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Knee Flashcards

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1
Q

What is the largest joint in the body?

A

Tibiofemoral joint

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2
Q

Which tibial plateau has a greater surface area? Which is thicker? Why?

A

Medial has a greater surface area and is 3x thicker

WBing!!

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3
Q

Pittsburgh knee rules:

A

MOI = fall, blunt trauma

Either one of the following:
Age: <12, >50 years old
Inabilty to take 4 WB steps

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4
Q

Ottawa knee rules

A

Radiographs appropriate if 1 of the following is present:
Age >55 years
Isolated patellar tenderness
Tenderness of the fibular head
Inability to flex the knee to 90
Inability to WB immediately post injury

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5
Q

3 outcome measure for the knee

A

KOOS
WOMAC
LEFS

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6
Q

This special test is known as the “grandfather” of meniscus tests

A

McMurray test

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7
Q

Identify three special tests for meniscal pathology:

A

McMurray test
Apley’s compression/distraction
Thessaly’s test

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8
Q

If there’s swelling at the knee, can you test for an ACL pathology?

A

Probably won’t. Either test on the field right away, or after swelling has gone down.

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9
Q

Identify two main ACL special tests:

A

Anterior drawer
Lachman’s

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10
Q

The Noble Compression Test is used to assess what?

A

ITB syndrome.

Careful: no established psychometrics

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11
Q

Term: Describes a spectrum of knee conditions in which loss of motion is a major finding.

A

Arthrofibrosis

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12
Q

Three interventions for arthofibrosis:

A

ROM exercises
Joint mobilizations
Manipulation under anesthesia (MUA)

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13
Q

VARUS/VALGUS deformity is common with OA at the knee.

A

Varus

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14
Q

Grade 1 and 2 ligamentous sprain conservative management:

5 things

A
  • PRICE
  • Decreased WB
  • Short term mobilization
  • Strengthening and proprioception
  • Gradual return to activity
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15
Q

What is the most studied musculoskeletal pathology?

A

ACL pathology

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16
Q

4 intrinsic factors for ACL injury:

A
  • Narrow intercondylar notch
  • Weak ACL
  • Generalized laxity
  • LE malignment
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17
Q

4 extrinsic factors for injury:

A
  • Quad and hamstring imbalances
  • Limb symmetry
  • Altered neuromuscular control
  • Playing surface
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18
Q

5 MOIs for ACL injury:

A
  • Sudden deceleration of foot
  • Quad-hamstring strength imbalance
  • Valgus force
  • Twisting with fixed distal segment
  • Extreme hyperflexion or hyperextension
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19
Q

What structures are included in the unhappy triad?

A

MCL+ACL+Medial meniscus

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20
Q

6 Key exam findings for ACL pathology:

A
  • Significant effusion
  • Feeling of “giving way”
  • Pain with WB/altered gait
  • Loss of quad function
  • Decreased A/PROM
  • (+) ant drawer, lachman’s
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21
Q

5 things to “pre-hab” the ACL before surgery

A
  • Decrease pain, edema w/ modalities
  • Hamstring strengthening
  • Re-engage quads as much as possible
  • Increase ROM
  • Gait training with AD if needed
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22
Q

What are the implications of a hamstring graft?

A

Delayed knee flexion post-op

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23
Q

5 general steps for ACL rehab:

A
  • Know graft type
  • Initial mangement
  • Strengthening
  • Perturbation training
  • Visual re-training
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24
Q

Phase 1 of ACL rehab timeframe

A

0-4 weeks

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25
Phase 2 ACL rehab timeframe
5-12 weeks
26
Phase 3 ACL rehab timeframe
12 weeks-1 year
27
Phase 1 ACL rehab | 5
* Pain management * Education * HEP (quad activation focus) * WBAT * ROM
28
Phase 2 ACL rehab | 3
Neuromuscular retraining approaching full ROM CKC progressions
29
Phase 3 ACL rehab | 4
* Return to function * Caution: 3-4 mo. Pt will want to do more, but graft is at it's weakest point! * CKC and OKC * WB -> walk -> run
30
Criteria needed to run post ACLR: | 7
* Pain <2/10 * Knee flexion A/PROM 95% of uninvolved * Full active knee extension * Joint effusion resolved * Quad/HS isometric strength = 70% uninvolved * Single leg hop tests = 70% uninvolved * Single leg squat/step up without knee valgus increase Need ALL to return to run
31
5 return to sport tests for ACL rehab:
* Single leg hop * Single leg vertical jump * Triple hop * Cross-over hop * Vail sports test
32
Limb symmetry index
Affected limb value/unaffected limb value x 100 = LSI
33
The Vail Sports Test consists of these 4 components:
* Single leg squat for 3 minutes * Lateral bounding for 90 seconds * Forward jogging for 2 minutes * Backward jogging for 2 minutes
34
Poor ____ strength symmetry is correlated with ris kof reinjury to ACL.
Quadriceps
35
3 main takeaways for return to sports after an ACL tear:
* Symmetry and strength * Both limbs need to be trained * Return to sports criteria completed (objective tests MUST be performed)
36
T/F PCL tears can be caused by micro or macro trauma.
False! Only macrotrauma due to strength.
37
ISOLATED/COMBINED injuries are more common in PCL.
Combined
38
3 signs of PCL tear
* Pain in posterior aspect of knee * Pain worse with kneeling * Minimal pain with extension, worse past 90 deg of flexion.
39
PCL rehab before/without surgery | 4 items
* Quad strengthening - main point * Control pain, edema * Increase ROM * Gait training if needed
40
2 MOIs for PCL tear:
* Blow to tibial tubercle * Contact or non-contact hyperextionsion injury
41
4 guidelines for post PCL reconstruction
* Brace * Assistive device * Early closed chain and isometric quads * NO resisted hamstring exercises
42
How long do you wait to do resisted hamstring exercises post PCL reconstruction?
~8 weeks post op
43
3 exam signs for MCL/LCL pathology:
* Pain with A/PROM testing * (+) varus / valgus testing * Possible pain with WBing
44
3 potential complications of knee dislocation:
* Structures that cross the knee at risk * Popliteal artery rupture or contusion * Common fibular nerve stretch
45
Conservative management of a knee dislocation: | 2 items
* Long cast in slight flexion * Knee rehab
46
Functional test for ruling out meniscus tear:
Squat
47
Total menisectomy leads to....
Early degenerative changes
48
Menisectomy management guidelines: | 5 items
* Control pain and edema * Increase ROM * NM strengthening * Gait training * Proprioception
49
Goals of the menisectomy subacute phase: | 3 items
* Increase to pre-op ROM * Normal gait * Increase strength
50
5 exercises for menisectomy acute phase:
* Bike * Isometrics * SLR * Knee ext and flex (pain free arc) * Hamstring and calf stretches
51
2 exercises for menisectomy subacute phase:
* Squats * lunges (pref reverse)
52
Don't forget to address these structures in menisectomy rehab!!
Hip and ankle (Above and below)
53
T/F PFPS patients will likely have a mal-tracking patella
False. They could, but not necessarily
54
2 factors that could predispose someone to a lateral tracking patella
* Increased Q-angle * Lateral tibial torsion
55
Most important interventions for PFPS: | 3 items
* Quad strengthening * Hip ER/ABD training * Neuromotor re-training
56
When managing PFPS what other 2 structures should be looked at?
Hip and ankle
57
What does McConnell taping address?
Lateral glide of the patella
58
MOI for patellar dislocation
Abduction/external rotation injury
59
Management of a patellar dislocation | 3 items
* Closed reduction * Immobilization in long leg cast in extension * Recurrent dislocations - lateral release, repair VMO and joint capsule.
60
Two causes of patellar tendinopathy:
* Overuse * Overload (increase in intensity)
61
4 signs of patellar tendinopathy:
* Inflammation * Decreased open chain AROM extension * Resisted static contraction of quads is painful * Squat painful
62
Name each stage of patellar tendinopathy rehab:
1. Load 2. Move 3. Bounce 4. Hop and bound
63
Adipose tissue is HIGHLY/MINIMALLY innervated at the knee
Highly
64
What sex is ITBS more predominant in?
Males
65
2 MOI for superficial and deep infrapatellar knee bursitis
* Kneeling * Direct trauma
66
# Identify: Pain and swelling on palpation of the prepatellar bursa
Prepatellar bursitis "housemaid's knee"
67
# Identify: Medial knee pain just distal to joint line Tibia may externally rotate compared with uninvolved side
Superficial pes anserinus bursitis
68
5 components of knee bursitis treatment:
* Removal of the irritation * Stretching adaptively shortened structures * Joint mobilizations as needed to correct alignment * Anti-inflammatory meds * Cryotherapy
69
3 potential causes of Hoffa's syndrome:
* Impingement between femoral condyles and tibial plateau during knee extension * Direct trauma or overuse causing irritation * Posterior tilt of the inferior pole of the patella
70
Diagnostic test for Hoffa's
Bounce test: pain elicited with passive knee hyperextension
71
2 treatment approaches for Hoffa's
* Active approach: Shift load away from anterior knee; modify WB * Passive approach: rest, ice, NSAIDs, local corticosteroid injection to fat pad
72
Red flag associated with direct blow to muscle, usually the quads.
Myositis ossificans
73
# Identify: Condition where bone tissue forms within the muscle
Myositis Ossificans
74
# Define: Genu Varum
Knees >6 cm apart with malleoli together
75
# Define: Genu Valgum
Malleoli >10 cm apart with knees together
76
Normal developmental course of knee position
* Birth to 18 months - increased varus * 18 months to 3-4 years - develop genu valgus * By age 8-10 - corrected to normal adult alignment
77
# Define: Genu Recurvatum
>5 degrees hyperextension at the knee
78
3 underlying diseases that may cause Genu recurvatum
* RA * Polio * Charcot's disease
79
# Identify: Joints without pain sense or proprioception
Charcot's disease
80
Internal tibial torsion is NORMAL/ABNORMAL in infants
Normal
81
Excessive INTERNAL/EXTERNAL torsion can lead to patellar tracking problems.
External
82
# Identify: Compression, fragmentation, or separation of a small fragment of bone
Osteochondritis
83
Osteochondritis commonly occurs in what demographic?
Childhood or adolescence
84
3 types of Osteochondritis:
* Crushing - compressive * Splitting - osteochondritis dessicans * Pulling - traction apophysitis
85
Osteochondritis dessicans (splitting) often occurs at which locations? | 2 Items
* Talus * Femoral condyle
86
Management of Osgood-Schlatter's disease | 5 items
* Rest * Decreased WB * Quad stretching (if tight) * Possible casting 2-4 weeks * Usually resolves on own
87
3 S/Sx of osteochondritis dissecans:
* Initially intermittent aching and swelling * Episodic catching or locking * Atalgic gait
88
What condition does osteochondritis dissecans present similarly to?
Meniscus lesion
89
# Identify: Poor mineralization problem occuring in kids
Rickets
90
# Identify: Adults rickets
Osteomalacia
91
3 S/Sx of rickets:
* Bone pain * Muscle cramping * Impaired growth
92
Management of rickets | 2 items
* Medical disease management * Osteotomy to straighten tibia
93
# Identify: Structurally weak bone commonly occuring in skull, pelvis, and tibia
Paget's disease
94
4 S/Sx of Paget's disease
* Increased skill size * Bowing of LEs * Increased kyphosis * Fractures occur more easily
95
Management of Paget's disease
Meds similar to those with osteoporosis

Musculoskeletal (15 decks)

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