Knee

Question 1

Overweight, very tall, and thin prepubescents males (8-17 y/o) w/ ant thigh and/or knee pain - negative examination (Dx?)

Answer 1

Slipped Capital Femoral Epiphysis

Question 2

identifying slipped capital femoral epiphysis

Answer 2

FABER test - flexion, abduction, ER of hip with overpressure

Question 3

Legg Calve Perthes syndrome

• age demographic
• pain location (most often)
• presentation, onset, and mobility

Answer 3

• 5-12 y/o
• anterior thigh and possibly knee
• knee swelling, gradual onset, with locking

Question 4

PFP provocative tests (6 total)

Answer 4

1. pain w/ manual compression of PFJ
2. pain w/ palpation of posteromedial and posterolateral patellar borders
3. pain w/ resisted isometric quadriceps femoris contraction
4. pain w/ squatting
5. pain during kneeling
6. pain during prolonged sitting

Question 5

Four biological phases of cartilage maturation

Answer 5

proliferation, transitional, remodeling, and maturation

Question 6

Motions to avoid following meniscal injury (4)

Answer 6

squatting, pivoting, cutting, and running

Question 7

Squatting angles permitted for meniscal repair at 4 and 8 weeks post-op

Answer 7

<45 deg and <90 deg (respectively); >90 deg permitted after week 8

Question 8

Two most important things for most knee surgery rehabs

Answer 8

Obtaining terminal knee extension and quadriceps strengthening

Question 9

Hyaluronic acid

Answer 9

Shock absorber and lubricant in synovial fluid - directly injected

Question 10

Posterolateral corner is comprised of…

Answer 10

arcuate ligament
LCL
popliteal tendon
lateral head of the gastrocnemius

Question 11

Five measures - Meniscal Pathology Composite Score

ALSO THE CPR FOR THE KNEE (John Snyder, DPT site)

Answer 11

1. history of catching/locking
2. joint line tenderness
3. pain with forced hyperextension
4. pain with max knee passive flexion
5. pain or an audible click with the McMurray test

Question 12

Step down test - how do you do it?

Answer 12

step down with measuring painful angle

Question 13

Sage sign

Answer 13

greater than 50% of patellar width displacement (25-50% of patellar width change is normal)

Question 14

Patellar tilt test - knee positioning

Answer 14

Completed in 20 deg of knee flexion

Question 15

Cluster testing for patellofemoral pain

Answer 15

positive reproduction of pain with isometric quadriceps muscle contraction and/or pain during squatting and/or pain during palpation (PL and PM borders)

Question 16

Important functional knee tests - walking for elderly and pt’s with OA (4)

Answer 16

1. Timed Stair-climbing test
2. Six-minute walk test
3. Timed Up and Go test (TUG)
4. Five time sit to stand

Question 17

Four phase of rehabilitation following osteochondral autograft transplantation (OATS) and autologous chondrocyte implantation (ACI) procedures

Answer 17

1. Proliferation phase (0-6 weeks)
2. Transition phase (6-12 weeks)
3. Remodeling phase (12-26 weeks)
4. Maturation phase (26-52 weeks)

Question 18

Distal Patellar Realignment Surgeries (3)

Answer 18

1. Fulkerson Osteotomy
2. Hauser
3. Elmslie Trillat

Question 19

Posterolateral drawer test - positive finding

Answer 19

Posterolateral rotation of tibia when NEGATIVE; when POSITIVE, tibia rotates posterolaterally and posteriorly subluxes

Question 20

Prone external rotation test

1. tests what?
2. position and testing?
3. positive findings indications?

Answer 20

1. posterolateral (PL) corner of the knee
2. prone position with B knees flexed 30 deg; both lower limbs ER
3. greater than 10 deg difference of ER on affected side may indicate PL corner injury

Question 21

Lachman’s test

1. tests what?
2. position and testing?
3. findings?

Answer 21

1. ACL
2. 30 deg knee flexion with anterior tibial translation
3. Empty end-feel with testing is positive

Question 22

Step-down test

Answer 22

record the angle of flexion achieved along with subjective pain report (VAS or VRS) during descent.

Question 23

Noyes Hop Test

• purpose
• how completed
• describe the four variants (cluster)(4)

Answer 23

Commonly used functional test for return to sports.

• involve hopping distance and time to that of uninvolved limb
• tests are: single hope for distance, triple hop for distance, crossover triple hop for distance, and a timed 6 m. hop

Question 24

Non-surgical ACL screen

1. Episodes of giving a way
2. Noye’s hop test
3. KOS ADLs
4. Global rating score

Answer 24

1. 1 or less since injury
2. > 80%
3. > 80%
4. > 60%

Question 25

Level 1 sports vs Level 2 sports

Answer 25

1. Level 1 encompasses jumping, cutting, and pivoting types of maneuvers for 50 hours or more per year 2. Level 2 are those that involve lateral movement (e.g. racquet ball and skiing)

Question 26

PCL - ranges restricting posterior tibia translation 1. Anterolateral - purpose 2. Posteromedial - purpose

Answer 26

PCL restricts 95% of posterior displacement of tibia on femur between 30-90 deg. 1. AL bundle bears 50-74% of the posterior force between 40-120 deg. 2. PM responsible for 57% of posterior force beyond 120 deg.

Question 27

Measures when determining a successful ACL rehab outcome:

Answer 27

1. less than mild persistent perfusion 2. >90% quad and hamstring muscle strength 3. absence of giving way episodes 4. participation in 1 or 2 seasons of sports 5. patient-reported outcomes

Question 28

Anterior drawer + translation with tibial ER? if so what is wrong? + translation with tibial IR? if so what is wrong?

Answer 28

Anterior drawer: positive with 6 mm change with translation with soft end-feel Increased excursion with tibial ER may indicate anteromedial instability (MCL, med capsule, post. oblique ligament) Increased exc. with tibial IR --> possible anterolateral instability

Question 29

Ideal testing position of LCL and MCL (pure test)

Answer 29

20-30 deg knee flexion

Question 30

Full knee extension varus and valgus tests what structures

Answer 30

Varus: LCL, ACL, and PCL Valgus: MCL, ACL, and PCL

Question 31

What may happen that could interfere with testing using the pivot shift test?

Answer 31

Pt's will tend to guard, anticipating a shift or pain.

Question 32

Level B evidence of what regarding ACL bracing immediately post-operative - to use or not to use?

Answer 32

Not using a brace

Question 33

Cryotherapy (per CPG) for ACL rehab has what level evidence

Answer 33

Level C evidence

Question 34

MCL pathology CPR

Answer 34

Rotational trauma Trauma by external force to the leg Pain with valgus stress test at 30 deg flexion Laxity with valgus stress test at 30 deg flexion

Question 35

1. Pittsburgh (CPR) knee rules | 2. what is this used for?

Answer 35

1. Blunt trauma or fall as mechanism of injury plus... - >50 y/o or <12 y/o * and/or* - inability to walk 4 steps WB steps in the emergency dept. 2. identify need for radiographs of the knee