1
Q
medial collateral ligament
A
-resists valgus stress
- gr II, III typically involve meniscus
2
Q
lateral collateral ligament
A
- resists varus stress
- stronger than MCL
- taut from 0-30 degrees
3
Q
ACL
A
- restraint for anterior translation of tibia on femur
-attachments with ant-medial horn of meniscus - anterior-media bundle: most taut in flexion
- posterior-lateral bundle: most taut in extension
4
Q
PCL
A
- anterior lateral bundle: most taught in flexion
- posterior medial bundle: most taut in extension
- main restraint of posterior tibial translation or anterior femoral translation
- also limits femoral external rotation or tibial internal rotation
5
Q
collateral ligament injury s/sx
A
- varus/valgus trauma
- varus/valgus stress testing will be positive (MCL may be associated with ACL and meniscal symptoms)
- swelling, ecchymosis
- joint effusion if meniscal involved
- tenderness to palpation of ligament
- difficulty with pivoting and cutting
6
Q
MCL exam
A
- valgus stress test
- knee flexed to 20-30, + if laxity or pain, SN of .86
7
Q
LCL exam
A
- varus stress test, + is presence of laxity or pain
8
Q
ACL s/sx
A
- severe pain with joint effusion
- popping, giving way, buckling
- continued effusion
- quad inhibition
- limited ROM
- flexed knee gait
- 80% non-contact injury
- contact- 20%
9
Q
ACL exam
A
- gold standard is lachmans
— thought to test more of posterior bundle - anterior drawer test
— thought to test more anterior bundle - pivot shift test
— highly specific
10
Q
PCL s/sx
A
- posterior knee pain
- not as much effusion
- flexion beyond 90 may increase pain
- difficulty squatting, descending stairs, running
- not as much problem with quad inhibition
- sag sign (100 SP), + posterior drawer, reduced palpation of tibial plateau step up
MOI
- hyperflexion
- fall on flexed knee with foot in plantarflexion
- step in pot hole
- dashboard injury
10
Q
PCL s/sx
A
- posterior knee pain
- not as much effusion
- flexion beyond 90 may increase pain
- difficulty squatting, descending stairs, running
- not as much problem with quad inhibition
- sag sign (100 SP), + posterior drawer, reduced palpation of tibial plateau step up
MOI
- hyperflexion
- fall on flexed knee with foot in plantarflexion
- step in pot hole
- dashboard injury
11
Q
Knee pain and mobility impairments CPG recommended physical performance measure
A
LVL C- single legged hop tests, that can identify patient’s baseline status relative to pain, function, side to side asymmetries, test return to sport
12
Q
Knee pain and mobility impairments CPG recommended physical impairment measures
A
Level B- meniscus
- modified stroke test
- knee AROM
- max isometric quad strength
- forced hyper extension
- knee PROM
- McMurray’s
- joint-line tenderness
Level D- articular cartilage
- modified stroke test
- knee AROM
- max quad strength
- joint line tenderness
13
Q
Knee pain and mobility impairments CPG recommendation for progressive knee motion
A
Level B: early progressive active and passive knee motion following surgery for both meniscus and articular cartilage
14
Q
Knee pain and mobility impairments CPG recommendation for progressive weightbearing
A
Level C: meniscus, early progressive weightbearing
Level B: stepwise progression of weightbearing to full bearing by 6-8 weeks after MACI for articular cartilage lesion
15
Q
Knee pain and mobility impairments CPG recommendation for progressive return to activity
A
Level C: may utilize progressive return to activity following meniscal repair
Level E: may need to delay return to activity depending on type of articular cartilage surgery
16
Q
diagnosis of patellafemoral pain
A
- presence of retropatellar or peripatelllar pain (LVL A)
- reproduction of pain with squatting, stairs, prolonged sitting, or other functional activities that load the PFJ in a flexed position (LVL A)
- exclusion of all other conditions (LVL B)
17
Q
PFP categories
A
- overuse/overload without other impairment
- muscle performance deficits
- movement coordination deficits
- mobility impairments
18
Q
Overuse/overload without other impairment PFP
A
- pain primarily due to overuse/overload
- patient presents with history suggesting an increase in magnitude or frequency of PFJ loading at a rate that surpasses the ability of his tissues to recover
19
Q
muscle performance deficits PFP
A
- may respond favorably to hip and knee resistance exercises
- patient presents with lower extremity muscle performance deficits in hip and quad
20
Q
Movement coordination deficits PFP
A
- may respond favorably to gait training and movement re-education interventions leading to improvements in kinematics and pain
- patient presents with with excessive or poorly controlled knee valgus during a dynamic task, but not due to weakness
21
Q
Mobility impairments PFP
A
- hypermobile or hypomobile structures
- higher than normal foot mobility or flexibility deficits of 1 or more of the following (hamstrings, quad, GS complex, lateral retinaculum, ITB
22
Q
Meniscus hx and MOI
A
- twisting injury
- pain worse with movement, better with rest
- may complain of locking
- joint line tenderness
- acute effusion (within 2 hours)
- acute: sudden onset in people <40
- chronic: no specific MOI in people >50
23
Q
good prognosis for meniscus
A
- age <35
- peripheral damage
- longitudinal tear
- short tear
- acute injury
- stable knee
24
poor prognosis for meniscus
- older patient
- central damage
- complete tear
- bucket handle tear
- chronic injury
- unstable knee
25
meniscus hallmark findings
- joint line tenderness: good SN
- effusion: mild to mod over 1-2 days
- positive entrapment test: mcMurray's, apley's, squat
- quad inhibition: atrophy over first week or two following injury
26
microfractures for articular cartilage
- encourage blood flow
- replaced with fibrocartilage (not the same as hyaline cartilage)
- WB is controlled
- not great for active people
- good short term outcomes
27
ACI (autologous chondrocyte implantation
- small biopsy of autologous cartilage is harvested
- cartilage is enzymatically digested in lab to release chondrocytes
- chondrocytes cultured and implanted in second surgery
28
Osteochondral autograft transplantation system
- full thickness defects
- remove plug from NWB surface
- "press-fit" plugs implanted into lesion
- need CPM if mosiac is done to smooth out surface
29
outcome measures for PFP
Lvl A:
- AKPS
- KOOS
- visual analog scale
- EPQ
30
exercise for PFP
LVL A
- hip and knee targeted exercises
- hip before knee in early stages
31
paterllar taping for PFP
LVL B
- may use taping with exercise to reduce pain and enhance outcomes in short term
32
Bracing for PFP
LVL B
- should not use orthoses for PFP
33
foot orthoses for PFP
LVL A
- for patients with greater than normal pronation to reduce pain but only for short term
- should be combined with exercise
- no evidence on custom versus prefabricated
34
biofeedback for PHP
LVL B
- should not use EMG based feedback for quad
LVL B
- should not use visual biofeedback for lower extremity alignment
35
running gait retraining PFP
LVL C
- forefoot strike pattern
- cueing to increase running cadence
- cueing to reduce peak hip adduction while running
36
BFR + high rep knee exercise PFP
LVL F
- may use for those with limiting painful resisted knee extension
37
needling PFP
LVL A
- should not use TPDN
LVL C
- may use acupuncture
38
manual therapy PFP
LVL A
- should not use manual therapy alone
39
biophysical agents PFP
LVL B
- should not use biophysical agents (ultrasound, cryotherapy, phono/ionto, estim, laser)
40
patient education PFP
LVL F
- may educate on load management, body weight, adherence to active treatments
41
combined interventions PFP
LVL A
- should combine physical therapy interventions
42
Anteromedial rotary instability test
- slocum test (PMC)
43
anterolateral rotary instability tests
-jerk test of hughston
- losee test
- side-lying test of slocum
- flexion rotation drawer test
44
posterolateral rotary instability tests
- dial test at 30 and 90 (prone external rotation test)
- reverse pivot shift test
- posterolateral drawer test
- external rotation recurvartum test
- posterolateral external rotation test
45
J sign
for patellar tracking
46
ottowa knee rules
- 55 years or older
- isolated tenderness of patella
- tenderness at head of fibula
- inability to flex 90 degrees
- inability to bear weight both immediately and in ED for 4 steps (unable to transfer weight twice onto each lower limb
47
CPM
knee ligament sprain
LVL C
- may use cpm immediately postop to decrease pain for ACL
48
early weightbearing
knee ligament sprain
LVL C
- may implement early weightbearing within 1 week for ACL
49
knee bracing
knee ligament sprain
LVL C
- may use functional knee bracing for ACL deficiency
LVL D
- should document patient preference in decision to use knee bracing following ACL reconstruction
LVL F
- may use appropriate knee bracing for acute PCL, severe MCL, or PLC injuries
50
immediate versus delayed mobilization
knee ligament sprain
LVL B
- should use mobilization within 1 week after ACL reconstruction to increase joint ROM, reduce joint pain, reduce risk of adverse responses of surrounding soft tissue structures
51
cryotherapy
knee ligament sprain
LVL B
- should use cryotherapy immediately following ACLR to reduce postop knee pain
52
supervised rehab
knee ligament sprain
LVL B
- should use exercises and proved and supervises HEP
53
therapeutic exercises
knee ligament sprain
LVL A
- WB and NWB concentric and eccentric should be implemented within 4-6 weeks, 2-3 times per week for 6-10 months
54
NMES
knee ligament sprain
LVL A
- should be used for 6-8 weeks following ACLR to augment muscle strength to enhance short term functional outcomes
55
neuro re-ed
knee ligament sprain
LVL A
- should be incorporated with muscle strengthening exercises in patients with knee stability and movement coordination impairments
56
risk factors for osgood schlatters
- male gender
- male: 12-15
- female: 8-12
- sudden skeletal growth
- repetitive activities like jumping and sprinting
57
osgood schlatters presentation
- anterior knee pain with or without swelling which can be bilateral or unilateral
- starts as dull ache over tibial tubercle
- insidious
- improves with rest and subsides minutes to hours after stopping activity
- worse with running, jumping, knee trauma, kneeling, squatting
- enlarged prominence
- poor flexibility of quad and hamstrings
58
treatment of osgood schlatters
- may last for 2 years until apophysis fuses
- relative rest, activity modification
- ice and NSAIDS for pain relief
- can use knee pad to protect tibial tubercle
- quad and hamstring stretching and strengthening
OCS Prep
flashcards
Decks in class (11)
# Cards
