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Flashcards in Knee 2 Deck (35)
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1

prevalence of Patellafemoral pain syndrome (PFPS)

40% of adults with reported knee pain (25% of all running injuries)

-overuse type injuries

2

what facet of the patella is most commonly associated with chondromalacia patella

odd facet (most medial)

3

what mechanical advantage does the patella provide

improves efficiency of extensor mechanism (last 30 degrees of extension)

4

Biomechanics of the patella @ flexion/ext

At 0 degrees- no contact of patella in femoral groove

at 120 degrees- odd facet makes contact in femoral groove (sitting tends to aggravate petelofemoral pain)

5

patella fx exam findings

-trauma hx
-swelling
-inability to weight bear
-Bony tenderness/ palpable cleft
-inability to perform aslr
-decreased knee flexion

6

what is the criteria to make a dx of PFPS

-Presence of retropaterllar/ peripatellar pain
-reproduction of pain w squatting, stair climbing, prolonged sitting
-patellar tilt test with the presence of hypo mobility

7

clinical stages of chondromalacia patella (4)

1. softening, swelling, blistering of articular cartilage
2. Fissuring of articular cartilage (clefts)
3. Fibrillation (crabmeat sign)
4. Thinning of articular cartilage

8

theory of causes of chondromalacia

1. abnormal patella excursion
2. abnormal patellofemoral pressure
3. trauma
4. genu valgus
5. patella alta
or just normal

9

signs/symptoms of chondromalacia patella- mc cohort

runners 20-30

s/s- recurrent effusion, coarse creapatis, night pain, pain with prolonged sitting

10

chondromalacia patella exam findings

+ patella compression
+squatting
+Clarks sign
+ resisted knee extension

11

conservative management and prognosis of chondromalacia patella

-CKC exercises: semi squats to stegthen VMO
-ITB stretching
-US
-Infrapatellar strap

6-8 weeks conservative= good in >50% pts.

12

Patellaofemoral malalignment syndrome

-tracking problem (pain in retropatellar area*)

13

Postural characteristics associated with patellofemoral malalignment syndrome

-femoral anteversion
-increase q angle
-hyperextension @ knee
-tibia varum (angled in)
-tibial tortion

14

Signs of patellofemoral malalignment syndrome

+ patella compression
crepatus
+ pain on ascending/descending stairs
+ clarks sign
+ patellar tilt test
+ resisted extension

15

normal q angle males + females

males= 13-18
females 18

16

what does a patellar tilt test indicate usually

inability to lift lat border of patella (indicates tight lat reticulum + likely lat tracking)

17

tx and prognosis of patellofemoral malalignment syndrome

-isometric ex for VMO
-stretch ITB/hams/quads
-6-8w
good prognosis

18

What is the most common ethology of patellar sublet/dislocation and moi

inadequate quadriceps strength

moi- Ext rot of leg, contraction of quad and ext of knee. Pivoting to one side

19

s/s of patella dislocation/sublux

-loud sound @ time of injury
-may spontaneously reduce
-swelling occurring rapidly within minutes (large hemarthrosis)
+aprehension sign
tender medial retinaculum

20

fat pad impingement ethology

-sudden forced knee extension
-with repeated activity, there may hypertrophy so a portion of the tissue becomes pinched between the patella and the femur
-overload syndrome

21

S/S of fat pad impingement

-tenderness on either side of patella
-petellar compression + in lower pole
- soft creates
-faber
-swelling/effusion

22

patellar tendinitis (jumpers knee)- what is it, eitology

-Inflamation of the distal tendon of the quads (/anywhere along the extensor mechanism of knee)

-overuse/overtraining
-eccentric forces
-running to fast/worse during running

23

s/s of patellar tendinitis

-ant knee pain
-*pain and tenderness localized to the infra patellar pole (quad tendon)
-clarks sign +
-knee flexion is painful

24

what hip rehab is beneficial in PFPS

improve hip flexion strength combined with increased IT band and iliopsoas flexibility

25

Triad of symptoms in osgood shlater

1. Swelling over tibial tubercle

2. point tenderness of tibial tubercle and patellar tendon

3. xray-irregular ossification

26

tx of osgood shlater

modify activity (but continue sport)
infra patellar strap
STT, PNF stretching
(US contra)

2-3m

27

What is Larsen Johanssen disease (onset, pop, signs)

juvenile osteochondrosis that disturbs the patellar tendon attachment to the inf pole of the patella
-adolescent boys
-insideous
-tenderness over inf pol

28

What is osteochondritis dissicans- pathology and location

-focal van of bone- lat part of medial femoral condyle, can cause a jt mouse

-knee pain jt effusion, giving away catching, decreased rom, adolescent

29

tx and prognosis of osteochondritis dissicans

prevent partial or complete detachment (pinning surg)
strengthening

good prognosis

30

IT band syndrome eitology/predisposing factors

friction of repetitive knee flex/ext causing inflammation of bursae underlying distal portion of the ITB\

predisposing= old shoes, leg length, lack of stretching

31

s/s of IT band syndrome

sharp pain over lateral femoral epicondyle posteriorly (superficial pain)

32

synovial plica syndrome- which is most clinically sig + symptoms

medial patellar plica
-anteromedial knee pain
-pain aggravated by reparative activity
-pain w sitting long

33

synovial plica syndrome signs

medial parapatellar pain
pain or palpable band over medial condyle
snap or grinding w mcmurrays test
quad atrophy
effusion

34

definite indicators of synovial plica

-present on orthography, ct, Sri
-pain relieved by medial intracapsular cortisone
-prolonged releif w medial intracasular cortisone

35

symptoms of popliteus syndrome

-pain, stiffness, fullness on back of knee
-posterolat jt line pain
-aggrevated by heal strike**