Knee Flashcards Preview

Musculoskeletal Pathophysiology > Knee > Flashcards

Flashcards in Knee Deck (68):
1

RA often presents with _____ deformity.

valgus

2

What is surgical tx for knee RA?

synovectomy
arthroplasty

3

Which is more common at the knee, RA or OA?

OA

4

Role of ACL?

prevent anterior translation of tibia on femur

5

Role of PCL?

prevent posterior translation of tibia on femur

6

OA often presents with _____ deformity.

varus

7

What ages have higher incidence of OA?

>50 ya

8

OA at the knee results in loss of _____ joint space. Leads to:

medial
severe genu varus

9

Pharma and Nutri management of OA?

NSAIDS
OTC analgesics
acetominophen
chondrointin sulfate
glucosamine sulfate

10

Surgical management of knee OA?

1. arthroplasty (most common)
2. osteotomy (corrects deformity)
3. Osteochondral autograft
4. autologous chondrocyte implantation

11

Hyalgan, synvisc, orthovisc, euflexxa are examples of:

visco-supplementaion injections

12

What is unconstrained knee arthroplasty?

spares PCL

13

What is constrained knee arthroplasty? When is it used?

removes PCL and has mechanical link for stability
used when there is poor ligamentous support or as a revision for a failed TKR

14

When would unicondylar replacement be selected?

when most of joint destruction is limited to one side (usually medial)

15

When is osteochondral autograft used?

used with small lesions 1-1.5 cm

16

TKR post-op concerns?

infection
DVT
wound healing
terminal extension
functional motion for stairs

17

Describe what happens with high tibial osteotomy for medial compartment OA:

remove lateral wedge
realign jt surface
NWB for 6 weeks

18

Describe what happens with an osteochondral autograft:

small piece of bone articular cartilage is moved from NWB area onto WB area (NWB for 6 weeks)

19

When is high tibial osteotomy used?

used mostly with younger patients

20

Tibial plateau fx are more prevalent on the ____ side.

Lateral (80%)

21

Tibial plateau fx often involve which ligament?

MCL (needs to be controlled with motion brace set at 45 degrees)

22

Lateral tibial plateau fx is secondary to:

valgus force with compression and knee in flexion

23

What is a common mechanism of injury for patella fx?

direct blow or traction from a quad injury

24

Patella alta ratio:

> 1:1

25

Patella balta ratio:

< 1:1

26

Osteochonditiris dessicans is usually a result of:

osteochondral fx
usually lateral aspect of medial femoral condyle

27

What are degenerative changes related to patellar dsyfxn?

softening and erosion of patellar articular cartilage
significant pain and crepitus under patella with motion

28

How is patellar degeneration treated?

arthrospopic debridement OR replacement of undersurface of patella

29

Lateral tracking dysfxn signs and symptoms?

anterior knee pain worse with sitting, stairs, cycling
crepitus
more common in women
may be related to Q angle, pronated feet

30

Which gender more commonly experiences patellar subluxation?

females

31

Patella more often dislocates/subluxes in which direction?

dislocates/subluxes laterally

32

What is the clinical sign for patellar sublux?

apprehension test

33

What is the Tx for patellar sublux?

closed reduction, braced in extension for 2-3 wks

34

When does patellar sublux most often?

planted foot and ER of femur with strong quad contraction

35

Osgood Schlatter disease is described as:

traction apophysitis of patellar tendon at tibial tubercle

36

Osgood Schlatter disease usually occurs in

adolescents

37

Osgood Schlatter disease signs and treatment?

pain with activity
may see lump on anterior tibia
treat by restricting vigorous activity until healed

38

Name the injury:
Anterior knee pain and edema that is worse with resistance to knee extension is.

Patellar tendinitis

39

Name the injury:
Often secondary to forceful quad contraction when knee is in flexed position with potential for myositis ossificans.

quad rupture

40

Name the injury:
Tendon irritation over lateral femoral condyle.

ITB friction syndrome

41

Medial: Lateral meniscal injury incidence?

9:1

42

Medial meniscus injury associated with:

MCL and ACL injury

43

Lateral meniscus injury associated with:

cyst - must be fully removed

44

Meniscal injury clinical test

McMurray

45

Meniscal signs?

pain
edema/effusion
locking
clicking
restricted motion

46

Management of meniscal injuries:

1. menisectomy (partial arthroscopic excision of fragment)
2. repair (if tear is in "red zone" where there is enough vascularity for healing)

47

What is synovial plica?

folds of remnants of embryonic synovial tissue in the knee

48

Signs and symptoms of plica?

pain with prolonged knee flexion, sitting
clicking/locking

49

How is plica treated?

arthroscopic removal

50

Name the components of the unhappy triad:

Medial collateral ligament
medial meniscus
Anterior cruciate ligament
(requires surgery to promote stability)

51

Which has greater incidence of injury, MCL or LCL?

MCL

52

MCL and LCL injury Sxs:

pain
giving way/frank instability

53

Clinical tests for MCL/LCL:

valgus and varus stress tests

54

1st degree collateral injury Tx:

RICE
support 1-2 wks

55

2nd degree collateral injury Tx:

RICE
immobilize 2-3 wks
assistive device for WB

56

3rd degree collateral injury Tx:

Full tear
Requires reconstruction (may be arthroscopic)
Controlled motion bracing
Assistive device

57

ACL mechanism of injury:

valgus/ER force with foot planted OR excessive IR

58

PCL mechanism of injury:

anteromedial blow to flexed knee or fall onto knee

59

Cruciate ligament tests?

lachman
drawer signs

60

What are Sxs of cruciate ligament injury?

pain
effusion
single plane OR rotary instability

61

Describe surgical reconstruction for ACL:

1. mid 1/3 patellar tendon (bone-tendon bone graft)
2. hamstring graft
3. augmentation with allograft (less common)

62

Name some rehab issues for ACL reconstruction:

1. minimize immobility effects w/out overloading soft tissues
2. graft is strongest right after operation, then gets avascular and necrotic
3. revascularization of the graft at 8-10 wks
4. up to 1 year to remodel and become dense mature ligament

63

Rehab principles for ACL reconstruction:

1. early: closed chain exercises better
2. limit open chain knee extension
3. achieve early full AROM

64

Pre-patellar bursitis, AKA?

"housmaid's knee"

65

Infra-patella bursitis, AKA?

"clergyman's knee"

66

What are the 4 common busae of the knee?

1. pre-patellar
2. infra-patellar
3. pes anserine (just distal to medial joint)
4. popliteal

67

GIVING WAY is a symptom that may be associated with which injuries?

ligament injury
meniscal injury
patellar dislocation
quad inhibition

68

LOCKING is a symptom that may be associated with which injuries?

meniscal injury
synovial plica
osteochondritis dessicans