Knee Lecture

Question 1

Screw Home Mechanism

Answer 1

As knee extends the tibia ER, as the knee flexes the tibia IR

Question 2

Which muscle will help unlock the knee?

Answer 2

Popliteus

Question 3

Structures for extension:

Answer 3

Rectus femoris
Vastus intermedius
Vastus lateralis
Vastus medialis
Patellar ligament
Quadriceps tendon

Question 4

Structures for flexion:

Answer 4

Biceps femoris
SM
ST
Popliteus
Gastroc

Question 5

Structures stabilizing the knee:

Answer 5

LCL
MCL
ACL
PCL
Medial/Lateral meniscus

Question 6

Chief complaint:

Answer 6

pain
click
instability
stiffness
locking

Question 7

History:

Answer 7

MOI
SINS
Functional Status

Question 8

Differential Dx:

Answer 8

Anatomy

Biomechanics

Question 9

Location

Answer 9

Superficial
Anterior/Posterior
Medial/Lateral

Deep

Question 10

Possible injured structures/pathology

Answer 10

Ligament
Articular
Bone
Bursitis
Nerve
Musculo-tendinous

Question 11

Health Condition

Answer 11

Articular Defects
Meniscal Tears
Ligament
Extensor Mechanism
ITB
Osgood-Schlatter
Fx
Fat pad/bursa

Question 12

Differential Dx:

Answer 12

Infection
RA
DVT
Neurogenic Claudication
PVD
Cancer
Med Side Effects
Lumbosacral Pathology
Thyroid Disorder

Question 13

Knee Questionnaires:

Answer 13

WOMAC
LEFS
KOOS

Question 14

Subjective

Answer 14

Current Hx
CC (SINS)
Social/Environmental
PMH
Activity Restrictions
Participation Limitations

Question 15

Objective

Answer 15

Anatomical components
Source of pain
Impairments/movements/posture

Question 16

Examination

Answer 16

Posture
Gait
Palpation
AROM
PROM
MMT
Accessory
Flexibility
Special Tests
Clearing Exam

Question 17

Postural Analysis:

Answer 17

Tibio-femoral valgus/varum
Genu recurvatum
Tibial varus
Patella alta
Patella laterally tilted
Edema/swelling
Eccymosis
Atrophy
Skin Callous

Question 18

Gait Analysis:

Answer 18

Antalgic?
Step length?
Trendelenburg?
Decreased knee extension at TSt

Question 19

Functional Activities:

Answer 19

SLB, squat (SINS)
Pain?
Movement faults?
ROM limited?

Question 20

Palpation

Answer 20

Joint line
Musculo-tendinous inserts
Bursa
Ligament
Popliteal Cyst
Fat Pad

Question 21

Normal knee ROM

Answer 21

0-150

Question 22

PROM

Answer 22

Endfeel?

Pain?

Question 23

Accessory motion (knee)

Answer 23

Tibiofemoral: AP & PA

Patellar glides

Question 24

ACL special tests

Answer 24

Anterior Drawer @ 90
Lachman’s @ 30

HS tightness, false negative

Question 25

PCL special tests

Answer 25

Godfrey's | Posterior Drawer

Question 26

MCL special tests

Answer 26

Valgus

Question 27

LCL special tests

Answer 27

Varus

Question 28

Meniscus special tests

Answer 28

McMurray Thessaly (gold standard) pain, audible or palpable catching sensation

Question 29

MCL

Answer 29

Valgus test Worst if positive in 0 extension than testing in 30 Why? Joint capsule now compromised

Question 30

Patellofemoral Compression (LongAQ)

Answer 30

Provocative | (+) pain

Question 31

What is OA?

Answer 31

Articular cartilage degeneration Bony hypertrophy & osteophyte formation *special test

Question 32

OA: Findings

Answer 32

``` Joint hypomobility, limited ROM Pain w/ motion & worse w/ compression Mornign stiffness & after being in a static position Muscle weakness Crepitus/grinding Deep, achy pain Insidious onset (hx of prior trauma) c/o knee gives during WB ```

Question 33

Meniscal Lesions

Answer 33

``` c/o pain, clicking, catching, locking MOI: can be traumatic or insidious (degenerative) joint line is tender to palpate McMurray & Thessaly Presentation depends on the tear ```

Question 34

ACL: MOI

Answer 34

``` valgus knee position hyperextension, rotation 70% non-contact deceleration phase cutting, landing "pop" Acute: swelling, laxity, pain Chronic: unstable joint, loss of function ```

Question 35

MCL: MOI

Answer 35

valgus force, knee collapse inward football, soccer, slip, direct blow to lateral knee injured with medial meniscus/ACL

Question 36

PCL: MOI

Answer 36

``` traumatic, hyperflexion injury football, falling onto knees, dashboard excessive tibial post translation c/o weakness, instability HS testing will aggravate ```

Question 37

Patellofemoral Pain

Answer 37

tenderness along facets crepitus passive patellar compression (QS/LAQ) --> CC squatting, kneeling, stretch to qudas/ITB may reproduce sx

Question 38

ITBS

Answer 38

MOI: tightness elicits increase rubbing, athletes with repetitive knee flexion/extension hip muscle imbalances

Question 39

Fractures

Answer 39

Patellar & Tibial Plateau most common | MOI: traumatic

Question 40

ACL: ICF

Answer 40

``` HC: ACL tear Body function & structure: decreased knee ext Activities: impaired walking tolerance Participation: can't play soccer Environmental: school has stairs Personal: very motivated ```