ORTHO Knee And Peds Flashcards
(106 cards)
1
Q
Define Plica syndrome
A
Fold of synovium of the knee
5 plicae (suprapatellar, medial, infrapatellar, 2 minor folds)
Usually asymptomatic
Become inflamed and thickened from trauma, overuse
Most commonly medial plica
2
Q
A pt presents with activity related aching anterior or anteriomedial knee pain
With TTP to the patella, with a pop o when the knee is extended from 90-60 degrees
Overuse injury
Think ? Tx ?
A
Plica syndrome
Tx: non op nsaids, profile limitation
Non op failure: arthroscopic resection
Dx order a AP, Lateral and patellofemoral rad, with MRI
3
Q
What are the most common PCL injuries
A
Primary restraint to posterior translation of the tibia
Tears with actions that force the tibia posteriorly
Dashboard, fall with foot plantarflexed
4
Q
What are the 4 MC events that lead to PCL injury
A
Dashboard injury (posterior force of anterior knee in flexion)
Fall onto knee with plantar flexed foot (direct impact to tibial tuberosity)
Pure hyperflexion injury
Hyperextension, after the ACL ruptures
—Frequently results in knee dislocation w/wo spontaneous reduction
5
Q
What artery and nerve can a PCL injury effect
A
Popliteal artery and tibial nerve
6
Q
What are two important exams in a PCL tear
A
Neurovascular exam and ABI
7
Q
What is the Tx appracoh to a PCL tear
A
Non-operative-
Isolated PCL injury: Resolution of swelling followed by early physical therapy
Operative-
Recurrent instability and combined injuries = PCL reconstruction
Adverse outcomes of treatment-
—Popliteal artery and tibial nerve damage
—DVT
—Infection
8
Q
What is the definition of shin splits
A
Medial tibial stress syndrome
Gradual onset of pain in the posteromedial aspect of the distal third of the leg
Periosteal reaction
Caused by Increased exercise, activity level
Diagnosis of exclusion
9
Q
A pt presents with TTP distal to the 1/3 posterior medial crest of the leg
W/ Pain with resisted plantarflexion
+/-pes planus,
Think>? Dx? Tx?
A
Shin Splints,
AP/lateral leg (tib/fib) radiographs- Rule out stress fracture
Non-operative- NSAIDs Activity avoidance Arch support shoes Foot/ankle stretching/strengthening Compression sleeve
10
Q
What is the muscle specific to Shin splints
A
Tibialis posterior muscle
11
Q
Describe bipartite patella
A
Failure of the ossification center of the patella to fuse
Superior lateral corner
Incidental finding
Symptomatic as result of direct blow or following repetitive flexion-extension exercises
Clinical Symptoms
Asymptomatic until fall
Pain after running, jumping in chronic cases
Localize tenderness/swelling to superolateral corner
12
Q
A pt presents with TTP to the superior-lateral patella after a fall on the knee..
What physiologically “normal” incidental finding is common in this etiology
A
Bipartite patella
Tx: nsaids and rest 5-7 days
Op: surgical removal of ossicles if pain persists
13
Q
How do you r/o a true bipartatite patella ?
A
X ray both knees
14
Q
What are the risk factors for dysplasia of the hip in children
A
Risk factors- Family history, breech, oligohydramnios, first-born, swaddling, female
15
Q
Define Hip dysplasia in peds
A
Relationship between the femoral head and acetabulum resulting in abnormal formation
Associated with metatarsus adductus, congenital muscular torticollis, hyperextension/dislocation of the knee
Neuromuscular HD with cerebral palsy, myelomeningocele, muscular dystrophy, flaccid weakness (spinal muscular atrophy or polio)
16
Q
What are the ADE of hip dysplasia in peds
A
Longer the dislocation=closed reduction unsuccessful
Premature degenerative joint disease
Unilateral: limb-length discrepancies, ipsilateral knee pain and valgus instability, gait disturbances
Bilateral: Back problems
17
Q
What is the ped hip exam for every child under 1 year ?
A
Barlow +Ortolani test for hip dysplasia
18
Q
What does a geleazzi sign tell you
A
Uneven knees on a baby indicates Dev Hip dysplasia
Will also have limited ROM
19
Q
When should an US or X-ray be done for Dev Hip Dysplsia in Peds
A
Hip radiographs-difficult to interpret due to cartilage
Not obtained until patient is 4-5 months
Ultrasound- not done prior to 6 weeks because of high false-positive rate associated with normal neonatal laxity
US for increased risk of DDH, equivocal exam
20
Q
What is the only modifiable risk factor for Hip Dysplsia in peds
A
Swaddling
21
Q
What is the Tx approach to Dev. Dysplasia of the Hip
A
Non-operative-
- Swaddling is only modifiable risk factor and should be avoided
- Achieve concentric reduction so a normal acetabulum forms, maintain reduction
- Pavlik harness less than 6 months
Operative-
Closed reduction + cast
Surgical reduction
22
Q
Describe Genu Valgum
A
Aka Knock Knees
“Knock knees”
Tibia laterally deviated relative to the femur
NML ranges
Birth= 10-15 deg of varus
12-18m= neutral
2y (max 3-4y)=10-15 deg of valgus
11y (adult) 5-7 deg valgus (normal range 0-10)
Clinical Symptoms
Parent/Grandparent concern
-Asymptomatic
-Rarely have pain or gait disturbance
23
Q
What are two common ADE of Pavlov harnesses
A
Femoral nerve palsy or hip necrosis
24
Q
How do you measure genu valgum
A
Tibio femoral angel with a goniometer
Distance between medial malleoli with the medial femoral condyles touching
25
when should rads be ordered for Genu Valgum
Radiographs- Considered when valgus is more than 15-20 degrees, short stature
Full length lower extremity
26
What are the Tx options for Genu Valgum
Non-operative-
Observation treatment of choice for an otherwise normal 3-4 year old & asymptomatic
Operative-
Excessive deformity/symptomatic
hemi-epiphysiodesis
osteotomy
27
Obvious genu valgum after age 11 should get/..
Referral
28
What is Genu varum
AKA bowlegs
Most infants/young children have physiologic genu varum
Older/Adolescents- Blount disease, posttraumatic deformity, metabolic disease, skeletal dysplasias
Pain in the medial compartment
29
What are the NML measurement for Valgum/ Varum in kids
Birth= 10-15 deg varus
12-18m= neutral
2y (max 3-4y)=10-15 deg valgus
11y (adult) 5-7 deg valgus
30
When should Genu Varum be Rads
WB lower extremity radiographs delayed until 2 years old unless:
- Less than 25th percentile for height
- Severe for child’s age
- Asymmetry
31
What is the Tx approach to Genu Varum
Non-operative-
Physiologic varus = reassurance
Blount- usually requires treatment
Bracing- less than 3 years and early in disease
Operative-
Surgery (osteotomy) successful if performed by 4 years
32
A pt presents with Genu Varum
At 5 years old
What should you do ?
Refer!
33
Describe in toeing vs out toeing
Intoeing=
foot deformities
inward tibial rotation (most common diagnosis)
inward femur rotation
Most common in children older than 4 years
Outtoeing=
External tibial torsion or external femoral torsion
Intoeing more common
34
What are the clinical S/s of in vs out toeing
Not pain, usually activity related tripping (intoeing) or inability to keep up (outtoeing)
Assess femur, tibia and foot
Foot progression angle, femoral rotation, thigh-foot angle (>10-15), foot alignment
35
What is the Tx approach to in and out toeing
Education and reassurance
Referral if:
- Asymmetric
- Not improving after 4 to 6 years of age
- Other complaints (deformities)
36
Discribe Legg- Calve-Perthes Dz
Idiopathic osteonecrosis of the femoral head in children
Most commonly diagnosed in boys between 4-8 years old
Clinical symptoms can last up to 18 months, and radiographic healing up to 4 to 5 years
S/S:
- Limping for 3-6 weeks by the time of initial visit
- Limp worsens with activity
- Symptoms worse at the end of the day
- Aching pain in groin or proximal thigh
37
What measurement is important to get in in/out toeing
thigh-foot angle (>10-15),
38
A child presents with a limp x 3-6 wks, limp worsens with walking, with acing pain in the groin or proximal thigh, has decreased abduction and internal rotation of AROM, with guarding at extremes of motion, +flexion contracture,
Gait presents with abductor lurch/ trendelenberg gait
With a pos trendelenberg sign
Think ?
Tx?
Legg-Calve-Perthes Dz
Order Ap/ Frog lateral pelvis Rads
(Pos crescent sign= subchondral fx)
(Smaller epiphysis and angular changes)
Tx:
Non-operative-
Normalize femoral head via bed rest, NSAIDs, range of motion
Patients less than 5=excellent outcome
Operative-
Possible, early consult is appropriate
39
What is the referral criteria for legg-calve-perthes Dz
Younger than 6 years with great involvement or less than 40 deg abduction!
All patients older than 6 years
40
Describe Osgood-Sclatter disease
Overuse injury in growing child that results from repetitive stress when a too-tight quad pulls on the apophysis of the tibial tubercule during rapid time of growth
Active in sports, boys
Apophysitis @ tibia tubercle= O-S
Apophysitis @ distal patella = Sinding-Larsen-Johansson
41
describe Sinding-Larsen-Johansson
Apophysitis @ distal patella
42
A 5 year old presents with pain exacerbated by quad activities
And pain with prolonged sitting with knees flexed (theater sign)
Think ?
Tx?
O-S Dz
Order AP/Lateral on the knee
(Normal or soft tissue swelling
+Heterotopic ossification
+Unfused apophysis)
Tx: Non-operative-
Initial treatment-
Mild to moderate symptoms-NSAID, RICE, knee pad, stretching
Severe/recalcitrant- immobilization
Operative-
Complete avulsion of ossification center or removal of heterotopic ossification
43
Describe Slipped Capital femoral epiphysis
Progressive displacement of upper portion of the femur relative to capital femoral epiphysis
Occurs thru the physis, typically during adolescent growth spurt
SH1 proximal femur fracture
Overweight (95th percentile), black, boys 13-15y, girls 11-13y
Bilateral-40-50%
44
An overweight black obese adolescent male, presents with pain worse with activity and a limp
On PE you find an externally rotated hip, unable to ambulate ever with crutches, Loss of internal rotation on exam
Alarm for ?
TX;
Slipped Capital Femoral epiphysis
order Ap/Frog-lateral pelvis views
(Should inspect for lateral capital femoral epiphysis)
Order Rads if inconclusive
Ranked MILD (less than 30) mod to severe (>50)
Tx Percutaneous Screw Fixation
Profile non wt bearing
Avoid necrosis and maximize function
45
When should you refer pt with Slipper capital femoral epiphysis
ALL PTs! Do not delay!
make pts non wt bearing upon Dx
46
Describe transient synovitis of the hip
Sterile effusion (not bacterial) of the joint that resolves without therapy or sequelae (4-6 wks)
Common source of limping in 2-7 yo males
Etiology is unknown
Mild trauma for some cases
History of viral illness (URI or GI) days to weeks prior to limping
Clinical Symptoms
Limp (painless or associated with discomfort) and pain localized in groin, proximal thigh, or knee
47
What is the Kline line
Line drawl to assess SCFE
48
A young male (2-7) year old presents with a limp
What is chief DDx
Transient Synovitis of the Hip
| Not septic
49
A 2-7 year old male presents with transient synovitis
What would you find on PE
Decreased ROM (particularly in ABduction and IR)
Gait abnormalities (abductor lurch/Trendenlenburg gait)
Most children are afebrile
50
A 2-7 year old male presents with transient synovitis of the hip
What would you find on X-ray
Order a Ap/Frog- lat of the pelvis
Usually normal or show widening of joint space due to effusion
Septic arthritis suspected- Urgent US and aspiration at same time
MRI- useful to rule out osteomyelitis, psoas abscess or early Legg-Calve-Perthes
51
What is the Tx for Transietn Synovitis of the Hip
```
Non-operative-
Activity restriction (bed rest) and NSAIDs
```
Limp improves with 3-14 days, but can take up to 4-6 weeks for resolution
Sick or substantial discomfort = aspirate + admit for observation
52
Describe Hip impingement
Femoral Acetabular Impingement
S/s at the extremes of motions
Assoc with labral Tera’s
Either Cam or Pincer abnormalities
Presents with decreases flexion and internal rotation
53
Describe Hip impingement
Femoral acetabulr impingement
Cam or Pincer AbNML
Pain at extremes of motion
Can be acute or insidious
S/S catching, loving, clicking or popping
PT states pain is in a C shape around the lateral hip
Provocked by sitting, stair climbing, rotational movements activities
54
What is the FADDIR test, and what Dz can it Dx
Place hip in maximum flexion, adduction, and internal rotation (FADDIR)
Can Dx FAI
55
What Rads should be ordered for Hip impingment
Plain films-
-AP/lateral of hip
-decreased femoral head-neck offset (cam) on AP or lateral
Crossover sign (pincer)
Pure Cam impingement- bump on anterior femoral neck that impinges on anteriosuperior labrum with flexion, causing labral tears, cartilage damage
MRI or CT 3D recon- better anatomy of hip
MRI arthrogram- more accurate for labral tears, osseous abnormalities
56
How do you treat FAI
Non-operative-
Initial treatment-NSAID, activity modifications, PT
Fluoro guided hip injection
All hip injections need guidance
—Diagnostic and therapeutic
Operative-
Non-operative treatment failure
57
What are three common ADE of Tx for FAI
Lateral femoral cutaneous nerve damage
Heterotropic ossification
Or a DVT
58
Define Osteonecrosis of the hip
Any disruption of blood supply from trauma or deficient circulation to the hip
59
What are the major Risk Fx for Osteonecrosis of the Hip
```
OA
Prior truama or fx
Corticosteroid use
ETOH abuse
Sickle cell
RA
Lupus
```
60
A pt with Osteonecrosis of the hip will present with what PE
Decreased ROM and Painful ROM with internal rotations
Pain with straight leg raise
And an antalgic gait followed by trendelenberg gait
61
What Rads Should be ordered for Osteonecrosis of the hip
AP pelvis, AP and frog lat
With crescent sign
—subchondral fracture
62
What are the only Tx options for Osteonecrosis
Operative only
Various complex procedures
- Core decompression
- grafting
- allografting
- Total hip arthroplasty
63
Describe snapping hip
1. IT band at greater trochanter- most common
2. Iliopsoas at pelvis- pectineal eminence
3. Intraarticular labral tears
64
What is the difference between Snapping hip from the IT band vs Illiopsoas vs Labrum
IT band- walking, rotation of hip (no pain)
Localized to greater trochanter
Iliopsoas – hip extension from flexion (i.e. rising from a chair) (no pain)
Localized to groin
Labrum- mechanical symptoms (disabling pain)
65
What are the Rads for Snapping Hip
Radiographs- normal
Labrum= MRI- intra-articular contrast
66
What are the special tests to evaluate snapping hip
Test the IT band with the Ober test
Can evaluate the iliopsoas with snapping felt with hip extensions from a flexed position of the knee
Labrum will present with restricted rotation
67
What rads should be ordered to R/o disorders in snapping hip
AP Pelvis and lateral hip
Exclude bony pathology or intra articular disease
Determine if Normal
CT Arthrogram- r/o loose bodies
MRA- r/o tear of the labrum
68
What is the treatment approach to snapping Hip
Non-operative-
Not painful- Education and reassurance
Guided by pathology- NSAIDS, PT, avoidance
Operative-
Labrum only
69
Describe transient osteoporosis of the hip
Uncommon, idiopathic condition characterized by spontaneous onset of hip pain associated with radiographic osteoporosis of the femoral head and neck
Most common in mid-aged men
Females in 3rd trimester pregnancy
Spontaneous resolution after 6-12 months
70
A pt presents with spontaneous onset of pain in the groin, lat hip, or buttock with increased pain with weight bearing that resides with rest
Is either an older male or pregnant female
Think of what condition and Tx
Transient osteoporosis of the hip
Tx:
Radiographs= Diffuse osteoporosis of the femoral head/neck
MRI= rule out other diagnoses and for confirmation of osteoporosis
Or bone marrow edema
Rx: Non-operative-
Self limiting process with spontaneous resolution in 6-12 months
Crutches with limited weight bearing until symptoms resolve and normal bone density on repeat radiographs
71
Describe trochanter in bursitis
Inflammation/hypertrophy of bursa without cause or due to previous surgery, limb-length issues, lumbar spine disease
S/s
- First motion and again over 30 minutes of exercise
- Night pain from laying on their side
- IT band friction at the hip
72
A pt presents with TTP to the greater trochanter with pain on active abduction
W/ Pain on First motion and again over 30 minutes of exercise
Night pain from laying on their side
IT band friction at the hip
Think what D/o and Tx
Trochanteric bursitis
Non-operative-
Initial management-NSAIDS, modify activities, stretching
Steroid injection
Operative-
Failure of non-operative treatment
—Bursectomy
Adverse outcomes of treatment-
—Infection
73
Describe ACL tear
Tear results from rotational +/- hyperextension force applied to knee joint (non-contact)
—Plant, pivot, pop
Often accompanied by meniscal tear, MCL tear
Rarely lateral ligamentous complex or PCL
Multi ligamentous tear uncommon but result in gross instability
74
What is the primary stabizer of the knee
ACL
75
A pt presents with Sudden pain and giving way of the knee; with an audible “pop” at POI
+lachmans test
+anterior drawers test
ACL tear
Non-operative-
Acute- Rest, ice, crutches (RICE)
—Aspiration of hemathrosis to relieve pain
—Early physical therapy for ROM
Elderly= rehab
Rehab goals-Decrease pain and inflammation with RICE
Operative-
Young= ACL reconstruction
76
How would an ACL tear show on Rads
Radiographs- AP/lateral and tunnel
Usually only positive for effusion
Segond fracture (avulsion of the lateral tibia)
Most common in patients with open physes
MRI- sensitive and specific
best for ACL, other path
77
Describe Bursitis of the knee
Overuse (housemaid’) vs trauma induced inflamation of the bursa
Prepatellar= septic and aseptic
—septic = Staph aureus and Strep spp (skin flora)
Pes anserine= beneath insertion of Sartorius, gracilis, semitendinosis muscles
—Commonly due to medial compartment OA
78
OA in the medial compartment of the knee often leads to what inflammatory condition,..
Bursitis of the knee
| Pes aneserine
79
A pt presents with intense joint pain, effusion, erythema, guarding with motion, limited ROM, low-grade fever, and inflammation of the knee
Think what D.o and treatment
Septic bursitis
Order: AP/ Lateral rads to r/o fx
Aspiration- gram stain and culture, cell count, and eval for crystals
Tx:
Non-operative-
Rule out septic arthritis with KNEE aspiration
Oral antibiotics= early, mild
IV antibiotics= more severe
Non-infectious- NSAIDs, Ice, modifications
Adverse outcomes of treatment-
—Iatrogenic infection if aspiration performed
80
What is the referral criteria for knee bursitis
Septic bursitis
Pes anserine bursitis secondary to OA
Recurrent prepatellar bursa infections
81
Describe Claudication of the knee
Activity-associated discomfort in the legs
Either:
1. Neurogenic- spinal stenosis
2. Vascular- Peripheral vascular
disease, compromised arterial flow
Both result in similar leg pain presentations
82
Describe the diff of Neurogenic vs Vascular Claudication
Neuro: Does not resolve immediately
Improves with stationary bike
Is distributed proximal to distal
And worse when walking down hill
Vascular: resolves immediately
Worsens with stationary bike
And is distal to proximal In distribution
83
What is an ABNML ABI in Claudication
Less than 0.9 is ABNML
84
A pt presents with Diminished/absent pulses below the waist, cool extremities, ulcerations with an ABI of 0.8
What is the Dz and Tx
Claudication
Order AP/ LAt of the spine to r/o neurogenic cause
Doppler US to visualize decrease blood flow
Tx:
Non-operative-
Neurogenic- NSAIDS, epidural steroid injections, PT
Vascular- Supportive measures
Meticulous foot care, well-fitting and protective shoes
Operative-
- Spinal decompression/fusion
- Vascular surgery-bypass grafting
85
What is stage I-II-III laxity grading in MCL and LCL tears
Laxity grading-
I= <5mm
II= 5-10mm
III= >10mm
86
What are the different Rads findings in MCL vs LCL
MCL; avulsion on the femoral origin
LCL; avulsion on the fibular head
87
What are the Tx options for MCL and LCL tears
Non-operative-
Grade I and II LCL and MCL
MCL III- proximal and midsubstance
RICE, crutches, NSAIDs, brace, ROM early
Operative-
LCL III, within 7 days
—Often involves PCL injuries
88
Describe Illiotibial band synonyms
Relational to lateral femoral condyle (at the KNEE)
Knee extended-ITB sits anterior to femoral condyle
Knee flexed >30-ITB moves posterior to condyle
Population
- long distance runners
- cyclists
89
A pt presents with TTP at anteriolateral knee 3cm to the proximal joint line
With a positve ober test
What is the syndrome and Tx
Illiotibial band syndrome
Tx:
Non-operative-
Initial treatment-NSAIDs, modifications, PT
Corticosteroid injection if no improvement with above
Operative-
Few options (rare)
—ITB lengthening
90
Describe a Gastrocnemius Tear
Acute strains or ruptures at medial head (musculotendinous junction)
From Tennis, running on a hill, jumping
Most commonly greater than 30 years old
CAN HAVE A DVT DUE TO TRUAMA/ Inactivity
91
a pt presents with Pulling/tearing sensation in the calf
W/ Diffuse pain, swelling, tenderness
Unable to perform a calf raise,
+Thompson test
Think what Tear and Tx
Gastrocnemius Tear
Tx:
Non-operative-
NSAIDs, RICE, CAM boot with heel lift, compression sleeve, crutches
Most return to previous functional level in 6-8 weeks
Operative-
Repair- Large (palpable defect)
Adverse outcomes of treatment-
—Loss of dorsiflexion and atrophy of the calf
92
A pt presents with twisting injury of the knee, yet continued to play through the injury
Later they have pain that worsens with twisting/ squatting activities
Think what tear and Tx?
Meniscal Tear
Tx:
Non-operative-
No mechanical symptoms and degenerative tear- RICE, NSAIDs, Early w/ physical therapy ROM
Locked knee?- May need sedation and should be managed surgically
Operative- Younger people, locked knee, older patients without response to nonsurgical treatment
Peripheral tears= repair
Large tears= arthroscopic debridement
Adverse outcomes of treatment-
Less meniscus= less shock absorption = more OA
93
What is the referral criteria for meniscal tear
Mechanical symptoms
Ligamentous instability
Peripheral tear
Failure of nonsurgical management
94
Describe Ocetonecrosis of the femoral condyle
“Bone death”
Etiology unknown- stress fracture with combination of trauma and altered blood flow
Weight bearing medial femoral condyle most commonly involved
Causes: Idiopathic, chronic steroid therapy, SLE, sickle cell, etc.
Women (3:1), older than 60
95
A pt presents with a sudden sharp pain to the medial compartment of the leg, with constant pain that worsens with activity,
TTP at the median femoral condyle beside the patella
Think? Tx?
Osteonecrosis of the femoral condyle
Rads will show early sclerosis and flattening of the joint space
Tx: Limit activists and brace
NSAIDs, steroids for pain
Early surgical referral
96
Define patellar/ Quad tendonitis
Aka Jumpers knee
Or extenso mechanisms tendinitis
Overuse or overload syndrome involving either the quadriceps tendon at its insertion on the superior pole of the patella or the patellar tendon at the inferior pole or tibial tuberosity
Younger (<40)- Jumping/kicking sports
Older- lifting, change in exercise level, weight gain
97
A pt presents with anterior knee pain
States it gets worse when climbing/descending stairs, running, jumping, squatting
TTP at bony attachments of the quad/ patellar tendon
With puffiness around the infrapettelar bursa
Knee rom is NML but has increased pain with resisted extension and at extremes of passive flexion
Think? Tx?
Patellar/ Quad tendonitis
Rads will show
Radiographs- AP/lateral often normal but may show enthesophytes or heterotopic ossification at upper/lower pole of patella
When at tibial tubercle= history of Osgood-Schlatter
MRI- recalcitrant cases
Tx:
Non-operative-
Initial treatment= Rest from aggravating activities
Regaining pain-free ROM, flexibility, THEN strengthening
Gradual resumption of activities
98
define patellar/ quad tendon rupture
Displaced patellar fracture or rupture of the quad/patellar tendon can disrupt the extensor mechanism of the knee = results in inability to actively extend the knee fully
Fall on a partially flexed knee
Quad= white male 40-60;
Patella= black male 40-60
99
What is the clinical triad of Patellar/ Quad tendon ruptures
Clinical triad:
1. palpable defect
2. inability to extend
3. change in patella height on x ray
100
A pt presents with a large effusion and palpable defect at the knee,
Unable to extend the leg against gravity and can not perform a straight leg raise
Think /?
Tx?
Petal/Quad tendon rupture
Rads will show:
AP/lateral plain films (30 degrees on lateral)-
patella alta= patellar
patella baja= quadriceps
MRI- will confirm a tendon rupture but rarely necessary if clinical triad present
```
Tx: Non-operative-
Rare and only for incomplete
—Knee immobilizer/cylinder cast
Operative-
—All complete ruptures or fractures= surgical
```
101
What is the likely time frame to retear the Patellar/quad tendon after repair
Retear in the 1st 6 months
102
When should Patellar/quad ruptures be referred
All complete ruptures should be referred in 1 week
103
Describe patellofemoral maltracking
Spectrum of conditions defined by abnormal motion of the patella
—Lateral patellar overload syndrome
—Recurrent patellar instability
Most commonly lateral
Medial patellofemoral ligament- torn or stretched
Subluxation or dislocation
104
A pt presents with a patella that can dislocate and spontaneously reduce
With retropatellar pain with climbing stairs, + Theater sign +TTP at the patellofemoral ligament
+j sign
+apprehension test
Think ?
Tx?
Patellofemoral maltracking
Rads with show
Plain films- AP, lateral and sunrise (Merchant or Laurin)
-Relationship of patella to femoral trochlea
MRI= bone bruising, medial patellofemoral ligament injury
Tx: Depends on chronicity
Non-operative-
Acute patellar subluxation or dislocation
—Initial treatment- NSAIDs, bracing, Ice, modified weight bearing (up to 4 weeks)
Followed by ROM and strengthening
Chronic recurrent maltracking
—Quad strengthening and flexibility, bracing, PT
Operative-
Non-operative treatment failure
Medial patellofemoral ligament reconstruction
105
Descibe patellofemoral pain
Constellation of problems
Diffuse, aching anterior knee pain
—Not “chondromalacia”
Multifactorial- related to overuse and overloading of the patellofemoral joint
106
```
A pt presents with Diffuse, aching, anterior knee pain with prolonged sitting (theater sign)
W/ Quad activities pain
- climbing stairs, jumping, squatting
W/ a hx of direct blow to the patella
+patellar grind
+apprehension test
+J sign
```
Think?>?
Tx?
Patellofemoral pain
Order Plain films- AP, lateral and sunrise (Merchant or Laurin)
Non-operative-
PT hallmark of treatment for PFPS
NSAIDs, weight loss (Obese)
Adverse outcomes of treatment-
—Avoid aggressive quad activities during or later in rehab period
