Boards Prep - MSK > Knee > Flashcards

Knee Flashcards

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1
Q

Grade I LCL/MCL Ligament lesion

A
  • pain with valgus/varus stress; palpation over ligament painful, may have swelling, joint is stable, AROM may be painful
  • little no instability
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2
Q

Grade II LCL/MCL Ligament lesion

A
  • local swelling and some effusion
  • pain with valgus/varus stress
  • ROM limited
  • laxity at 30 degrees
  • may have palpable defect
  • minimal to moderate instability
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3
Q

Grade III LCL/MCL Ligament lesion

A
  • full thickness tear
  • grater amounts of Grade II findings
  • extreme instability
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4
Q

LCL/MCL Ligament lesion - maximum protection phase (Weeks 1-3)

A
  • PRICE
  • ambulation training
  • PROM/AAROM
  • patellar mobs (I and II)
  • muscle setting
  • SLR
  • aerobic conditioning
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5
Q

LCL/MCL Ligament lesion- moderate protection phase (weeks 3-6)

A
  • continue multiple angle isometrics
  • initiate PRE
  • CKC strengthening
  • LE flexibility
  • endurance
  • balance
  • walk/jog program at end of this phase
  • skill specific drills at end of phase
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6
Q

LCL/MCL Ligament lesion - minimul protection phase (5-8 weeks)

A
  • LE flexibility
  • advance PRE
  • advance CKC strengthening, endurance
  • isokinetics
  • progress running program, full speed job sprits, cutting
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7
Q

LCL/MCL Ligament lesion return to activity (weeks 6-10)

A
  • continue flexility and strengthening
  • agility drills
  • running drills
  • perturbation drills
  • sport specific drills
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8
Q

what is the unhappy triad

A
  • MCL
  • medial meniscus
  • ACL
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9
Q

ACL lesion etiology

A
  • noncontact: forceful hyperextension or ER force when foot is planted
  • contact: valgus force to knee
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10
Q

ACL lesion symptoms

A
  • acute, tense effusion
    • lachman’s
    • anterior drawer, levers
  • posterior knee pain (acute)
  • posterior and lateral knee pain (chronic)
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11
Q

PCL lesion etiology

A
  • most commonly injured by a forceful blow to anterior tibia while knee is flexed
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12
Q

ligament repair considerations

A
  • may take 9-12 months for full healing of repair
  • early ROM typically allowed
  • immobilization in safe position
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13
Q

muscle and tendon repair considerations

A
  • muscle: ROM within protected ranges AFTER immobilization is removed
  • tendon: ROM in max phase
  • when strengthening begins: being with low load, high reps, concentric contractions
  • vigorous stretching and full contraction against resistance often contraindicated for first 6-8 weeks
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14
Q

gold standard ACL reconstruction

A
  • patella tendon autograft
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15
Q

ACL reconstruction

A
  • immobilization for early protection
  • ROM: early extension is important; 90-110 by 4-6 weeks
  • varies WBAT to some form of PWB
  • NO OKC TKE 45-0 degrees; CKC squad strengthening between 60-90 degrees
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16
Q

What causes meniscal/articular cartilage injuries

A
  • a combination of forces to include tibiofemoral joint flexion, compression, and rotation
  • fixed foot with rotation
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17
Q

symptoms of meniscal injury

A
  • feel something give in the joint, sickening, deep pain
  • pain with full ext or flex
  • history of locking
  • difficulty WBing when acute
  • joint line tenderness
    • mcmurrays
    • apley’s
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18
Q

meniscal healing potential

A
  • tears in peripheral zone have rich vascular supply and response well
  • inside… not so much –> probably gave to take it out
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19
Q

diagnostic test for meniscal injury

A
  • MRI
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20
Q

meniscal repair immobilization

A
  • locked in knee ext
  • typically 24 hr wear
  • progressing unlock from 4-8 weeks
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21
Q

meniscus repair ROM restriction

A
  • restricted to 90 degrees flex for 2 weeks
  • typical 10 degree increase each week
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22
Q

meniscal repair WB

A

NWB/TTWB for central/root repair for 4-6 weeks
- peripheral zone repair sometimes PWB; FWB by 4 weeks

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23
Q

meniscal repair squatting progression

A

0-45 flex for first 4 weeks
0-60/70 for up to 8 weeks
deep squat, twist, and pivot at 4-6 mo
**hamstring curls avoided for 8 weeks

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24
Q

Meniscectomy

A
  • no immobilization
  • WBAT
  • ROM progressed as tolerated
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25
Knee ligament sprain CPG - diagnosis
Made with reasonable level of certainty when pt present with following: - symptom onset linked to trauma - deceleration, cutting or vagus motion with injury - "pop" heard or felt - hemarthrosis within 0-12 hrs - effusion - subjective knee instability - excessive tibfem laxity - pain/symptoms with ligament integrity tests - LE strength and coordination deficits - impaired SL balance - abnormal compensatory strategies during deceleration or cutting movements (I)
26
Knee ligament sprain CPG - interventions - Therapeutic exercise and NMES
- concentric and eccentric exercises in non-WBing to increased quad strength and functional performance following ACL reconstruction - starting within 4-6 weeks and continuing up to 10 months - NMES following ACL reconstruction (up to 6-8 weeks) to increased quad strength and short term function
27
Knee ligament sprain CPG - interventions - NMR
- NMR along with strengthening in pts with knee stability and movement coordination impairments
28
Knee ligament sprain CPG - immediate vs delated mobilization
- use immediate mobilization following ACL reconstruction to decrease pain, increase ROM, and avoid adverse soft tissue responses (II)
29
Knee ligament sprain CPG - cryotherapy
- use immediately after reconstruction (II)
30
Knee ligament sprain CPG - supervised rehabilitation
- education and exercises following ACL reconstruction for supervised in clinic period and home program (II)
31
Knee ligament sprain CPG - continuous passive motion and early WB
- use CPROM immediately after reconstruction - implement WBAT within 1 week (III)
32
ACL Prevention CPG - review evidence for prevention programs
clinicians should recommend use of exercise based knee injury prevention programs in athletes for prevention knee and ACL injuries (I)
33
ACL Prevention CPG - prevention program effectiveness in subgroups of athletes
- to reduce the risk of ACL injuries, female athletes, particularly <18 yo, should implement knee injury prevention programs prior to training/practice (I) - to reduce risk of severe knee and ACL injuries, soccer platers, esp women, should implement knee injury prevention programs (I) - to reduce risk of knee injuries, team handball (m & f) platers should implement knee injury prevention programs (II)
34
ACL Prevention CPG - evidence for program components, dosage, delivery
- incorporate multiple components, proximal control exercises, and a combination of strength/plyometric exercises (I) - train multiple times/week, > 20 mins/session, >30mins/weeks (I) - start programs in preseason and continue though reg season (I) - clinicians, coaches, parents, athletes ensure high compliance (I) - may not need balance (II)
35
ACL Prevention CPG - provide suggestions for program implementation
- implement knee injury prevention programs in all youth athletes, not just those identified at risk for ACL injury (I) - to reduce future medical costs, implement evidence based ACL injury prevention in athletes 12-25 yo involved in high risk sports (I)
36
are F or M more likely to have ACL tear?
F
37
meniscal lesion CPG - risk factors
- cutting and pivoting sports (II) - older age and delated ACL reconstruction (III)
38
meniscal lesion CPG - physical performance measures
- single legged hop test to asses pain and function, detect side to side asymmetries, determine readiness to return to activities (III)
39
meniscal lesion CPG - physical impairment measures
- modified stroke test for effusion - AROM - maximum isometric or isokinetic quads strength - McMurray's and joint line tenderness (II)
40
meniscal lesion CPG- diagnosis
- twisting injury, tearing sensation at time of injury, delayed effusion, history of catching or locking, pain with forced hyperextension, pain with max flex, pain or addable click with McMurray's, joint line tenderness, discomfort or sense of locking or catching in knee over medial or lateral joint like during Thessaly when at 5 or 20 degrees of flex (II)
41
meniscal lesion CPG - interventions
- Progressive knee motion (II) - supervised rehab (II) - therapeutic exercise (II) - NMES on quads (II) - progressive WB (III) (FWB by 6-8 weeks) - progressive return to activity
42
What is patella Alta
malaignmeent in which the patella superiorly in femoral intercondylar notch
43
what can patella Alta result in
chronic patellar subluxation - may also be the result of patellar tendon rupture
44
what sign will be positive with patella Alta?
- camel back sign - two bumps over anterior region instead of one --> two pumps since patella rides high in femoral condyles, creasing superior pump with tib tub forming second inferior bump
45
what is patella Baja
- malignement in which the patella tracks inferiorly in femoral intercondylar notch
46
what does patella Baja result in
- restricted knee extension with abnormal cartilaginous wear, resulting in DJD - may also be result of patella tendon rupture
47
diagnostic tests for patella femoral dysfunction
plain film imaging including "sunrise" view
48
PT goals for patella femoral dysfunction
- regaining functional strength of the lower extremity, including quads and gluteal mm - regain flexibility - patellar taping/bracing
49
What is patellofemoral pain syndrome
common dysfunction that is the result of elevated PF joint loading caused by trauma, biomechanical factors and/or muscle tightness and weakness
50
patellofemoral pain syndrome may be associated with...
patellar tendinopathy and/or chondromalacia patellae
51
What is Hoffa's syndrome
fat pad syndrome in the knee
52
patellofemoral pain syndrome CPG - diagnosis
- should use reproduction of retropatellar or peripatellar pain with squatting and other functional activities that load the PFJ in flex positions as diagnostic test (I) Can use following criteria (II) - presence of retropatellar or peripatellar pain - reproduction of pain with squatting, stair climbing, prolonged sitting (movie goer's sign), or other functional activities that load PFJ in flexed position - exclusion of all other conditions that can cause ant knee pain
53
patellofemoral pain syndrome CPG - outcome measures
(I) - should used anterior knee pain scale, patellofemoral pain and osteoarthritis sub scale of knee injury and osteoarthritis outcome score (KOOS-PF), or VAS for activity to measure pain and function - should use VAS for worst pain, usual pain or numeric pain rating scale to measure pain
54
patellofemoral pain syndrome CPG - interventions
(I) - should combine PT interventions with exercise as critical component - should consider addition of foot orthosis, patellar taping, patellar mobs, and LE stretching - should include hip and knee exercises - hop exercises should target posterolat hip mm - knee exercises may include WB or nonWB exercises
55
should you brace for PFPS per the CPG?
no (II)
56
should you use biofeedback on LE for PFPS per the CPG
no (II)
57
patellofemoral pain syndrome CPG - foot orthoses
- should prescribe prefabricated foot orthoses for pts with grater than normal pronation, only for short term (up to 6 weeks) (I)
58
what is patellar tendonosis/tendinopathy?
degenerative condition of the patellar tendon, typically of deep aspect
59
what may patellar tendonosis/tendinopathy be related to?
overload and/or jumping related activities/sports - may be interrelated to patellofemoral dysfunction
60
how is patellar tendonosis/tendinopathy diagnosis made
clinical examination
61
meds for patellar tendonosis/tendinopathy
- NSAID - acetaminophen - corticosteroid
62
what typically causes pet anserine bursitis
overuse or contusion
63
femoral condyle fracture
- medial most often involved due to anatomical design - trauma, shearing, impacting, and avulsion forces - MOI is a fall with knee subjected to sheering force
64
tibial plateau fracture
- common MOI is combination of valgum and compression forces to knee when in flexed position
65
tibial plateau fracture often occurs with
MCL injury
66
epiphyseal plate injury
- MOI frequently WBing torsional stress - presents more frequently in adolescents, where an ACL injury would occur in adults
67
patellar fracture
- MOI is direct blow to patella due to fall - X ray unless complex
68
should you use dry needling for PFPS?
no (I)
69
manual therapy for PFPS?
should not use manual therapy, including lumbar, knee or patellofemoral manipulation/mobilization (I)
70
should you use biophysical agents on PFPS?
no (II)
71
Knee normal flex/ext
flex: 135 ext: 0-15
72
knee normal IR/ER
ER: 30-40 IR: 20-30
73
knee capsular pattern
flex> ext
74
knee OPP/CPP
OPP: 25 degree flexion CPP: full ext and ER
75
knee concave/convex rule
tibiofibular: concave on convex knee: concave on convex
76
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