Knee 3: ARJC- PFPS (Test 3) Flashcards by Braden Talbert

in the year prior to TKA over 50% of non-inpatient costs were associated with what

injections
PT
Orthotics
Prescriptions (about 30% of this is HA injections alone)

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how much of a cost reduction would occur for knee patients if CPG treatments alone were used

cost associated with OA would be decreased by 45%

shows over utilization of ineffective interventions and less efficient use of visits

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effectiveness of NSAIDs for ARJC

strong support
better than Tylenol
includes topical application

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effectiveness of tylenol

stong support

NSAIDs better

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effectiveness of narcotics for ARJC

adverse effects and not effective

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effectiveness of injections for ARJC

cortisone = inconclusive; maybe short term relief

hyaluronic acid (synvisc) = claims to mimic synovial fluid; strong evidence against

platlet rich plasma = may help

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effectiveness of arthroscopy for ARJC

strong recommendation against in nearly all patients

no clinically important benefits vs placebo in regards to pain, function, or quality of life

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prognosis for ARJC for patients with TKA + PT vs PT alone for 12 months

greater pain relief/function with TKA, but higher risk of adverse events

non-surgical Rx delayed TKA

timing of TKA influences outcome (dont wait to long; may affect other parts of the body)

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MD Rx for ARJC

partial knee arthroplasty

total knee arthroplasty
-more common
-mini-procedure
-increasing in prevalence

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MD Rx prior to TKA

pre op PT reduced cost by $1215
-assistive device
-recovery plan
-expectations

better quality of life with 8 weeks of exercise 5x/week prior to sx

3x/week for 4-8 weeks increased strength and function for those with severe OA

3 week program accelerated functional recovery after a TKA

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what does a TKA involve

incise capsule

collaterals remain and possibly the PCL

ACL always removed

forceps hold back adj structures

dislocate knee

add prosthetic

close capsule

full range ensured under anesthesia

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importance of early rehab within 24 hours after a TKA compared to 48-72 hours after

earlier decreases mean hospital stay and number of sessions

greater progress with ROM/strength

faster autonomy and normal gait and balance with TKA

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early and intense rehab variables to consider

higher intensity

spread visits over a longer duration

single leg training

higher level of functional exercises

results in better quad activity out to a year

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ROM goals for PT after a TKA

0 degrees extension - 1-2 weeks

110 degrees flexion - 6 weeks

120 degrees overall

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other names for patello-femoral pain syndrome

PFPS

anterior knee pain

retripatellar pain syndrome

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describe the ground reaction forces associated with the patello-femoral joint for: walking, 30 deg flexion, stair climbing, squatting, and peak

walking = 50% BW

30 deg flex = BW

stair climbing = 3x BW

squatting = > 7x BW

peak = at 90 deg

forces are even greater with those who have patellofemoral pain syndrome

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prevalence of PFPS

37% of military recruits

70-90% recurrent and persistent

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risk factors for PFPS

military recruits

dynamic NOT static excessive pronation

females > males
-larger Q angle
-differing hip strength/coordination

patellar and femoral bone shape

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etiology/pathomechanics of PFPS

trauma is rare

idiopathic is the largest % of pts

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describe the idiopathic etiology of PFPS with the theory of malalignment or maltracking

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patella glides and tilts more laterally relative to the femur

involves decreased surface area contact between the patella and femur due to:
-patellar and femoral bone shape
-femoral IR and add
-quad weakness/incoordination/atrophy
-unclear contribution from excessive pronation and tibial IR

changes that take place with PFPS

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overload of patellar subchondral bone, especially the lateral facet

tissue ischemia

loss of tissue homeostasis

neural ingrowth increase in substance P nerve fibers that transmit more pain

structures involved with PFPS

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subchondral bone of patella

infrapatellar fat pad
-behind patellar tendon/in front of capsule
-inflamed with excessive tibial IR and patellar hypermobility
-can refer to groin

bursae (superficial and deep)
-between skin and patellar tendon
-between patellar tendon and tibia

quad and patellar tendons

synovium

medial and lateral retinaculum (help hold patella and tendon in position)

symptoms of PFPS

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gradual onset

usually anterior medial knee pain (inhibition of VM)

pain increased with stairs, squatting, or kneeling or prolonged sitting

observation of those with PFPS

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increased Q angle

open chain maltracking of patella

quad atrophy

impaired LE control

explain how impaired LE control may contribute to PFPS

proprioceptive deficits dynamic excessive pronation

concerns related to dynamic excessive pronation

possibly leads to IR may contribute to greater genu valgus possible contributions from impaired DF because of DF is limited then more EV may occur

what might you observe related to impaired LE control associated with PFPS

abnormal planar motions (females especially) frontal and sagittal plane: increased hip add -glut med or max incoordination -hip ext and abd weakness transverse -hip ER weakness/incoordination -mixed conclusions with contributions from rotational impairments

how is poor control defined related to PFPS during a squat

significant valgus movement knee medial to foot

how is reduced control defined related to PFPS during a squat

some valgus movement knee NOT entirely medial to foot

how is good control defined related to PFPS during a squat

no valgus movement knee vertical to toes

what might you observe with PFPS in other parts of the body

trunk weakness including excessive trunk lean possible contributions form L4-S1 regional interdependence

ROM findings for those with PFPS

limited and painful especially at end ranges FLX = greater PF compression EXT = more fat pad irritation

resisted/MMT for PFPS

possibly pain with ext MMT and weakness likely inhibited quad activity (especially VM) potential anti gravity trunk and hip weakness

stress test findings for PFPS

possible pain with PF compression

possible neuro findings for PFPS

limited dural mobility of femoral nerve in 1/3 of patients

accessory motion testing for PFPS

usually excessive lateral motion and limited medial motion all glides could be hypermobile

special tests for PFPS

medial patella plica test pain with knee ext MMT hoffa's sign apprehension test

special tests for M length associated with PFPS

thomas for rectus ober's for TFL/IT band SLR for hamstrings gastroc

palpation findings for PFPS

peri patellar TTP position of patella -patella alta -patella balta -WNL = inferior pole aligned with joint space at 90

PT Rx for PFPS

POLICED taping Knee orthotics foot orthotics STM and JM MET verbal and visual feedback

effectiveness of taping for PFPS

patellar taping most often medial or inferior to unload fatpad improves posiitoning for better contact good for pain, kinematics, and function less efective with patients who have higher bMI or smaller Q angle provides proprioceptive benefits can also tape arch for excessive pronation

effectiveness of knee orthotics/different types

neoprene sleeve with hole -increases surface contact between patella and femur (30-40%) without changing alignment/tracking -can help with function -proprioceptive benefits J-lat brace none interfere with muscle activity

effectiveness of foot orthotics for PFPS

effective immediately effective in short and mid term no difference at a year

what would cueing a pt to "run softly" do

changes landing pattern from rearfoot to non rearfoot strike pattern improves pain and function also cue "dont let your knee fall in"

how/why to cue to "contract glutes and keep knee pointed straight"

can use a visual of hip angle with mirror improved pain and function also helped hip mechanics

prognosis for PFPS

80% of those who did rehab still had pain 74% had reduced PA in 5 year follow up can lead to OA

what is a lateral retinacular release

arthroscopic longitudinal incision of lateral retinaculum should be used in rare instances

prognosis of lateral retinacular release and when to use

use only with 10% of cases unsuccessful with PT with hyperpressure of lateral facet without instability can lead to medial instability if additional tissue is cut or used on the wrong pt

what is an extensor mechanism realignment

repositioning of the insertion site open procedure long rehab extensor lag issues

Knee 3: ARJC- PFPS (Test 3) Flashcards

(49 cards)