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Flashcards in Knee Deck (13):
1

What type of collagen are ligaments made of?

Type 1

2

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

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.

4

Typical movement leading to ACL injury

Rotational hyperextension

5

What type of injury causes PCL tear?

Direct blow to anterior aspect of flexed knee (dashboard, fall). Associated w/ femur fracture.

6

What is the main job of the meniscus?

Bear weight

7

What is the meniscus made of?

Type 1 collagen

8

Meniscus tear
What type of movement causes injury?
Hallmark
What movement increases pain?
Diagnosis
Treatment (3)

•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.

9

2 major factors that increase loads across the knee

1) Malalignment – varus / valgus may be reinforcing
2) Loss of meniscus

10

Knee OA imaging findings (4)

Joint space narrowing, sclerosis, osteophytes, subchondral cysts

11

Treating knee OA

•Decrease loads – weight loss, activity modification, correct alignment, brace
•PT – improve motion, strength, and balance
•Surgery
• Arthroscopy for mechanical sxs (beware that 90% have meniscal tears).
• Knee replacement for older pxs

12

Treating patellofemoral pain

•Non-operative is 1st line – activity modification, PT, taping, bracing, orthotics
•Surgery is rare and used for dislocations (rather than pain)

13

Patellar tendonitis characteristics

Common w/ aging.
Should be called tendonosis b/c no swelling.