochlea shallow/flat -Insufficient medial stabilizers (MPFL & VMO). -Tight lateral retinaculum. -Traumatic MOI = forceful quad contraction.
58
PF Instability: treatment & considerations
Taping, strengthening mm. Recurrence high. Risk of PF OA.
59
Apprehension Test: procedure, purpose, (+)
Patellar subluxation or dislocation. Knee slightly flexed, apply force medial to lateral on patella. (+) = apprehension, palpable subluxation or dislocation.
60
PFPS: key sxs
-Anterior knee P! -Lateral patella tracking. -Movie Goer's Sign (agg by prolonged sitting). -P! with end-range flexion. (+) Clarke's Test (+) Step Down Test (+) Patellar Apprehension Test
61
Clarke's Test: procedure, purpose, (+)
PFPS Place web-space over superior patella, apply pressure downward + inferiorly. Pt contracts quads. (+) = P!
62
Step Down Test: procedure, purpose, (+), and variations
PFPS Step down (mimics stair descend). Variations: lateral step down, decline step down. (+) = P!
63
Patellar Apprehension Test: procedure, purpose, (+)
PFPS Medial to lateral glide over patella. (+) = P! and excessive lateral displacement.
64
Tibiofemoral Arthrokinematics (open chain)
Concave tibia moving on fixed femur. Flex = tib roll & glide posteriorly. Ext = tib roll & glide anteriorly.
65
Tibiofemoral Arthrokinematics (closed chain)
Convex femur moving on tibia. Flex = posterior roll, anterior glide. Ext = anterior roll, posterior glide.
66
Screw Home mechanism
Describes rotation at end range extension. Lateral side of tibial plateau smaller, so stops first. Open Chain: tibial ER. Closed Chain: femoral IR.
67
Tibial Posterior Glide: procedure & promotes what motion?
Flexion. Push posteriorly while pt digs heel into table. *Variation = add angulation (slightly ER or IR tibia). -ER = relief laterally. -IR = relief medially.
68
Tibial Anterior Glide: procedure & promotes what motion?
Extension. Slightly IR femur & ER tibia. Posterior glide to femur + anterior glide to tibia.
69
Patella Superior & Inferior Glides: promote what motions?
Superior = ext. Inferior = flex.

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