Knee Pathology - Tendons & Ligaments

Question 1

Tendinopathy

Answer 1

general term, pain + loss of function.
no specifc structures required for Dx.

Question 2

Tendinosis

Answer 2

microtears
visible on imaging

Question 3

Tendinitis

Answer 3

inflammation

Question 4

Jumper’s Knee definition & MOI

Answer 4

Patellar Tendinopathy (most common) or Quad Tendinopathy
MOI = Overuse

Question 5

Patellar Tendon Rupture is common in what population?

Answer 5

Younger, usually sports-related MOI

Question 6

Quad Tendon Rupture is common in what population?

Answer 6

Age 45+

Question 7

Tendon Ruptures MOI

Answer 7

High tensile force on weak tendon.
Sudden quad contraction on flexed knee.

Question 8

Patellar Tendinopathy clinical presentation

Answer 8

Pain at inferior patella
Gradual onset
Load dependent (agg = higher load/activity)

Question 9

Quad Tendinopathy clinical presentation

Answer 9

Pain at superior patella
Gradual onset
Load dependent (agg = higher load/activity)

Question 10

Tendon Ruptures clinical presentation

Answer 10

Unable to extend
Palpable gap
Acute onset

Question 11

Grade 1 Ligament Sprain

Answer 11

A few fibers torn
Integrity maintained
Pain with stretch

Question 12

Grade 2 Ligament Sprain

Answer 12

50% fibers torn
Partial integrity lost
Pain with stretch

Question 13

Grade 3 Ligament Sprain

Answer 13

Complete rupture
No pain to ligament (may have pain if surrounding structures affected).
Excessive joint play

Question 14

The ligament that most commonly gets fully ruptured is the ___

Answer 14

ACL

Question 15

ACL Rupture MOI (non-contact)

Answer 15

Quad contract w/o ham co-contract in near-full extension.
Dynamic Valgus position.

Question 16

ACL Rupture MOI (contact)

Answer 16

Lateral contact = valgus torque

Question 17

Dynamic Valgus position

Answer 17

Hip ADD & IR
Knee ABD

Question 18

Common presentation if ACL detaches near insertion

Answer 18

Hemarthrosis (bleeding in the joint)

Question 19

ACL Injury: indications for rehab (no surgery) as first tx approach

Answer 19

Dynamic stability (potential Coper)

Question 20

Coper Classification tests

Answer 20

6-min hop
Knee Outcome Survey
Global Rating Score
Number of give-way episodes

Question 21

A potential Coper meets threshold on ___ criteria

Answer 21

All 4

Question 22

A non-Coper fails ____ criteria

Answer 22

1 or more

Question 23

ACL Injury: indications for surgery

Answer 23

Persistant instability (non-Coper)

Question 24

ACL Injury: types of reconstruction surgeries

Answer 24

Autograft (bone-patellar tendon-bone or quad tendon graft).
Allograft (from donor).

Question 25

ACL Injury: repair surgery

Answer 25

BEAR implant: Bridge-Enhanced ACL Repair. Creates bridge btwn ligament ends, promotes natural healing. Maintains mechanoreceptors.

Question 26

ACL Injury: criteria for return to sport

Answer 26

9 months to reduce risk of re-injury. Criteria: 1. No pain or effusion 2. Quad strength 90% symmetry btwn injured and non-injured. 3. SL hop test 90% symmetry 4. Good movement patterns and symmetric loading

Question 27

ACL Injury: open-chain knee extensions post-op is a controversial topic. What is the argument for doing this exercise with NO restrictions?

Answer 27

Quad strength is critical! Open-chain trains quads for functional movement. Closed-chain often leads to compensations. OKC Ext more accurate than MMT for monitoring progress.

Question 28

ACL Injury: open-chain knee extensions post-op is a controversial topic. What is the argument for RESTRICTING this exercise early? Rebuttals?

Answer 28

Concern for loosening graft due to strain on ACL - BUT walking & closed-chain also strain ACL! Concern for patellar tendinopathy (if BPTB graft) - BUT this is how we treat pat tdnopathy anyway!

Question 29

PCL Injury: common MOIs (3)

Answer 29

1. Posterior-directed force on proximal tibia (common in car accidents, knee hits dash). 2. Falling on flexed knee. 3. Sudden, violent hyperextension.

Question 30

PCL Injury: indication for conservative management

Answer 30

PCL isolated, no other structures affected

Question 31

PCL Injury: indication for reconstruction

Answer 31

Grade 3 Lots of instability

Question 32

MCL Injury: MOI

Answer 32

Valgus stress on planted leg (lat to med force), contact injury

Question 33

MCL Injury: non-operative tx

Answer 33

Grade 1: treat pain and swelling, brace for pain. Grade 2/3: treat instability, medial immobilization. Early WB to work quads!

Question 34

Why does the MCL have the best prognosis for recovery without surgery?

Answer 34

Blood supply!

Question 35

LCL Injury: MOI

Answer 35

Varus stress on planted leg (med to lat force), contact injury

Question 36

What commonly occurs with an LCL injury?

Answer 36

Avulsion at femur or fib head

Question 37

Posterolateral Corner (PLC) Injury: what structures involved (3)?

Answer 37

LCL Popliteus Tendon Poplito-fibular Ligament

Question 38

Posterolateral Corner (PLC) Injury: isolated MOI

Answer 38

Post/Lat force to tibia (hyperext + varus), contact injury

Question 39

Posterolateral Corner (PLC) Injury: combined MOI (3)

Answer 39

1. Hyperext, ER, varus 2. Knee dislocation 3. Posteror force on flexed knee & ER tibia.

Question 40

Posterolateral Corner (PLC) Injury: often occurs in combination with what other injuries?

Answer 40

ACL or PCL

Question 41

3 most common concomitant injuries

Answer 41

1. ACL + MCL 2. ACL + MCL + Med Meniscus (Unhappy Triad) 3. PLC + ACL or PCL