Flashcards in Knee Deck (68):
RA often presents with _____ deformity.
What is surgical tx for knee RA?
Which is more common at the knee, RA or OA?
Role of ACL?
prevent anterior translation of tibia on femur
Role of PCL?
prevent posterior translation of tibia on femur
OA often presents with _____ deformity.
What ages have higher incidence of OA?
OA at the knee results in loss of _____ joint space. Leads to:
severe genu varus
Pharma and Nutri management of OA?
Surgical management of knee OA?
1. arthroplasty (most common)
2. osteotomy (corrects deformity)
3. Osteochondral autograft
4. autologous chondrocyte implantation
Hyalgan, synvisc, orthovisc, euflexxa are examples of:
What is unconstrained knee arthroplasty?
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
When would unicondylar replacement be selected?
when most of joint destruction is limited to one side (usually medial)
When is osteochondral autograft used?
used with small lesions 1-1.5 cm
TKR post-op concerns?
functional motion for stairs
Describe what happens with high tibial osteotomy for medial compartment OA:
remove lateral wedge
realign jt surface
NWB for 6 weeks
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)
When is high tibial osteotomy used?
used mostly with younger patients
Tibial plateau fx are more prevalent on the ____ side.
Tibial plateau fx often involve which ligament?
MCL (needs to be controlled with motion brace set at 45 degrees)
Lateral tibial plateau fx is secondary to:
valgus force with compression and knee in flexion
What is a common mechanism of injury for patella fx?
direct blow or traction from a quad injury
Patella alta ratio:
Patella balta ratio:
Osteochonditiris dessicans is usually a result of:
usually lateral aspect of medial femoral condyle
What are degenerative changes related to patellar dsyfxn?
softening and erosion of patellar articular cartilage
significant pain and crepitus under patella with motion
How is patellar degeneration treated?
arthrospopic debridement OR replacement of undersurface of patella
Lateral tracking dysfxn signs and symptoms?
anterior knee pain worse with sitting, stairs, cycling
more common in women
may be related to Q angle, pronated feet
Which gender more commonly experiences patellar subluxation?
Patella more often dislocates/subluxes in which direction?
What is the clinical sign for patellar sublux?
What is the Tx for patellar sublux?
closed reduction, braced in extension for 2-3 wks
When does patellar sublux most often?
planted foot and ER of femur with strong quad contraction
Osgood Schlatter disease is described as:
traction apophysitis of patellar tendon at tibial tubercle
Osgood Schlatter disease usually occurs in
Osgood Schlatter disease signs and treatment?
pain with activity
may see lump on anterior tibia
treat by restricting vigorous activity until healed
Name the injury:
Anterior knee pain and edema that is worse with resistance to knee extension is.
Name the injury:
Often secondary to forceful quad contraction when knee is in flexed position with potential for myositis ossificans.
Name the injury:
Tendon irritation over lateral femoral condyle.
ITB friction syndrome
Medial: Lateral meniscal injury incidence?
Medial meniscus injury associated with:
MCL and ACL injury
Lateral meniscus injury associated with:
cyst - must be fully removed
Meniscal injury clinical test
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)
What is synovial plica?
folds of remnants of embryonic synovial tissue in the knee
Signs and symptoms of plica?
pain with prolonged knee flexion, sitting
How is plica treated?
Name the components of the unhappy triad:
Medial collateral ligament
Anterior cruciate ligament
(requires surgery to promote stability)
Which has greater incidence of injury, MCL or LCL?
MCL and LCL injury Sxs:
giving way/frank instability
Clinical tests for MCL/LCL:
valgus and varus stress tests
1st degree collateral injury Tx:
support 1-2 wks
2nd degree collateral injury Tx:
immobilize 2-3 wks
assistive device for WB
3rd degree collateral injury Tx:
Requires reconstruction (may be arthroscopic)
Controlled motion bracing
ACL mechanism of injury:
valgus/ER force with foot planted OR excessive IR
PCL mechanism of injury:
anteromedial blow to flexed knee or fall onto knee
Cruciate ligament tests?
What are Sxs of cruciate ligament injury?
single plane OR rotary instability
Describe surgical reconstruction for ACL:
1. mid 1/3 patellar tendon (bone-tendon bone graft)
2. hamstring graft
3. augmentation with allograft (less common)
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
Rehab principles for ACL reconstruction:
1. early: closed chain exercises better
2. limit open chain knee extension
3. achieve early full AROM
Pre-patellar bursitis, AKA?
Infra-patella bursitis, AKA?
What are the 4 common busae of the knee?
3. pes anserine (just distal to medial joint)
GIVING WAY is a symptom that may be associated with which injuries?