lecture 9: conditions of the knee Flashcards
1
Q
what are the two joints that make up the knee
A
tibiofemoral joint
proximal tibiofibular joint
2
Q
what type of jointt is the tibiofemoral joint and explain what that means
A
synovial hinge
=flexion and extension
3
Q
what type of joint is the tibiofibular joint and explain
A
plane synovial joint
=gliding up and down,ant and posterior
4
Q
what is the primary function of the proximal tibiofibular joint
A
dissipate the torsional stress applied to tthe ankle
5
Q
what are some ligaments of the knee joint
A
menisci PCL ACL meniscofemoral lateral coll. and medial collacteria
6
Q
what is the mainn weight bearing bone of the body
A
tibia
7
Q
what percentage of weight does the tiba bear
A
80%
8
Q
how much weight percentage does the fibula hold
A
15-20%
9
Q
if you injury your tibia, can you walk on it and why
A
no t usually because it bears most the weight
10
Q
which fracture is longer to heal and why (tibia or fibula)
A
tibia because you cannot walk on it which takes longer to recover
11
Q
can you usually still walk with fibula fracture
A
yes
12
Q
true or false: the knee usually compensates for other strucures? explain
A
true because there are so many msucles (from ankle and hip) that cross in that area which makes the knee compensate for if thre is any weakeness anywhere
13
Q
if there is knee nerve damage, you will only feel it in the knee?
A
no because the nevre at the knee splits meaning yoy can feel symptoms in other places
14
Q
what are the knnerves that pass posterior to the kneeS
A
sciatic (tibial and common fib)
15
Q
what are the nerves that pass anterior to the knee
A
saphenous, deep and superficial peroneal
16
Q
what are the functions of the meniscus
A
Absorption and dissipation of forces. Improve joint congruency and the stability of the joint.
17
Q
since the meniscus is mostly water it helps with …
A
lubrification
18
Q
what percentage of the meniscus is water
A
74%
19
Q
with WB movements, what happens to the fluid in the meniscus
A
most of the fluid is pushed in the joint to promote gliding and lubrification.
20
Q
the meniscus is thicker on the medial or lateral aspect
A
thicker on lateral
21
Q
is there more movement on the medial or lateral side of the meniscus
A
mor emovement laterally
22
Q
where are both horns of the menisucs attached to
A
are attached to the tibial plateau and linked together with the transverse ligament.
23
Q
how are the two meniscus attached to each other
A
trhoug hthe traverse ligament
24
Q
where is the medial meniscus attached to
A
medial meniscus is attached to the MCL and the semimembranosus muscle.
25
where is the lateral menisucs connected to
The lateral meniscus is connected to the PCL and popliteus muscle.
26
which meniscus is more easily injured
medial
27
what is the function of bursae
Reduce friction between two structures.
| q
28
the post bursea comminicates with what
with the joint capsule
29
how can the bursae be inflammed
with intracapsular injuries
30
the fluids in the bursae are influenced by what
postition of the joint
31
the postiion of the joint affects what in the bursa
fluid
32
if there is flexion of the knee, what happens to the bursa
fluid will be pushed posteriorly
33
if there is extension of the kne, where will the fluid in bursea be pushed
extension will push fluids anteriolrly
34
true or false; a brusea cannot rupture
false it can rupture with traumatic events
35
what are the structures that provide dynamic stability to the posterolateral knee
include the iliotibial band, long and short heads of the biceps femoris muscle, and the lateral head of the gastrocnemius muscle.
36
the include the iliotibial band, long and short heads of the biceps femoris muscle, and the lateral head of the gastrocnemius muscle provide STATIC stability
false, dynamic
37
the posterolateral corner of the knee is very stable/unstable
stable
38
Anatomic components comprising the posterolateral corner of the knee serve to provide what to the poserolotaral corner
both dynamic and static stability to the posterolateral corner
39
the structures of the posterolateral prevent what movements
preventing hyperextension, tibial external rotation and varus angulation.
40
the ligaments in the posterolateral corner provide dynamic or static stability
stabtic
41
what are the primary ligaments that provide static sttability to the knee
lateral collateral ligament, popliteus tendon, and popliteofibular ligament.
42
what are the secondary static stabilizers of the posterolateral corner
lateral capsule ligament, the coronary ligament and the fabellofibular ligament.
43
a medial collateral ligament sprain creates what type of instability
straight medial instability
44
what structues are damaged in a medial collateral lgiament sprain
MCL damaged, potentially the posteromedial capsule and PCL
45
in a medial collateral ligament sprain there will be varus or valgus insptabilt
valgus
46
what is the MOI of medial collateral lig sprain
valgus force inn weight bearing psotitionn
47
what is more common MCL or LCL sprains
MCL more common
48
what type of isntability arrises from LCL
straight lateral instability
49
tension on lateral comparment causes what in LCL sprains
Tension on lateral compartment, damage to LCL, lateral capsule ligaments and potential PCL
50
why is LCL sprain rare
, since biceps femoris, IT band and popliteus provide strong stability
51
what type of isntability do you have in ACL tear
sraight anterior disability
52
what are the forces associated with ACL tear
Cutting, decelerating, change of direction, and landing
53
when you have an ACL tear what is the motion of the bones
Tibial plateaus subluxes anteriorly on the femur
54
there is a higher rate of ACL tears in women or men
in women
55
what ratio is important in ACL tears and explain
Quad to hamstring ration (lack of eccentric hamstring)
=your must have a good ration to provent anterior translation of the tibia (caused by the quads)
56
true or false; the middle of the ACL isnt painful but sides are
rtue
57
for ACL sprain, it can be non traumatic?
true
58
what are the SS for ACL tear
```
Popping, tearing sensation- 80% of patients
Rapid swelling
Hamstring spasm
Pain deep in the knee
Feeling of “giving away”
```
59
what symtpom is common is 80% of patients with ACL tear
poppint, tearing senstaion
60
what is the main MOI for PCL tear
knee hyper flexion
| Posterior glide of the tibia on the femur
61
why is the PCL harder to tear
it is thicker and more solid
62
what is the difference in ACL vs PCL tear
for PCL you need direct contact to push it posteriorly to tear whereas ACL does not need to be traumatic.
63
what is the role of the hamstrings in ACL tears
quads pulls on tibia forward threfore the hamstrings need to be strong to combat that
(to protect against anterior glide)
64
in the acute phase of ligament sprains, what is the mamangement
```
PEACE & LOVE
Early strengthening
Maintain full ROM
Swelling management
Proprioception
Pain management
```
65
what is needed before going into surgery for lig sprains
they need to maintain full ROM
66
the treatment for MCL is usually conservative or invasive
conservative
67
what is the healing process ofr MCL
4-6 monthos
68
why is bracing sometimes recommeded for MCL tear
to help with fear but not necsessary since the muscles around it should stabilze it with rehabilitation
69
for MCL sprain, do they usually operate
no
70
if you completely tear your MCL, will there be laxity still
yes
71
when do you use surgery for PCL
surgery for severe tears
72
true or false: you can use bracing for PCL
true it might help with fear
73
what is the rehab time for PCL
6 montsh
74
is the treatment for LCL conservative or invase
conservation
75
what needs to be streignthed after LCL injury
biceps femoris, IT band and popliteus strengthening
76
ACL tear is usually surgical repair or conservattive
surgical repair
77
what is the rehab period for ACL
6 months
78
true or false, the quicker you get out of rehab for acl, the less likely you are to get injured
false, Every extra month of rehab decreases the risks of re-injury
79
anteromedial rotary instability is caused by what moement of the bones
anterior external rotation of the medial tibial condyle on the femur
80
true or false:
Instabilities are not necessarily unidirectional.
81
what are the strucutes associated to anteromedial rotary instability
medial compartment ligaments and oblique popliteal
82
anteromedial rotary instabiltiy is accentuated by what
Accentuated by medial meniscus tear and ACL (unhappy triad)
83
what is the unhappy triad
ACL, MCL and medial meniscus
84
what is the movement of bones in anterolateral rotatry instability
anterior internal subluxation of the lateral tibial condyle on the femur
85
what strucures are usually damaged in anterolateral rotary instability
ACL main ligament damaged, IT and lateral capsule ligaments as well
86
which type of instability is the most rate
posteromedial
87
why is the posteromedial rotaary rare
beacuse of amount of muscles in this area
88
what is the movement of bones in posteromedial rotary instab./
The medial tibial plateau shifts posteriorly on the femur and opens medially
89
what are the structures injuryed in posteromedial roray instab.
Superficial MCL, posteromedial capsule, oblique popliteal ligament, both cruciate ligaments*** severe injury
90
what are some of the muscles in the posteromedial area
sartorius, gracilis semi tend and mem and medial gastroc
91
what is the MOI for posterolotary rotary isntabi
Sudden anteromedial force that brings the knee joint from full knee extension into hyperextension, combined with varus moment
92
what structutes are usually injured in posterolateral rotary instab
PCL, arcuate-popliteal complex, posterolateral capsule and LCL
93
when injuring one quadrant, you should only focus on rehabingt that 1 quadrant?
no , also strngthing and rehab oppsotie quadrant
94
what are the 3 types of acute/traumatic meniscus tears
longitudinal
radial
horizontal
95
what are the three types of chronic/degenerative mendiscus tears
bucker handle
parrot beak
flap
96
a longitunial tear may lead to
buckle handle
97
a radial tear may lead to
parrot beak
98
a horizontal tear may lead to
flap tear
99
what type of tear can lock the knee joint
flap tear
100
what is the percetttage of colalgen 1 in meniscus
75% type 1 collagen
101
whatt are the functions of the mensicus
Distribute load (90% in knee flexion/ 50% in knee extension)
Joint lubricant
Deepens the articulation
Increases stability
Limits femoral translation on tibial plateau
102
what is the load distribution for menisucs
90% in knee flexion/50% in knee extension
103
explains why deepending the articulation of the knee is good
increases stability
| limits femoral translation on tibial plateau
104
what is the medial attachement of menisuc
MCL
105
what is the lateral attachement of the meniscus
meniscofemoral ligament
106
what is the anterior attachement of he meniscus
ACL, transverse ligament (between both meniscus) and the patellomeniscal ligament (thickening of the anterior capsule)
107
what is the posterior attachment of the meniscus
PCL, semimembranosus muscle (medial) and popliteus (lateral).
108
what influecnes the movement of the medial meniscus and why
the semimembranosus by constaction
109
the blank meniscus is less mobile
medial
110
what is the different in medial vs lateral transltation
medial : 2-5 mm
lateral 9-11 mm
AP plane
111
what forces cause meniscal tears
compression, tensile, shearing with rotation (on femor on fixed tibia)
112
why is medial more injured than lateral menisuc
due to decrased mobility
113
meniscus tears can be acute trauma only
false, also degenratice
114
what are the 3 knee injury classifcationns
red/red
red/white
white/white
115
which classification is the best to heal and why
red/red
| most vasculature so more blod
116
which classifcation is the worst to heal
white white
| no blood supply
117
describe the locationn of meniscus tear inn red red
Occur in the vascularized outer third of the meniscus
118
describe the lcoatinn of red white tear
Occur in the middle-third of the meniscus where the vascular supply is predominately located at the outer edge of the tear
119
decrsibe the locationn of the white white tear
Occur in the inner third and where no blood supply exists.
120
what is healinng of the menisuc tear based on
type of tear and severity
121
which heals are easier to heal, lonngitudinnal or radial
lonngituinal
122
traumatic and acute or chronnic and degenrative have higher healing rates
traumatic and acute
123
what it the MOI for meniscus tear
cutting or shearing forces
| compressio
124
true or false: you will feel dull pain at the time of injury for mensicus tear
false, sharp
125
where will you feel pain with a mensicus tear
pain along the cpllataeral lig
| pain with rotationn and extreme flexionn
126
is there more or less swelling in menisuc vs acl
lesss joint effusion for menisum (less blood supply
127
will your knee by givibg out with menisuc tears
yes
128
what is managemnt for menisuc tears
```
PEACE & LOVE
Pain management
Swelling management
Gait retraining
Proprioception
Maintain ROM
Standard of care is the conservative management
Surgery has a greater chance of leading to degenerative arthiritis
```
129
why is the menicus healing usually done conservatively
because
| Surgery has a greater chance of leading to degenerative arthiritis
130
what are the cases where we would do surgery on the minsucs
tear geater than 1cm less than 4 cm
if its a long tear (vertical) vs a horsonntal
if it occurs in the red red rad
131
where will you feel pain for patellofemoral pain syndorm
pain in the patellofemoral joint (feel clicking)
132
what is patellogemoral syndrom
when the patella is not follownig its usually track in the groove
133
what can patellofemoral pain symdrome be cauesd be
```
muscle imbalacnes (quads)
malalighments
```
134
what are the signs are symptoms for patellogemoral
Anterior knee pain, dull and achy
Increases with squatting, sitting in tight space and descending stairs
Point tenderness over lateral facet of patella
Crepitus
135
when dopes pain get worse for patellofemoral pain symdrome
incraeses with squating, knee flexion (sitting) and descing stairs
136
what is chondromalacia patiella
degeneration of the articular cartilage of the pate;;a
137
what facets are most affects wtith chondromallacia patiella
medial and lateral facets
138
what are the forcest that cause chondromalacia patiella
shearing and compressire
139
what ate the 4 stages of chondromalacia patella
1) articular cartilage
2) fissures
3) fibrulations
4) exposes bone
140
patellar instabilities and discolations are more common laterally or medially
lateally
141
what are the 4 causes of patellar dispplacement
- muscle imblances
- bony deformation
- cutting motion
- q angle
142
explain q angle
angle between your patella and your quads
| + q angle= more valgus
143
what is patella plica
sydrome where synoval lining folds into knee joint cavity
144
how can the synovial lining become inflammed for patella plica
repreatd direct blows to capsule or repeating stresses as it passese over femoral condyles
145
whay is the patella plica impinged from
patellogemoral joint
146
true or false: patella plica is aggravted by quad exercises
true
147
what are thr 4 signs are symptoms of patella plica
- movie like going signs (bilateral stiffness caused by knee flexion for too long)
- sharp pain for 8-10 steps (max stretched and impiged within patellofem joint)
- pseudol locking meniscus tears)
- pop or snap in knee extension
148
what2 syndromes have movie going synfomr
patella plica syndrome
| patellofemoral pain syndomr
149
what ia patellar tendinitis (jumpers knee)
Inflamed/irritated tendon from repetitive or eccentric knee extension activities
150
jumpers knee (patellar tendinitis) is caused by extrincis or intrinnsic factors
both
151
where will you feel pain in patellar tendinitis
at the patellar tendon (sharp or achy)
152
what is the complication that patellar tendinitus can lead to
patella tendon rupture or patellar avulsion
153
what are two common conditions that cause bone defromation of the knee in kids
osgood schlater
| sining larsen johanson
154
what is osgood slater disease
traction type injury to the tibial apophysis where patella tendon meets tibial tubuercle (muscles full on it)
155
who is more likely to get osgood slater
women 8-13
men 10-15
=near growth spurts
156
what is the main obivious sign of osgood slaters
enlarged and prominent tibial tuberly
157
true or false: there wont be any pain for osgood slaters
false, during activtiy
158
what van you wear to relieve pain from osgood slaters
tendon straprs which creates new point of muscle insertion ehile on
159
what singing larson johanson syndrome
ssimilar to osgood
| however it is deformtion/excessive strain on the inferior patella pile (at origin or patella tendon)
160
which ager is more likely to get sinding larsenjohanson
kids 8-13 bones are growing
161
osgood slater is an injury to where
tibial apopyshysis (where tendon meets tubercle)
162
sining larsen johanson is an injury to where
closer to the patella
| the patella tendon origion
163
what is IT band frcition syndrome
IT moves ove lateral condyle of femur
| becomes irritated gfrom snapping force
164
when is IT band friction syndrome paricularly intense
durinng strike through contact (mid foot stance)
| first 30 degrees from flexion to extension
165
what part of the knee will be inn painnn
lateral aspect of the knee )2-3 cm above joint line)
| and may raidate to thigh or distal tiabial attachment
166
what are some intrinsic factors that cnan cause IT band frctiin syndrome
Intrinsic factors- muscle weaknesses/imbalance, genu valgum, leg length discrepancy, tightness in gluteals/TFL
167
true or false: training errors can have an effect on IT band friction
true
168
what is the management for ALL TENDINOUS PATHLOGIES
Pain management
Isometric strength
Eccentric strength
```
Gradual re-exposure to mechanical stress (hydrotherpay)
Biomechanical analysis (running, gait and other functional movements)
```
169
chondral and osterochondral fractures involve what
articulat cartilage and bone att the jpint
170
what makes up 75% of the lesions in chondral and osteogchondra fractions
femoral
171
what is the MOI for chondral and osteroxhonrdral factures
compression with shearing
| rotaion
172
when will you get locking in chondral anf osteochondril fractures
if the joint fisplaces (osteochondritis dissecans)
173
what are the strectures intra artticulr/capsular that cause the most swelling
ACL
PCL
medial and latt meniscus
174
what are the strucures that cause swelling in the extrecapsular
```
patellar lig
patellar retinatum
MCL
LCL
popliteal lig
anteriolat lig
```
