Knee Flashcards
(54 cards)
1
Q
Femoral
A
L2-L4
sartorius, quads
2
Q
Sciatic
A
L5-S2
biceps fem
3
Q
Tibial
A
S1-S2 - semis, gastroc
L4-S1 - pop, plant
4
Q
Obturator
A
L3-L4
gracilis
5
Q
Valgus Stress Test
A
0 - MCL (possible ACL, PCL, PMC)
30 - MCL (check other ligaments with grade III)
6
Q
Varus Stress Test
A
0 - LCL (possible ACL/PCL)
30 - LCL (check other ligaments with grade III)
7
Q
Anterior Drawer
A
neutral - ACL
15 ER - ACL, PMC, possible MCL
30 IR - ACL, PLC
8
Q
Lelli’s Test or Lever Sign
A
ACL
9
Q
Pivot Shift
A
ACL, ALC
10
Q
Slocum’s
A
ACL, ALC
11
Q
Jerk (Hughston)
A
ACL, ALC
12
Q
Losee Test
A
ACL, ALC
13
Q
Posterior Drawer
A
PCL
14
Q
ER Recurvatum (tibia ER)
A
PCL, PLC
15
Q
Posterior Sag
A
PCL
16
Q
Reverse Pivot Shift
A
PCL
17
Q
McMurray’s
A
IR - lat men
ER - med men
18
Q
Apley’s
A
med men
19
Q
Thessaly’s
A
med and/or lat men
20
Q
ACL Injury
A
over 70% noncontact
C - decel, hypertext, rotational movement
common when knee is stressed closed to full ext
landing from jump with min flex knee
inc quad vs HS = inc translation
21
Q
ACL Non-op vs OP
A
Non-op best
- single/crossover/triple/timed jumping (80% of unaffected)
- < 1 giving way episodes during testing
- knee outcome survey 80%, subjective global rating 60%
OP Best prognosis
- full ROM, dec swell, good leg control
- excellent mental state
22
Q
Allograft
A
Adv
- dec morbidity, op time, incident of fibrosis
- preservation of flex/ext mech, availability of larger graft
Disadv
- risk of infection, slow healing or incomplete graft
- inc cost, tunnel enlargement
- alteration of structural properties w/ sterilization/storage
23
Q
ACL Risk Factors
A
Intrinsic - intercondylar notch size, ACL size, physiologic laxity, hormonal fluctuations
Extrinsic - kinematics, kinetics, muscle strength, muscle activation
24
Q
ACL Rehab Protocol
A
Day 1-7 - crutches, WBAT after nerve block wears off, AROM 0-90, no quad lag, normal WB at end of stage
Wk 1-2 - stationary bike for ROM, gait training, partial squat to 30 deg on shuttle/total gym
Wk 1-4 - 0-120 by 3 wks, full by 4 wks, normal giat, SLR w/o quad lag, SL standing
Wk 4-8 - B squat to 60, min pain, mild effusion, no giving way
**graft is weakest
Wk 8-12 - advance balance exercise, lap swimming except breast stroke (no fins), stationary bike, nearly equal quad girth, SL squat to 60, SLS 60
**watch for pat tendinopathy
Wk 12-16 - elliptical, perturbation training, shuttle jumping, jogging in place
- *hop test 80% of unaffected prior to running
- *perturbation training - normal gait/ROM/SLR, min effusion, SLS > 60 EO, SLS 45 deg no valgus
Wk 16-24 - progressive jumping, then running program; progressive plyometrics, cutting and sport specific week 20
25
ACL Considerations after HS graft
no active HS exercises for 2 weeks
no OKC HS exercises for 4 weeks
delayed HS resistive strengthening for 12 weeks
26
PCL Injury
normal - pop works with PCP to control ER, varus, and post translation
C - direct trauma to prox tib, fall on knee with PF foot, excessive hypertext
S - post draw, post sag, reverse pivot shift, ER recurvatum
T - grade I/II conservative, III surgery
Grade I/II (isolated) - protected WBing, return 2-4 wks
III - splint in ext 2-4 wks; non-op (older, inactive), post-op (active, young, chondrosis cont dysfunction)
Combined PC - surgery within 2 weeks
27
PCP Non-Op Protocol
Days 1-7 - ROM 0-60, WBing w/ crutches, SLR, mini squats/leg press 0-45
Wk 2-3 - ROM 0-60, WBing w/o crutches, bike at 3 weeks, leg press 0-60
@ 3 weeks - DC brace; bike, stairmaster, rowing; mini squat/leg press 0-60
Wk 5-6 - continue exercise with weight, pool running, fit for functional brace
Wk 8-12 - no pain, swelling or laxity; functional and quad testing > 85% contra; begin running program
28
PCP Post-Op
Guidelines - no OKC initially, avoid post tib trans, resistance or hip resistance exercise placed above knee, rehab protocol more conservative due to greater post shear forces
Wk 0-4 - brace locked at 0 for 1 wk, unlocked after; WBAT w/ brace locked at ext; achieve full knee ext, 60 flex
**pillow under post tib to prevent sag
Wk 4-6 - brace unlocked for gait training (wk 6-8 for all activities)
Wk 4-12 - knee flex 90-100; wall slide, mini squat, hip strengthening, leg press 0-90
Mo 3-6 - 10 flex can lack up to 5 mo, normal gait, OKC exercises, jogging in pool
Mo 6 - normal ROM, strength equal to unaffected, jumping/running progression, sport specific and RTP
29
MCL/LCL (CESI)
tight in ext, lax in flex
C - direct blow to outer or valgus force (MCL); inner or varus (LCL)
**noncontact from rotation can occur, usually includes cruciate
E - tender at jt ling along ligament, laxity
**extra-articular surface, effusion not common
S - valgus/varus testing
I - A/P, lat, merchant (X-ray; T2 MRI
30
MCL/LCL Grades and Surgery Indications
I - 1-2 weeks return, no inc jt line opening, some tenderness along lig
II - 3-4 weeks; 5-10 mm opening, firm end pt
III - 6+ weeks; > 10 mmm complete disruption, vague end pt (brace/immob possible)
Indications - bony avulsion, tib plat fx, cruciate lig, intra-articular entrapment of ligament`
31
Meniscal Injury
Lat meniscus more mobile than medial
ant horn more mobile than post horn
*less mobility = more vulnerable
C - direct contact, rotational mechanism, cut/pivot, degeneration
E - pain, stiffness, locking/catching, giving way
T - rehab, meniscectomy, repair (limit WBing, flex)
32
Meniscal Repair (conservative)
Day 1 - Wk 3 - brace locked at 0 for ambulation, ROM 0-90, WBAT w/ crutches and brace at 0
**post horn - no resisted HS for 6 weeks
Wk 4-6 - PREs (1-5 lbs), cycling, mini squat within 90
Wk 6-10 - continue CKC strengthening, cycling, balance exercises, possible initiation of plyometrics
Wk 11-15 - continue plyometrics, begin running progression
33
Patellar Fx (CEIT)
C - indirect cause by pull of pat tendon when knee part flex, fall or direct blow
E - swelling, possible bone separation
I - X-ray
T - immob, usually 2-3 mo
34
Articular Cartilage Procedure
Progressive WBing 6-8 wks after surgery (if debridement only done, pt can WB)
Unloaded A/PROM begin immediately (CKC avoided for 6 weeks)
35
Osteochondritis Dissecans (CEIT)
C - partial or complete separation of articular cartilage and subchondral knee due to lack of blood flow
E - clicking, locking, swelling (lesions more common at med fem condyle)
I - tunnel view
T - surgery if conservative tx fails
36
Acute Patellar Dislocation (CESIT)
C - direct blow or sudden twist
E - misalignment, tender of med aspect, effusion
S - patellar apprehension, lat glide test
I - sunrise view
T - must be relocated (relocation often happens with knee ext)
often bracing, splinting, casting up to 6 weeks
37
Segond Fx
avulsion fx at LCL insertion
| C - excessive IR and varus
38
Patellar Instability, Overuse, Fx, Direct Trauma
acute and chronic patellar dislocations, recurrent subluxations
tendinopathy, OS, SLJ
fx, fx/dislocation, OCD
art cart lesion
39
Patellar Compression Syndrome, Soft Tissue Lesions, Biomechanical
excessive lateral pressure, global patellar pressure
ITB, plica, Hoffa's (inflamed fat pad), bursitis, MPFL pain
foot hyperpronation, LLD, loss of flexibility
40
J-Sign
lat pat tracking when flex and ext
41
Pat Glide Test
hypo < 1/4 of pat
| hyper > 3/4 of pat
42
Patellar Tilt
no up movement due to tight retinaculum
43
Basset Sign
tenderness over med epi of femur
44
Sulcus Sign
line draw med/lat walls of trochlea
| > 150 deg shallow, may be predisposition for instability
45
Q angle
angle between ASIS and tib tub (going through center of patella)
Men 13, Women 18
46
Ottawa Knee Rules
trauma, > 55
tender over pat/fib head, unable to flex > 90, 4 steps
for patellar pathology:
A/P - best for tib plat, joint space at 30 deg flex
axial image
47
X-ray Views
A/P - jt space narrowing
Lat w/ Part flex - pat and jt effusion
Sunrise/Merchant - relationship of pat and femur
Tunnel - tib and fem condyles
48
Patellar Tendon Rupture (CEIT)
C - strong quad contraction vs fixed LE, fall on part knee flex
E - unable to WB, dec knee ext AROM, instability, effusion
I - MRI, US, may see pat alta on X-ray
T - surgery
49
Acute Pat Rupture Repair
Wk 0-2 - hinged knee brace full ext, TTWB w/ B crutches, ROM 0-15, quad isos
Wk 3-6 - brace 0-45 (0-60 wk 4, 0-90 wk 5-6); WBAT w/ brace in ext, FWB and full ROM wk 6; balance and prop in brace]
Wk 7-12 - CKC strengthening < 70
Wk 12-16 - progress to SL squat, leg press, light agility drills
Wk 16-24 - advance agility drills, running progression, begin plyometrics, sport interval progression
50
OS and SLJ (CET)
C - condition affect adolescents; OS - pain of attachment of pat tendon to tib tub; SLJ - pain at inf pole of pat
E - swelling, pain, pt tender, pain with kneel/run/jump
T - dec activity, iso strengthening, ice
51
Pat Tendinitis (Jumper's Knee) (CET)
C - jumping, kicking, running
E - pain at pat tendon (can be after, during and after, and even just at rest)
T - ice, pat tendon strap, friction massage
52
Runner's Knee (ITB Friction Syndrome) (CET)
C - repetitive and overuse, possible structural abnormalities at foot (common with genu varum and over pronated)
E - pain at lat knee, + Ober
T - address foot structure, possible orthotics, ice, proper warm up, rest
53
Peroneal Nerve Contusion (CET)
C - compression of nerve as it goes behind fibula; most often with direct contact
E - local pain after radiating down ant leg into foot, numbness usually lasts short time
T - RICE, return as soon as symptoms as gone and no weakness
54
Bursitits (CET)
C - prepatellar most common, usually from pressure such as kneeling
E - localized swelling (not intra-articular)
T - eliminate cause (kneeling)
