Flashcards in Knee Deck (13):
What type of collagen are ligaments made of?
Grading acute ligament injuries
•Grade 1: injury w/o laxity
•Grade 2: partial injury w/ laxity, but some fibers intact
•Grade 3: complete ligament rupture
3 phases of ligament healing
•Inflammatory phase – bleeding / clot / inflammation
•Proliferative phase – increase in cell density and revascularization of ligament. Fibroblasts in granulation tissue produce disorganized collagen matrix
•Remodeling phase – cellularity decreases and collagen fibers become aligned w/ forces acting on ligament. May last months / years after injury. Immobilization slows remodeling, so movement is important.
Typical movement leading to ACL injury
What type of injury causes PCL tear?
Direct blow to anterior aspect of flexed knee (dashboard, fall). Associated w/ femur fracture.
What is the main job of the meniscus?
What is the meniscus made of?
Type 1 collagen
What type of movement causes injury?
What movement increases pain?
•Often occur w/ twisting injuries in young pxs and may be spontaneous in older pxs.
•Hallmark of meniscal tear is joint line pain / tenderness.
•Deep squatting or twisting often increases the pain.
•H&P allows diagnosis 80% of time. MRI may be needed.
•Treat w/ repair, menisectomy, or observation / PT
• Repair allows for weight-bearing preservation, but can only be done in vascular peripheral third where healing can occur.
• Menisectomy increases joint loads and risk for late DJD.
• PT focuses on increasing ROM and decreasing swelling. Better for older pxs w/ associated knee OA.
2 major factors that increase loads across the knee
1) Malalignment – varus / valgus may be reinforcing
2) Loss of meniscus
Knee OA imaging findings (4)
Joint space narrowing, sclerosis, osteophytes, subchondral cysts
Treating knee OA
•Decrease loads – weight loss, activity modification, correct alignment, brace
•PT – improve motion, strength, and balance
• Arthroscopy for mechanical sxs (beware that 90% have meniscal tears).
• Knee replacement for older pxs
Treating patellofemoral pain
•Non-operative is 1st line – activity modification, PT, taping, bracing, orthotics
•Surgery is rare and used for dislocations (rather than pain)