MSPT - EXAM 3 KNEE Flashcards
(228 cards)
1
Q
What is KT-1000?
A
Device used to test knee laxity by testing AP translation of the tibia relative to the femur.
KT-1000 is more accurate at diagnosing ACL instability than MRI and can be used to test the effectiveness of an ACL repair.
2
Q
Should a person with an ACL repair use a Functional Knee Brace? What about a person with an ACL tear that did not have a repair?
A
FKB are indicated if the patient has not had an ACL reconstruction. It does not do much for patients that had surgery.
3
Q
Marny is 9 days s/p ACL reconstruction. Current flexion ROM is 90° and she has substantial effusion. Before aggressively pushing the knee into flexion with PROM, what should you do?
A
Reduce swelling and pain.
4
Q
Uma is 2 days s/p ACL reconstruction and is having trouble activating (contracting) her quads during quad setting exercises and during knee extensions from 90° to 40°. What intervention should be used to help her re-establish voluntary quad control?
A
Electrical stimulation while performing quad sets.
5
Q
Once Uma is able to independently contract her quads, what intervention should be used to further facilitate quad performance (ACL rehab)?
A
Proprioceptive exercises, squats, single-leg balance
6
Q
Which type of graft selection has the greatest ultimate load-to-failure and biomechanical stiffness (ACL repair)?
A
Quadrupled hamstring
7
Q
Contraindications for ACL reconstruction
A
Partial tear, minimal instability, no joint laxity
Older, less active pt w/ minimal instability
Comorbidities that put pt at high risk for surgery
8
Q
ACL loading is greater with weight-bearing or non-weight bearing exercises?
A
NWB
9
Q
What trunk movement increases load on ACL during lunging or squatting?
A
Forward trunk lean
10
Q
What heals/matures faster: autograft or allograft?
A
Autograft
11
Q
Lower intensity plyometric double leg drop from a 60 cm platform results in a load similar to performing…
A
seated knee extension
12
Q
What 2 special tests should be used in conjunction with a valgus stress test to assess injury to medial knee structures?
A
Anteromedial Drawer Test
Dial Test
13
Q
Why is there more gapping when the stress radiograph is taken with the knee at 20 deg than when the knee is at 0 deg?
A
In full extension, the ACL, MCL, and posterior oblique ligaments limit gapping
At 20 deg, knee is dependent on MCL. If torn, it’d gap.
14
Q
For non-operative treatment of Grade III medial knee injury, at what week can the hinged knee brace be removed for gait?
A
6 weeks post-injury.
15
Q
Peripheral single longitudinal tear in red-red indicates…
A
meniscal repair is needed
16
Q
Prior menisectomy is an indication for…
A
meniscus transplantation
17
Q
3 types of cases where surgical repair of a ruptured Achilles tendon is recommended
A
Acute and complete tendon rupture
High-demand, elite-level participants
Complete rupture undiagnosed or untreated so that end-to-end apposition can’t occur
18
Q
What post-operative complications of Achilles repair have greatest negative impact on long term outcomes?
A
Tendon rerupture
Severe wound infection
19
Q
What benefits have been seen in early motion / early weight bearing protocols for Achilles repair?
A
Lower rate of adhesion formation and improved ankle ROM
Better levels of physical and social functioning with higher pt satisfaction at 6 weeks
20
Q
Too much motion in what direction would overstretch and damage the repair site (Achilles)? What should be used to prevent this motion?
A
Dorsiflexion
Use protective splint or orthosis
21
Q
How much dorsiflexion AROM is allowed 3-7 days post-op Achilles repair? 2 exercises permitted?
A
-5 deg
- AROM PF/DF in pain free ROM
- Toe curls
22
Q
How much dorsiflexion AROM is allowed 2-4 weeks post-op Achilles repair? Exercise permitted?
A
0-5 deg w/ knee ext.
5-10 deg w/ knee flexed
Gait training in walking splint
23
Q
On what post-op day is the patient allowed WBAT post Achilles repair?
A
2 weeks
24
Q
On what post-op day is the patient allowed to do unilateral heel raises for Achilles repair?
A
9-16 weeks
25
Describe an exercise that can be used to activate/strengthen the plantarflexors at 3 weeks s/p Achilles repair.
Elastic band plantar flexion exercise
26
5 factors that could delay the healing process and thus prolong rehab s/p Achilles repair
```
Infection
Anesthetic problems
Rerupture
DVT
Incomplete return to function
```
27
Why is treatment of articular cartilage a challenge?
It has no vascular supply and low metabolic activity.
28
Palliative treatment of articular cartilage?
Debridement and lavage
29
Reparative surgery for articular cartilage?
Marrow stimulation
30
Restorative surgery for articular cartilage?
Transplantation
31
What are the 3 joints of the knee?
Tibiofemoral joint
Patellofemoral joint
Proximal tibiofibular joint
32
What is the screw home mechanism?
Terminal knee extension is achieved through open chain ER of the tibia or closed chain IR of the femur.
33
Popliteus contraction on a fixed femur...
causes IR of tibia to unlock knee
34
Popliteus contraction on a fixed tibia...
causes ER of femur to unlock knee
35
Roll glide of open chain knee flexion/extension?
Concave tibia on Convex femur
| same roll/glide
36
Roll glide of closed chain knee flexion/extension?
Convex femur on Concave tibia
| opposite roll/glide
37
Self-reported outcome tools for the knee?
Lysholm Knee Scale (specific for ACL)
| Lower Extremity Functional Scale
38
Why do women have a wider Q angle?
They have wider pelvis
39
Normal Q angle for men/women?
Men: 13 deg
Women: 18 deg
40
If a patella is pointed medially, but sits properly on the condyles of the femur, what could this indicate?
Medially rotated femur - compensated femoral anteversion or glute max weakness
41
Red flags
```
Persistant/constant pain
Unexplained weight loss, loss of appetite
Unwarranted fatigue
Unusual lumps or growths
SOB, dizzy, chest pain, discoloration
Swelling w/ no injury
Fever or night sweats
Frequent or severe headaches
Problem swallowing/speech
Change in vision
Problem balance, coordination, falling
```
42
Special questions to ask patient about the knee pain?
Mechanism of injury - twist, deceleration, blow to knee, knee position?
Hear anything - tear, pop, ripping?
Feel like shifted in and out, popped out?
If no trauma - any change in training, job, functional demands?
Any problems with walking, running, stairs?
43
Causes of knee giving way (buckling)
```
Instability of ligaments, particularly ACL
Subluxation of joint
Muscle inhibition (effusion, pain)
Muscle weakness (especially quads)
```
44
Muscle inhibition can be caused by...
pain or effusion
45
During stance, quads keep the knee from...
buckling, falling into flexion
46
Locking or catching of the knee can indicate...
a meniscal tear
47
Popping of the knee can indicate...
instability
48
What is a Baker's cyst
Swelling specifically in popliteal fossa
49
ACL repair needs to be done either within hours or several weeks later. Why?
Too much effusion and muscle inhibition.
50
Girth measurements are used to observe...
Swelling or atrophy
51
Patella alta is caused by?
Strained, overstretched patellar ligament
| Tightness or spasm of quads
52
Patella baja is caused by?
Scar tissue or adaptive shortening of patellar ligament
53
Tibiofemoral capsular pattern
Loss of flexion > loss of extension (both are limited)
54
Patella always subluxes in what direction?
Laterally
55
Limited extension (knee flexion contracture) can be due to...
Tight posterior capsule
Ligaments
Posterior knee structures
56
If limitation of knee extension is greater with hip flexed, then what is also tight?
Hamstrings
57
Limited knee flexion can be due to...
Tight anterior capsule
Tight Medial/lateral retinaculum
Tight Ligaments
Tight VM, VL, VI
58
If limitation of knee flexion is greater in prone, then what is also tight?
Rectus femoris
59
What is a quad lag? What MMT grade does that get?
Patient has full knee range of motion, but when seated, cannot actively perform full knee extension against gravity.
MMT grade is < 3
60
How do you measure quad lag?
Ask patient to extend knee as far as they can, then measure amount of flexion (ex: 20 deg quad lag)
61
Why are knee varus/valgus stress tests done in full extension and in 20-30 deg flexion?
Most structures are taut in extension, so testing in slight flexion isolates the MCL/LCL more. Gapping in full extension indicates major disruption of stability (many ligaments damaged).
62
(+) sag sign can lead to what false positive?
Anterior drawer
63
McMurray test specificity/sensitivity?
Specificity: 93.4%
Sensitivity: 58.5%
64
Reasons for not reaching full knee extension during gait?
Hamstring tightness/spasm
Knee flexion contracture
Knee joint effusion
Internal derangement (meniscal tear, loose body)
65
What stages of gait require full knee extension?
TSw and IC
66
3 reasons knee might be giving way?
Instability
Muscle inhibition (pain, effusion)
Weakness, reduced endurance
67
What is an antalgic gait pattern?
Limping; decreased stance time on involved side; typically due to pain
68
What causes genu recurvatum in gait?
Quad weakness - using hip extensors to pull femur back
Laxity in posterior capsule
69
3 structures that make up pes anserine?
Sartorius
Gracilis
Semitendinosis
70
Tis better to have a normal gait pattern with an assistive device...
than a dysfunctional pattern with no assistive device (compensations just cause more orthopedic problems).
71
Sprain vs. strain
Sprain: ligament damage
Strain: muscle damage
72
Grade 1 strain
Minimal fiber tearing due to overstretch or overload; weakness, spasm, functional deficits, swelling.
Pain with contractile testing and stretching
73
Grade 2 strain
Moderate amount of fibers torn; overstretch or overuse injury; moderate to severe spasm, swelling, and functional deficit; ROM and strength deficit.
Pain with contractile testing and stretching
74
Grade 3 strain
Complete rupture of fibers; overload, overstretch, or laceration injury; severe weakness, functional deficits, swelling; marked loss of ROM
Mild or no pain with contractile test and stretching.
75
Ligamentous injuries can lead to
Joint laxity/instability
76
Grade 1 sprain
Minimal tearing of fibers; overload/overstretch injury; spasm, swelling, min loss of function; no significant laxity.
Pain with stretch but not contractile test
77
Grade 2 sprain
Moderate tearing; overload/overstretch injury; moderate loss of function, swelling; mild laxity.
Pain with stretch but not contractile test
78
Grade 3 sprain
Complete rupture; overload/overstretch injury; moderate to severe functional loss, swelling; marked laxity.
No pain with contractile test or stretch
79
What are the 3 stages of inflammation and repair of soft tissue lesions?
Acute stage: inflammatory reaction
Subacute stage: repair and healing
Chronic stage: maturation and remodeling
80
What should you do during the acute inflammatory stage?
Put the fire out before you inspect for damage!
81
Ligamentous injuries most commonly...
between 20-40 years as result of sports injuries
82
Unhappy triad
MCL
ACL
Medial Meniscus
MOI: rapid deceleration with rotation with knee in flexion
83
How can female athletes prevent ACL tears?
Preseason training and conditioning - stronger muscles, greater control, better proprioception
84
MOI of ACL injuries
```
Hyperextension
Valgus
Internal/external tibial rotary stresses
Combinations of the above
"Cutting" maneuvers
Non-contact decelerations (w/ or w/o rot.)
```
85
In patients with ACL tears, the reason for lack of extension ROM is NOT...
limited anterior tibial gliding or posterior femoral gliding
Probably: muscle guarding, spasm, posterior capsule, etc.
86
What mobilization should you avoid when treating ACL injury?
Anterior glides
87
Why are the hamstrings important in ACL rehab?
Hamstrings make up for lack of ACL (limit excessive anterior tibial glide).
88
What exercises are contraindicated in ACL rehab?
Open chain terminal knee extension (60 to 0 deg) with resistance to distal leg (quads are unopposed and applying an anterior glide on the tibia)
Squatting between 60 and 90 deg.
89
What kind of exercises should you do in ACL rehab? Why?
Closed chain: increases stability and facilitates muscle co-contraction to prevent anterior tibial glide.
90
H/Q goal of strengthening in ACL rehab?
H/Q 70% - hyperstrengthening hamstrings (usually 50%)
91
MOI of PCL injuries
Posteriorly directed force on tibial tuberosity ("dashboard" injury)
92
What is focus of strengthening for PCL rehab?
Quadriceps - prevents posterior translation of tibia to compensate for lack of PCL
93
What activities should you avoid in PCL rehab
Activities that may cause large posterior sheer forces: isometric hamstring contractions, open chain hamstring exercises, jogging, ascending/descending stairs, squats > 60 deg, isokinetic HS testing, high demand gastroc activity
94
What kind of strengthening should you avoid with MCL sprain?
Adductor strengthening with resistance distal to knee
Watch poor hip control during closed chain - avoid valgus forces
95
Grade II MCL return to activity in how many weeks?
6-10
96
What kind of strengthening should you avoid with LCL sprain?
Abductor strengthening with resistance distal to knee
97
Which meniscus is more commonly injured?
Medial because it is more fixated (attached to MCL) and not enough movement to avoid injury
98
MOI meniscus injury
Valgus/varus/hyperextension
Hyperflexion
Forced rotations
Fixed foot with femur IR
Often associated with other intra-articular pathology, usually ACL disruption
99
Is deep squatting good or bad?
Dependent on the patient - definitely bad for someone with a meniscal tear (lots of joint compression), but good for normal healthy joint (maintains flexibility of heel cords, natural movement).
100
Signs/symptoms of meniscal injury?
```
Pain along the joint line
Joint swelling
Quadriceps atrophy
Catching, locking, giving way
(+) McMurray and or Apley compression
```
101
If a patient has a meniscal tear, why does the knee give way?
Swelling and pain deactivate the quads.
102
What are the indications for meniscal repair?
Partial menisectomies are performed if the lesion is in the white zone (area with no blood supply.
103
What are the meniscal zones?
Red zone: most blood supply
Red-white zone: some blood supply
White zone: no blood supply
104
Osgood Schlatter disease is also called
Epiphysitis of the tibial tuberosity
105
What is prepatellar bursitis?
"Housemaid's knee"
Bursa directly superior to the patella that reduces friction between skin and knee cap is irritated - swelling that sticks out like a baseball.
106
Knee OA exam findings
```
Bony exostosis (spurs)
(+) or (-) swelling; no warmth
ROM loss & strength impairments
Function limited by pain
Varus deformity more common than valgus
```
107
What kind of laxity is indicated by genu varus deformity?
LCL laxity (compression of medial compartment)
108
What kind of laxity is indicated by genu valgus deformity?
MCL laxity (compression of lateral compartment)
109
What does a knee unloader brace do?
Unloads medial or lateral compartment by apply varus/valgus force
110
Why increase ROM for knee OA?
Increases surface area to redistribute forces
111
(+) locking and catching episodes
Pain with attempts to deep squat
(+) McMurray test
Meniscus tear
112
Swelling over anterior aspect of the patella ("like a doorknob")
Prepatellar bursitis
113
Episodes of "giving way"
Knee feels unstable
History of ski injury leg twisted on flexed knee
Heard a "pop" at the time
ACL sprain
114
History of direct valgus blow to knee when hit by cab
(+) gapping of medial joint line when valgus force applied
Tenderness over medial aspect
MCL sprain
115
Sudden onset of severe pain after running down steep stairs
Now with 0/5 knee extension strength
Unable to support weight on affected limb in stance
Swelling and ecchymosis over anterior proximal knee
Quad tendon rupture
116
Clinical signs of osteoarthritis of the knee?
Thickening of joint
Varus/valgus deformity
Narrowing of joint space on x-ray
117
Indications for TKA
Severe jt pain w/ WB or motion that compromises functional abilities
Extensive destruction of articular cartilage
Marked deformity
Failure of conservative tx or previous surgery
118
3 generations of knee orthoses
1st: hinged; high failure rate; too constrained
2nd: unconstrained; high failure; unstable
Current: semi-constrained (provides some degree of stability with little compromise of mobility)
119
TKA compartmental designs
Unicompartmental - only medial or lateral joint surfaces
Bicompartmental - entire femoral and tibial surfaces
Tricompartmental - femoral, tibial, and patellar surfaces replaced (most frequent)
120
Fixed-beraing or mobile-bearing TKA design
Decreases long-term wear of the polyethylene tibial component
121
What ligament is retained or excised during TKA?
PCL - generally excised
122
What are the 3 types of TKA fixation?
Cemented - most often used; WBAT
Uncemented - younger, more active pts
Hybrid - cemented tibial and uncemented femoral
123
After a patient has a TKA, they are not allowed to walk outside unless...
they have full knee extension and adequate quad/pelvic control
Hip and knee flexion together can indicate strength and control.
124
What knee ROM should be worked toward during max protection phase s/p TKA?
0-90
125
What knee ROM should be worked toward during mod protection phase s/p TKA?
0-110 or more
126
What are highly recommended physical activities for TKA patient?
Stationary bike, swimming, walking, golf, ballroom dancing, table tennis
127
What are recommended physical activities for TKA patient, if they had already been doing it before surgery?
Road cycling, speed/power walking, low impact aerobics, cross country skiing, doubles tennis, rowing, bowling, canoeing
128
What are physical activities not recommended for TKA patients?
Jogging/running, basketball, volleyball, singles tennis, baseball/softball, high impact aerobics, stair climbing machine, handball/racquetball/squash, football, soccer, gymnastics, tumbling, water skiing
129
How long can TKA patients expect to have satisfactory function before revision is needed?
10-20 years
130
How much knee flexion is needed to negotiate stairs or stand up from a standard height chair without arm support?
> 100 deg flexion
131
Why is the ACL the rock star of knee ligaments?
Return to presurgical function is not high
Risk of reinjury is high
Most patients develop OA in next 10 years
132
What is the most frequently surgically repaired ligament in the knee?
What is the most frequently injured ligament in the knee?
Repaired: ACL
Injured: MCL
133
What are the 3 types of ACL repair?
Direct repair
Extra-articular reconstruction - used infrequently; does not restore normal arthrokinematics
Intra-articular reconstruction
134
Which tendon is the only option for bone on both ends of the autograft (ACL repair)? Why is this the best option?
Patellar tendon
Bone to bone healing is faster and more stable
135
What 2 tendons have a single osseous attachment and can be used for ACL repair?
Achilles
| Quadriceps
136
What tendons are used as soft tissue grafts for ACL repairs?
```
Hamstring
Tibialis anterior
Tibialis posterior
Fibularis longus
Tensor fasciae latae
```
137
Why is the preoperative period critical to a successful outcome in ACL repair?
```
Reduce pain, swelling, inflammation
Restore ROM, especially extension
Restore quad control and prevent atrophy
Normalize gait pattern
Patient education
```
Generally 21 days is adequate
138
What is the most important ROM to restore after ACL repair? Appropriate exercise?
Full passive knee extension during first few days post-op
Work towards symmetrical ROM - if patient has hyperextension in opposite knee, try to get that in involved knee
Exercise: prolonged stretch - supine with heel propped up
139
Poor patellar mobility results in...
ROM complications and difficulty contracting the quads
140
When should you try to train the ACL repair patient to assume FWB?
2nd week of rehab
141
How is flexion ROM progressed during ACL repair rehab?
0-90 deg in 5-7 days
About 10 deg per week
142
Why is full extension so important in ACL rehab?
Failure to achieve full extension has been associated with poor post-op outcomes.
143
What should be used in addition to exercise to improve quad strength after ACL surgery?
NMES during quad sets, SLR, hip add/abd, and knee ext 90-40
144
The greatest amount of hamstring and quadriceps co-contraction occurs at approximately...
30 deg of knee flexion during squat
145
ACL rehab: compared to NWBE, individuals who perform predominantly WBE tend to have...
less knee pain, more stable knees, generally more satisfaction with the end result, and a quicker return to sport
146
Is the load on an ACL higher during a seated knee extension or squats?
Higher between 0-30 deg knee flexion
147
ACL exercise: squatting and lunging with a more forward trunk tilt...
recruit the hamstrings, which helps to unload the ACL by decreasing anterior tibial translation
148
Anterior knee translation beyond the toes may also increase...
ACL loading during squatting and lunging
149
What can plyometric jumping drills do for restoring neuromuscular control at the knee?
Facilitates dynamic stabilization and neuromuscular control of the knee joint; trains dissipation and production of forces through the muscle's stretch-shortening properties.
150
Timeframe for patellar tendon ACL graft incorporation? Soft tissue autografts?
Patellar: 6-8 weeks
ST: 8-12 weeks
151
There is a weakening of the ACL graft in the first 2-4 weeks post-op, then...
it goes through process of revascularization and maturation, which over a period of several weeks increases its tensile strength.
152
What takes longer to incorporate: autograft or allograft?
Allograft
153
ACL rehab: the exercises chosen in rehabilitation must be carefully selected based on...
the stage of incorporation and maturation of the graft.
154
ACL rehab: When the goal is to minimize ACL loading, seated knee extension should be performed...
at higher knee flexion angles (between 50-100) regardless of the location of the resistance pad.
155
When is surgical intervention typically used for PCL injury?
When it is combined with injury to other structures
156
What is preferable to total menisectomy?
Partial menisectomy
| Meniscal repair
157
Indications for meniscal repair
Lesion in vascular outer 1/3 of meniscus
Tear extending into central avascular 1/3 of young or physically active older pt
158
Contraindications for meniscal repair
Presence of tear localized to inner, avascular 1/3 of meniscus
Tear with considerable tissue fragmentation
Tear that can't be re-opposed
159
What is the most common arthroscopic approach to meniscus repair?
Arthroscopically assisted inside-out
160
The most important factor influencing the outcome of a meniscal repair
Status of the ACL
161
Partial menisectomy has been performed to manage...
complex, fragmented tears and tears involving the centrl (middle 1/3), relatively avascular zone of a meniscus
162
The patella is the largest...
sesamoid bone in the body
163
What are the 3 patellar facets?
Lateral facet (to lat. fem. condyle)
Medial facet (to med. fem. condyle)
Odd facet (medial to medial facet; engaged at end range flexion)
164
The patella is embedded in the...
Quadriceps tendon
165
The patellar fat pad decreases friction between...
the anterior tibia and patellar ligament
166
2 bursae of the patellofemoral joint?
Suprapatellar bursa
| Prepatellar bursa
167
What are the lateral restraints of the patella?
Medial: medial retinaculum and VMO
Lateral: lateral retinaculum, vastus lateralis, and ITB
168
Functions of the patella
Anatomical pulley; increases moment arm of the quads
Friction reducing mechanism
169
As the knee flexes, the patella slides...
distally in the intercondylar groove
170
The contact area of the patella shifts throughout ROM, allowing for...
nourishment/protection of articular cartilage
171
As the knee extends, the patella tends to track...
laterally
172
When are there no compressive forces acting on the patello-femoral joint?
0 deg. knee flexion (no bone contact)
Rationale for quad sets
173
As knee flexion increases, the quad tendon/ligament...
...acts like a belt stretched over the anterior surface (patella compression)
...have an increasingly oblique angle of pull (patella compression)
174
As flexion increases, so does contact area between the patella-femoral joint spaces, BUT as closed chain flexion angle increases...
the increases in joint reaction forces exceed the potential offset of increased contact area leading to overall increased joint stress
175
At > 70 deg knee flexion, the quad tendon...
is in contact with the femoral condyles, which helps dissipate some of the contact forces.
176
Patellofemoral joint reaction forces associated with:
Walking
Stairs
Deep squat
Walking: 50% BW
Stairs: 3.3 x BW
Deep squat: 7.8 x BW
177
Open chain vs. closed chain exercise: pat-fem joint stress and knee flexion
Open chain: stress highest at full extension and lowest at full flexion
Closed chain: highest at full flexion and lowest at full extension
178
Patellar "tracking" determined by...
Soft tissue restraints and position of patella in the intercondylar groove
179
Normally, pull of quads is somewhat lateral due to Q angle. Pull of quads becomes even MORE lateral if:
> than normal Q angle
Genu valgus
Weak VMO
180
If a patella subluxates or dislocates, it is most likely to go in what direction?
Lateral
181
If a pt has weak hip ER, what happens to the patella during knee flexion?
Femur internally rotates as knee bends which increases lateral tracking and pat-fem joint stress
182
Both patello-femoral instability and biomechanical dysfunction are typically associated with...
Some combination of soft tissue issues: something too tight, too loose, too weak, inflamed/irritated
Bony alignment can contribute: excess femoral torsion, genu valgus, excess tibial torsion, excess foot pronation
Cartilage may be involved: OA, chondromalacia, osteochondritis dessicans
183
Chondromalacia patella
Softening of the cartilage; some is normal with aging; subcategory of DJD
Bad correlation between DX and symptoms
184
Patellofemoral Pain Syndrome (PFPS)
Retro or peri patellar pain (anterior knee pain)
Umbrella term; may or may not include chondromalacia
185
PFPS possible tissue sources of pain:
```
Subchondral bone
Infrapatellar fat pad
Quad tendon
Patellar ligament
Synovium
Med/Lat retinaculum
Med/Lat patellar ligaments
Medial plica
```
186
Patellar tendinitis/osis is also called...? What structure is involved?
Also called Jumper's Knee
Patellar ligament is involved
187
Plica syndrome
Plica is inflamed or irritated; thickening of synovial folds
Medial is often the problem area
188
Why does a patellar dislocation put you at risk for further sublux/dislocation?
Overstretching of the medial structures
189
Theater movie sign
Knees flexed greater than 90 deg for long period of time --> pop, crack, pain upon rising
190
Patella alta? Cause?
Positioned too high
Tight quads, sprained patellar ligament
191
Patella baja? Cause?
Positioned too low
Scar tissue, tight patellar ligament
192
Assessing quadriceps performance in PFPS
Quad lag?
Open chain RROM: resistance at multiple angles and note which reproduce pain
Closed chain RROM: measure the angle
VMO timing and observation of pat-fem tracking
193
Assessing glute max performance in PFPS
If you can "break" hip extension with an MMT, it is weak
194
Normal quad to hip ext. ratio is 1:1. How would you measure if both are weak by equal amounts?
Quad strength should be 1:1 with body weight and therefore so should hip ext.
195
How do you test a pat-fem tape job?
Find functional task that reproduces the pain. Use that to test tape effectiveness.
196
How would you treat delayed VMO firing/activation?
Biofeedback during quad exercises (can't isolate via exercise specifically)
197
What is goal of pat-fem taping?
Decrease pat-fem pain in order to do exercises.
Looking for at least 50% decrease in pain rating
198
Why use a chopat strap for patellar tendinitis?
Redistributes forces to decrease pain
199
The medial femoral condyle extends farther distally causing a natural...
valgus angle at the knee; femoral shaft projects laterally
200
Superficial MCL limits...
most valgus forces and tibial rotation
201
Injury to the superficial MCL may spare...
the medial meniscus
202
MCL and LCL are both taut...
in 0-30 deg knee flexion
203
Which is stronger: PCL or ACL?
PCL
204
ACL limits...
anterior glide of tibia on femur
205
ACL is pulled tightest in...
extension
Limits hyperextension
206
PCL limits...
posterior glide of tibia on femur
207
PCL is pulled tight in...
knee flexion
208
Normal knee ROM
0-135 deg
Flexion: soft end feel
Extension: firm end feel
209
Resting position of tibiofemoral joint
25 deg flexion
210
Close packed position of tibiofem joint
Full extension, tibia ER
211
Miserable malalignment syndrome
```
Increased femoral anteversion
Genu valgum
VMO dysplasia
Lateral tibial torsion
Forefoot pronation
```
Excessive lateral forces and patellofemoral dysfunction
212
Squinting patella
Point medially due to excessive femoral anteversion or increased medial femoral torsion
213
W sitting may lead to excessive...
lateral tibial torsion
Patella faces forward, but foot points outward
214
Innervation:
- Biceps Femoris
- Semimembranosus
- Semitendinosus
Sciatic (L5-S2)
215
Innervation: Gracilis
Obturator (L2-L3)
216
Innervation: Sartorius
Femoral (L2-3)
217
Innervation: Popliteus
Tibial (L4-S1)
218
Innervation: Gastrocnemius
Tibial (S1-S2)
219
Innervation:
- Rectus Femoris
- VM, VI, VL
Femoral (L2-4)
220
What muscles contribute to IR of flexed leg?
```
Popliteus
Semimembranosus
Semitendinosus
Sartorius
Gracilis
```
221
What muscles contribute to ER of flexed leg?
Biceps femoris
222
What ligaments limit lateral rotation of the knee?
MCL, LCL
223
What ligaments limit medial rotation of the knee?
ACL, PCL
224
Common fibular nerve (L4-S2) is vulnerable to injury...
in the posterolateral knee and as it winds around the head of the fibula.
Causes foot drop
225
Muscle weakness caused by common peroneal nerve injury
```
Tibialis anterior
Ext dig brevis
Ext dig longus
Ext hall llongus
Fibularis tertius
Fibularis longus
Fibularis brevis
```
226
Muscle weakness caused by saphenous nerve injury
None
227
Sensory alteration caused by common peroneal nerve injury
Area around head of fibula
Web space between 1st and 2nd toes
Lateral aspect of leg and dorsum of foot
228
Healing times:
- Muscle
- Soft tissue
- Bone/cartilage
Muscle: 4 weeks
Soft tissue: 6 weeks
Bone/cartilage: 8 weeks
