Knee Flashcards

Question

Open pack position of patella

Answer 1

full knee extension

Answer 2

angle of 2 lines intersecting ASIS to midpoint of patella Tibial tuberosity and midpoint of patella normal Q angle: 10-15 degrees women usually have a greated angle angles greater than 19 degrees the patella tracks more laterally

Answer 3

valgus stress test identifies MCL instability apply pressure and valgus stress at 0 degrees and 30 degrees extension + test= excessive gapping at medial joint line

Answer 4

varus stress test identifies LCL instabilty apply varus stress at 0 degrees and 30 degrees extension +test= excessive gapping at lateral joint line **gapping at 0 degrees suggest a more severe injury such as ACL or PCL

Answer 5

identifies ACL tear patient supine with knene flexed 20-30 degrees *more comfortable and muscles put on slack but ACL is tighter stabilize distal femur with one hand and grasp proximal tibia moves tibia anteriorly on femur +test= excessive movement of tibia

Answer 6

Identifies ACL tear patient supine with knees in hook lying position sits on patients foot to stabilize lower leg pull anteriorly on proximal tibia knee bent to 90 degree +=excessive anterior movement of tibia

Answer 7

identifies PCL tear pt. supine with knees in hook lying position sit on patients foot to stabilize lower leg push posteriorly on proximal tibia +test = excessive posterior movement of tibia

Answer 8

identifies PCL tear pt. supine with hips and knees flexed to 90 degrees lower legs resting in therapist hand or chair +sign= observable posterior translation of tibia

Answer 9

identifies meniscal tear patient prone with knee flexed to 90 degrees therapist applies compressive force through foot and rotates tibia medially and laterally +test = pain

Answer 10

identifies lateral or medial ligament tear pt. prone with knee flexed to 90 degrees apply distraction force through foot and rotates tibia medially and laterally +=Pain

Answer 11

identifies meniscal tear pt. supine grasps foot of patient with one hand and palpates joint line knee is passively extended while applying a rotation force (internal/external) while also applying valgus/varus stress +=a click or crepitus over joint line

Answer 12

small holes down to subchondral bone to stimulate growth of articular cartilage

Answer 13

articular cartilage plugs taken form non WB portion of joint and placed in area of damage

Answer 14

hyaline cartilage cells removed and then grown in a lab surgically transplanted in area of damage

Answer 15

wearing of joint surfaces which may include bone spurs may cause genu valgum or varum possible treatments for mild-mod: cortisone or hyaluronan injections

Answer 16

indication: | severe pain from OR or RA and/or significant impairment in functional mobility

Answer 17

gait- WB depends on if cemented or non-cemented transfers, stairs ROM quad sets, SLR,heel slides,hip abd/add, gluteal sets, ankle sets

Answer 18

progression of ROM with goal of functional ROM for patient Gold standard 120 degrees or more normalize gait pattern strengthening/functional activities

Answer 19

attempts to realign tibiofemoral joint by surgically creating a wedge in proximal in tibia or distal femur rehab considerations: - No CKC exercises until secure bone union - immobilizer - initially NWB

Answer 20

``` large Q angle muscle and fascial tightness pronatory forces at foot hip muscle weakness Medial VMO knee weakness ```

Answer 21

misalignment of patella in trochlear groove SIGNS: patellar misalignment pt. can c/o knee buckling dull ache of knee at rest, sharper pain with stairs Chondromalacia= crepitus -softening/degeneration of articular cartilage underside of patella

Answer 22

wide Q angle femoral anteversion - IR femur femoral trochlear groove now medially rotated patella faces more medially forces on the patella pull on it laterally

Answer 23

chondromalacia of patella strengthen quadcrips-VMO stretching/mobilization of tight structures pulling laterally on patella patella alignment brace patella taping

Answer 24

release of lateral retinaculum with goal of improved neutral patellar tracking

Answer 25

surgery using hamstring graft | reconstruction of medial patellofemoral ligament

Answer 26

ACL functions to prevent anterior translation of tibia on femur Injury: -forceful hyperextension blow to knee +/or twist with foot planted CLINICAL SIGNS: -person may hear or feel a pop usually with immediate pain immediate swelling-intracapsular TESTS: - lochmans - anterior drawer sign

Answer 27

``` 2-10 x more common in females than males LE alignment-increased Q angle estrogen/progestrone and joint laxity Biomechanical risk factors: -increased lateral trunk motion and valgus torques on the knee ```

Answer 28

``` immobilization control swelling increase ROM strengthening may need brace to protect against rotation forces ```

Answer 29

Autografts: middle third of patellar tendon hamstrings Artificial-may degenerate over time

Answer 30

follow MD protocol graft goes through a point of necrosis during first few months-it becomes fragile and stresses must be controlled *PROTECT GRAFT* brace-may be locked into extension at first NO OPEN CHAIN EXTENSION **NO TKE in from 15-45 degrees Avoid CKC 60-90 degrees of flexion early on **Quad working will cause anterior translation** no additional resistance to distal tibia with quad strengthening

Answer 31

PCL prevents posterior translation occurs when there is excessive force that moves the tibia posteriorly falling on knee blow to anterior knee with knee flexed

Answer 32

immediate pain | immediate swelling

Answer 33

Sag test | posterior drawer sign

Answer 34

RICE immobilization Quadricep strengthening-reinforces knee and decreases posterior translation No open chain hamstring strengthening **avoid for 6-12 weeks **pulls/contracts causes a pull on tibia posteriorly

Answer 35

closed kinetic chain exercises as tolerated | strengthening of hamstrings once quadriceps strength is good

Answer 36

can be from quad, hamstring or gastroc allowgraft can be from donor

Answer 37

follow MD protocol avoid exercises and activities that place excessive posterior shear forces and causes posterior displacement of the tibia on the femur NO open chain AROM knee fleixion for 2-3 motnhs Be aware as patient progresses toward functional exercises: - avoid downhill inclines - avoid activities that involve rapid deceleration with both feet planted

Answer 38

provides medial stability - valgus stress - lateral to medial blow to the knee

Answer 39

valgus stress test

Answer 40

MCL tear ACL tear medial meniscus tear

Answer 41

varus stress medial to lateral blow to the knee **lateral stability of knee**

Answer 42

Varus stress test

Answer 43

can be nonsurgical or surgical management may have other injured/torn ligaments acute management=RICE follow MD protocol

Answer 44

degenerative tear sudden trauma to knee -often occurs when leg s planted and body twists over leg

Answer 45

locking or catching of knee swelling constant or intermitten pain along joint line

Answer 46

McMurray's Test | Apley Compression Test

Answer 47

Vertical transverse bucket handle flat

Answer 48

location of tear will predict management of tear due to vascularity --OUTER EDGE: more vascular, may do well without surgery --INNER PORTION: less vascular and will need surgery

Answer 49

usually in white zone often outpatient surgery physical therapy immediately slowly return to weight bearing

Answer 50

usually associated with other ligamentous repairs follow MD protocol-depending on what was repaired usually weight bearing precautions

Answer 51

decent blood supply

Answer 52

compromised blood supply

Answer 53

blow to knee or fall signs; - pain - swelling - xray treatment: - non displaced= immobilization - displaced or comminuted= WB limitations, Quad contraction restriction - -painful-> follow MD protocol

Answer 54

follow MD protocol

Answer 55

``` IN PATIENT: -bed mobility, transfers OKC exercise program -femoral nerve block or no quad control=use knee immobilizaer -ambulation training with AD -enviornmental barrier training -compression and cold packs-DVT prevention -1-4 days in hospital ```

Answer 56

pt. education of procedure and long term outcomes well joint motion knee ROM: 0-90 ASAP GOAL: Max 0-full flexion STM gait training, progressive AD weaning strengthening: isometrics, isotonics, OKC, CKC balance supportive modailities

Answer 57

CRITERIA: Ind. SLR, decreasing Edema, improving ROM, full WB - wean from AD - max ROM - max strength: OKC, CKC - max mobility and tissue - max balance - functional acitivities - environmental barriers

Answer 58

CRITERIA: weaned from AD if appropriate, appropriate balance strategies, normalized gait on level surfaces and env. barriers, resolved edema, nearly full ROM, minimal to no pain - functional activities - return to recreational acitivies with support of new joint limitations - if applicalble: plyometrics and return to sports activities