The Knee

Question 1

How frequently should a person with a mild injury ice?

Answer 1

4 times a day for 15 minutes

Question 2

What is the clinical presentation of someone with a patellar fracture? What is the treatment for them?

Answer 2

Pain with flexion; keep them in full extension, allow them to weight bear

Question 3

What is the classic mechanism of injury for MCL, MM, and ACL (Triad of O’Donohue)?

Answer 3

1) knee flexion PLUS 2) foot planted PLUS 3) lateral impact PLUS 4) rotation

Question 4

What is the test for MCL stability?

Answer 4

Valgus stress test

Question 5

What does a grade of 0 on valgus stress test represent?

Answer 5

if it is equal to the other knee, it means there is no significant laxity

Question 6

What does a grade of 1+ on valgus stress test represent?

Answer 6

5 mm of medial joint space with FIRM (but abnormal) ENDPOINT

Question 7

What does a grade of 2+ on valgus stress test represent?

Answer 7

10 mm of medial joint space with SOFT ENDPOINT

Question 8

What does a grade of 3+ on valgus stress test represent?

Answer 8

15 mm with SOFT ENDPOINT

Question 9

What does a grade of 4+ on valgus stress test represent?

Answer 9

20 mm, may have associated cruciate tear as well

Question 10

What is the test for LCL stability?

Answer 10

Varus stress test (same classification as valgus)

Question 11

What is the most important structure for knee stability?

Answer 11

ACL

Question 12

What are the 3 primary mechanisms of injury for ACL?

Answer 12

Planting and cutting, straight knee standing, and one-step stop with hyperextension

Question 13

What is a/w 50% of ACLs?

Answer 13

Meniscal tears

Question 14

How do you treat someone with an ACL tear conservatively?

Answer 14

immobilization and NSAIDs

Question 15

What population is at highest risk for ACL sprain?

Answer 15

Women athletes in sports like soccer and basketball

Question 16

What does Lachman’s test screen for? How?

Answer 16

ACL tear, tests anterior displacement of tibia vs. femur

Question 17

What is the alternate Lachman’s test useful for?

Answer 17

Patients with muscles that prohibit a solid grasp of the femur with one hand

Question 18

What is the biggest downside to using the anterior drawer test?

Answer 18

false negatives are elicited by swelling

Question 19

Which meniscus is more susceptible to injury? Why?

Answer 19

Medial; greater forces and less mobile structure than lateral

Question 20

What is the McMurray test used to check for and how?

Answer 20

Meniscal tears, one thumb on MM and one hand rotating the lower limb.

Question 21

Pain with medial rotation on McM test indicates

Answer 21

lateral meniscal tear

Question 22

Pain with lateral rotation on McM indicates

Answer 22

medial meniscal tear

Question 23

What is the most common knee complaint in primary care?

Answer 23

Chondromalacia, or patellofemoral syndrome

Question 24

What causes patellofemoral syndrome?

Answer 24

imbalance of quad strength (lateral>medial), recurrent patellar subluxation

Question 25

What is the pain of patellofemoral syndrome described as?

Answer 25

Anterior pain under the patella, worse with stairs and after extended sitting. Usually with crepitus, popping, and instability

Question 26

What component of the visit is most helpful in diagnosing chondromalacia?

Answer 26

History

Question 27

How do you reproduce pain in extremities with patellofemoral syndrome?

Answer 27

knee in slight flexion and gently press patella and contract quads

Question 28

Treatment for patellofemoral syndrome

Answer 28

strengthen quads, esp medial

Question 29

what are clinical manifestations of Osgood-Schlater?

Answer 29

Local swelling and tenderness, worse with jumping +/- radiograph due to pre-ossification stages

Question 30

What is Osgood-Schlatter? How is it caused?

Answer 30

Partial avulsion of tibial tuberosity; repetitive stress on immature bone

Question 31

What is the tx for Osgood-Schlatter?

Answer 31

avoid strenuous exercise and jumping sports, +/- brace, usually self resolve in 1-2 years, NSAIDs are usually effective

Question 32

What is the biggest differential b/w Osgood-Schlatter and patellar tendonitis?

Answer 32

age of onset, +/- TT avulsion

Question 33

What can exacerbate patellar tendonitis symptoms?

Answer 33

excessive foot pronation and running hills

Question 34

What is the treatment for patellar tendonitis?

Answer 34

NSAIDs, ice, brace, etc (nonsurgical, no steroids)

Question 35

What direction does patellar dislocation usually occur?

Answer 35

Laterally b/c of size of vastus lateralis

Question 36

How do you distinguish b/2 patellar fracture and bipartate patella?

Answer 36

Fx appears with sharper edges