Knee Flashcards
Patella subluxation/dislocation
Hypermobile medial and lateral glide, tightness of lateral restraints, Osseous factors, increased Q-angle, wide and anteverted hips, genu valgus, shallow femoral grooves, flat lateral femoral condyles, high and flat patellas, vmo and ligament laxity, genu recurvatum, ER tibia, pronated feet, ER patella
Planting foot, decelerates, cuts in opp direction, thigh rotates Internally while lower leg rotates externally causing a forced valgus
Quad tries to pull straight and forces patella laterally -sudden twisting while foot planted
ACL and PCL also involved
S/S:
Giving out
gross deformity
Quad spasm
Swelling-blood
Pain from stretching and tearing of capsular restraint
AROM restricted in flexion and extension and complete loss of function
Palpable tenderness over adductor tubercle where retinaculum attaches
ST:
Apprehension test
Tx:
Needs to be reduced with knee in extension and pressure to patella and hip flexed
Aspiration of joint hematoma
Ice and splint for 4 wks and crutches when walking
X-Ray to rule out fx before and after reduction
Isometric exercises while immobilized
Horse-shoe pad that is held around the patella by elastic wrap or sewn into sleeve for when RTP
Bracing
Muscle rehab-confine to straight leg raises first
Shoe orthotics
Patellofemoral syndrome
Insidious onset
Need to observe normal flexion to extension motion
Patellar maltracking-congenital, increased Q-angle, previous injury, increased weight/gait mechanics, muscle imbalance, foot malalignment, and pelvic position
S/S:
Anterior knee pain that worsens with activity
Pain w/climbing stairs, prolonged sitting, and knee flexion
Pain w/ADL
Tx: Patellar taping/bracing Patellar mobilization Quad strengthening Stretching exercises Foot orthotics
Patellar tendinitis
Common in jumping activities, running sports, and weight lifting
Insidious onset
Micro tearing of fibers-formation of excessive connective tissue which alters tendons normal structure
S/S:
Tender to palpation
Crepitus
Painful knee flexion and resistive knee extension
Tx:
Conservative
Patellar tendon rupture
Quads overload patellar tendon-hyper flexion, powerful knee extension, eccentric contraction
S/S: Obvious deformity Rapid swelling Inability to extend leg of perform straight leg raise Quad contraction may still be present
Tx:
Immobilize and transport
Patellar bursitis
Acute or chronic-prepatellar and infra patellar most commonly injured secondary to direct trauma also suprapatellar
Placing pressure on top of knee or kneeling-pre
Overuse of patellar tendon-infra
S/S:
Pain remains localized
Decreased ROM
Pre-swelling above knee cap, redness and warmth
Tx: Modifying activity Control inflammation Rest Compression wraps and AIs Aspiration and steroid injection
Synovial plica syndrome
Plica-fold of fibrous membrane that protects into joint cavity (extension of joint capsule thickened area) synovial knee cavity that wasn’t absorbed by the fetus
Most commonly affects medial joint capsule
Inflamed through trauma or chronic friction
Congenitally larger or thickened plica
Infrapatellar and suprapatellar most common, least common but most susceptible to injury is mediopatellar
Most asymptomatic but can become thickened and fibrotic
S/S: Clicking, popping, psuedolocking of knee Worst in the morning, that gets better Blunt force trauma, fall, or twist Snapping Stairs and squatting exacerbate No swelling and no laxity
ST:
Medial synovial plica test
Stutter rest
Hughston plica test
Tx:
Rest, AI, heat
Surgery to remove
Meniscal tears
MOI: rotation and flexion or extension, valgus and torsion
Medial more common because coronary ligament attaches the medial to the tibia and capsular ligament and lateral does not attach and therefore is more mobile
Repeated sprains reduce the strength of the knee
Cutting, stretching of anterior and posterior horns, forceful extension from a flexed position while internally rotated-bucket handle/longitudinal
Lateral-forceful knee extension with femur ER-parrot break/oblique
Strong IR with flexed knee while foot is planted-medial
S/S: Locking, popping, clicking, jt pain, giving way, swelling may develop (bleeding-red zone) AROM-may have locking PROM-pain near end range RROM-possible pain/decrease ROM Joint line tenderness Effusion gradually Loss of motion Pain with squatting and changing direction Muscle atrophy
ST: McMurray test Apleys compression and distraction test Bounce home Thessaly test
Tx:
MRI to confirm
White zone-Surgical, menisectomy to trim away tear, no bracing, crutches w/partial WB to full for 2 weeks/ repair requires immobilization in brace for 5-6 weeks, crutches from partial to full WB, AROM from 0-90 then full and resistive once WB
Red zone/outter 1/3-heals on own
ACL injury
MOI: anterior translation of tibia or posterior translation of femur, non-contact rotational injuries (cutting or pivoting), hyperextension
Isolated trauma to ACL unlikely
Need to assess PCL
More likely in females-larger q-angle, smaller bones, external tibial torsion, hyperpronation, pes planus, laxity, hormones, muscle strength and flexibility, jumping and landing mechanisms, less dynamic knee stability, smaller ACL size, genu valgum or recurvatum, excessive pronation
Decelerating, heel in little plantar flexion, WB with knee in full extension and abducted or in knee valgus. Axial and valgus force in combination with contraction of the quads produces an anterior shear and internal rotation subluxation of the tibia on the femur. IR causes greater loading but ER has produced tears.
Hip adducted to pelvis, opp hip drops trendelenberg pushing the hip into more adduction, increasing injury
Decelerating and changing directions, foot is planted with knee abducted, forces knee into valgus and IR, hyperextension
S/S: Pop followed by immediate disability and will complain that the knee feels like it is shifting Rapid swelling at the jt line Decreased proprioception Cannot walk
ST:
Anterior drawer test
Lachmans test
Pivot shift
Tx:
Swelling w/in 2 hrs, hemarthrosis w/in 6 hrs
Surgery with graft to replace ACL-week of protective wound healing, 3-5 weeks in a brace, 4-6 month of rehab, 2 yrs to regain normal quad strength
MCL injury
Rule out meniscal and ACL involvement because rarely occurs alone
MOI: valgus-adduction and internal rotation
Grade 1: ligaments stretched, little or no effusion, pt tender below medical jt line, full rom, stable valgus st-RICE 24 hrs, crutches, ice, ultrasound, rehab (isometrics and straight leg exercises, progress to bike an prop. 1-3 wks, brace)
Grade 2: complete tear of deep and partial tear of superficial or partial tear of both, laxity, moderate swelling, lacking extension and loss of PROM, pain in the medial aspect with weakness and instability, RICE 48 hrs, crutches, splint for 2-5 days, modalities for pain and inflammation, isometric for quads, closed kinetic chain exercises and cycling, stairs, and resisted flexion and extension, hinged brace when returning activities and progress
Grade 3: complete tear, complete loss of stability, swelling, immediate, severe pain followed by a dull ache, loss of motion, laxity with stress testing, RICE 72 hrs, immobilize, hinge brace 30-90 and progressive WB for 2-3 wks, increase ROM and rehab
S/S:
Pt tender length of MCL
A/PROM, pain and possible loss of ROM at end range
RROM: weak secondary to pain
ST:
Valgus stress test
Tx:
Conservative
Grade 1-approx 10 days
Grade 2 and 3- 3 to 6 weeks
LCL injury
Varus force and IR of Tibia-foot exerted and knee forced laterally
Rule out ACL involvement
Evaluate peroneal nerve-weakness and paralysis, medical emergency
S/S:
Pain over lateral jt line and fibular head
Diffuse swelling
AROM: pain and decreases ROM, flexion end range
P/RROM: pain and decreased ROM at end range
Laxity w/ST
Intense pain that becomes dull ache if grade 3
ST:
Varus stress test
Tx:
Poor healing-needs surgery
Rehab and immobilization like MCL
PCL injury
“Dashboard injury”
MOI: post translation of tibia, hyper flexion
Fall w/Full weight on anterior aspect of the bent knee with the foot in PF
Rotational force
S/S:
Initially asymptomatic
Pain in posterior knee, muscular weakness, decreased ROM
Swelling and Not a lot of instability
Pop in back of knee
Tenderness and little swelling in popliteal fossa
Laxity
ST: Posterior drawer test Godfreys 90-90 test Posterior sag sign quad active test
Tx:
Surgery not always necessary-quads provide support-6 wks of immobilization in extension w/full WB on crutches, ROM begun at 6 wks, PRE at 4 months
RICE
Rehab to focus on quad strength
Anterolateral instability
Lateral tibial plateau subluxes anteriorly
Damaged structures-ACL, LCL, IT band, biceps femoris, lateral meniscus
S/S:
Increased anterior displacement and IR of tibia
ST:
Lateral pivot shift
Slocum drawer test IR
Crossover
Anteromedial instability
Medial tibial plateau subluxes anteriorly
Damaged structure-ACL, MCL, pes anserine, medial meniscus
S/S:
Increased anterior displacement and ER of tibia
ST:
Slocum drawer ER
Crossover
Posterolateral instability
Lateral tibial plateau subluxes posteriorly
Damaged structures-PCL, LCL, accurate complex
S/S:
Increased posterior translation and ER of tibia
ST:
Hughstons drawer-ER
ER test
Posteromedial instability
Medial tibial plateau subluxes posteriorly
Damaged structures-PCL and MCL
S/S:
Increased posterior translation and IR of tibia
ST:
Hughstons drawer-IR
