Knee concepts

Question 1

what is the meniscal blood supply like?

Answer 1

*** Poor Blood supply
Red Zone (outer 1/3)
Pink Zone (middle 1/3)
White Zone (inner 1/3)

Question 2

OA of the knee cluster

Answer 2

Pain in the knee + 3 of the following:
1. > 50 years old
2. less than 30 min of morning stiffness
3. Crepitus on active motion
4. Bony tenderness
5. Bony enlargemnet
6. No palpable warmth of synovium

Or, pain in the knee + 1 of the first 3 +imaging:

Question 3

Ottawa knee rule

Answer 3

any one of the 5 for radiography:
1. age 55 or older
2. can’t take more than 4 steps both immediately and in the emergency department
3. can’t flex beyond 90 degrees
4. tenderness in head of fibula
5. isolated tenderness of patella (no bone tenderness of knee other than patella)

Question 4

TKA

Answer 4

> Primary Indication is knee OA
Total vs Partial (unicompartmental)
Usually WBAT afterward
– Especially if cemented
Patient may require assistance with lifestyle modification
Complications:
– Loosening – Infection – DVT

Question 5

ACLR rehab precautions

Answer 5

Avoid: open chain 0-30 degrees, increased strain on ACL graft (4-6 weeks)
limit PFJ forces with BPTB; limit HS strength for 12 weeks, STG

Question 6

ACLR standard treatment guidelines

Answer 6

Immediate post-op (1-3 wks)
Achieve ROM 0-90 degrees, quadriceps activation and patellar mobility

Early post-op(4-6 wks)
Increased flexion ROM, gait without AD, increased quad strength

Intermediate (7-15 wks)
Flexion within 10 degrees of uninvolvedside, quad strength 60% of uninvolved side

Late post-op (16-25 wks)
Quad strength > 80% of uninvolvedside, normal gait pattern, Full ROM, minimal effusion

Return to Sport (25-38 wks)
Maintain quad strength,hop test 85% symmetry, PRO’s > 70%,minimal to no effusion