knee

Question 1

knee rom

Answer 1

flexion 135

extension 0

Question 2

knee open pack

Answer 2

flexion 25

Question 3

knee closed pack

Answer 3

full extension

ER

Question 4

actions of sartorius muscles

Answer 4

hip - flex, weakly abduct, laterally rotate the femur
knee - flex the leg;
when the knee is flexed, medially rotates the leg.

Question 5

when does the screw home mechanism occur? why does it occur?

Answer 5

During the last 20 or 30 degrees of knee extension, the tibia (open chain) ER or
femur (closed chain) IR ~10 degrees.
Why - slight rotation is due to inequality of the articular surface of femur condyles - medial condyle larger.
Rotation must occur to achieve full extension and then flexion from full extension - lock and unlock knee

Question 6

what tests used? what pathology?

• knee pain following a twisting injury while landing from a jump while playing soccer
• patient’s knee is swollen significantly and is unable to jump or run.

Answer 6

• ACL
• majority of injuries to female soccer players is to the ACL, especially with a running/twisting injury and swelling.
• Pivot shift - 81.8% sensitive and 98.4% specific.
• Lachman’s test- 81.8% sensitive and 96.8% specific
• Anterior drawer sign - 40.9% sensitive and 95.2% specific

Question 7

what deg flexion with eccentric loading, the point of the greatest compression of the patella into the femur?
if pain, what pathology?

Answer 7

30 deg flex

Patellofemoral pain syndrome

Question 8

common complication post ACL repair

Answer 8

loss ROM

Arthrofibrosis following ACL repair is the MOST common complication, limiting range of motion.

Question 9

what pathology?

Mild pain or tightness in the hamstring muscle, especially when stretched or contracted.

Answer 9

grade I mild hamstring strain

Question 10

what pathology?

Immediate pain with injury, painful with stretching, and significant bruising over the hamstring.

Answer 10

grade II, moderate hamstring strain, partial tear

Question 11

what pathology?

Burning pain immediately after injury, inability to walk, and significant bruising over the hamstring.

Answer 11

grade III, severe hamstring strain, complete tear

Question 12

most dangerous point of rehabilitation is approximately # weeks when the graft is remodeling?

Answer 12

6 weeks

Question 13

what medication?
first several weeks post TKA
- precautions?

Answer 13

Warfarin, common anticoagulants

- require frequent blood tests and his diet will require close supervision

Question 14

Trauma to the tibial nerve

• motor
• sensory

Answer 14

weaken plantarflexion and alter sensation of the plantar surface of the heel.

Question 15

Gliding the proximal phalanx which direction?

will improve the 1st MTP joint extension

Answer 15

dorsally

concave surface glides in same direction as roll

Question 16

knee flexion needed for gait, what phase?

Answer 16

0-60 Initial swing

Question 17

knee flexion needed for gait

Answer 17

83-107

Question 18

knee extension needed for gait, what phase?

Answer 18

0
midstance - terminal stance
terminal swing - initial contact

Question 19

what test?

• Patient supine with the knees extended.
• Therapist applies slight pressure distally with the web space of their hand over the superior pole of the patella and asks the patient to contract the quadriceps muscle.
• Positive test: failure to complete the contraction without pain.

Answer 19

Clarke’s sign

may be indicative of patellofemoral dysfunction.

Question 20

MMT what muscle?

• Patient prone, knee is flexed to 50-70 degrees with the thigh in slight lateral rotation and the leg in slight lateral rotation on the thigh.
• Therapist applies pressure against the leg, proximal to the ankle, in the direction of knee extension.

Answer 20

biceps femoris

Question 21

What test? what for?

-Patient in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees.

Answer 21

anterior drawer test - ACL injury

Question 22

What test? what for?
Patient in supine with the knee flexed to 90 degrees and the hip flexed to 45 or 90 degrees. The test is often positive in the presence of a posterior cruciate ligament injury.

Answer 22

posterior sag sign - PCL tear

Question 23

What test? what for?
Patient prone. Therapist passively flexes the patient’s knee through the available range of motion.
Positive test is indicated by spontaneous hip flexion and may be indicative of a rectus femoris contracture.

Answer 23

Ely’s test

Question 24

what term? greater in women or men? increased value associated with? abnormal?
measurement of lateral line of pull of the quadriceps relative to the patella is referred to as
Angle formed by 2 lines. One line connecting from the anterior superior iliac spine to the middle of the patella and the other connecting from the middle of the patella to the tibial tuberosity.

Answer 24

Q-angle
-females is between 13-18°
-increased Q angle: 
Femoral anteversion
External tibial torsion
Laterally displaced tibial tubercle
Genu valgum: increases the obliquity of the femur and concomitantly, the obliquity of the pull of the quadriceps
-abnormal value: risk of developing chondromalacia patellae, patella alta or mal-tracking of the patella.

Question 25

what test? why? | medially rotated tibia position with an applied valgus force to the knee

Answer 25

assess anterolateral rotational instability of the knee | often used as part of the examination of a patient with a suspected ACL injury.

Question 26

what test? why? - patient lying supine and support the patient’s foot or ankle. - Therapist competely flex the knee and allow the knee to passively extend. - Normally, knee should extend completely, or “bounce home” into extension. - Positive: extension is not complete.

Answer 26

knee menical lesion

Question 27

pathology? inflammation of the bursa located at the common insertion of the tendons of the sartorius, gracilis, and semitendinosus muscles on the anteromedial portion of the superior tibia. - typically report pain just distal to knee, medial side tibia

Answer 27

Pes anserine bursitis

Question 28

pathology? - cyst in posterior knee, often associated with arthritis or a cartilage tear. - Discomfort is typically reported in the posterior knee and is often exacerbated by extremes of flexion or extension.

Answer 28

Baker’s cyst, also referred to as a popliteal cyst, refers to a fluid filled cyst that develops in the posterior knee.

Question 29

pathology? caused by repetitive tension to the patellar tendon over the tibial tubercle in young athletes. Knee pain is typically reported over the patella tendon at the insertion on the tibial tubercle.

Answer 29

Tibial apophysitis, Osgood-Schlatter disease

Question 30

what pathology? - Effusion and bruising may be minimal as bleeding may diffuse into soft tissues rather than the joint space. - compared to the unaffected limb, pronounced laxity will be noted during valgus stress testing with the knee slightly flexed (e.g., >10 mm of medial gapping),

Answer 30

grade III MCL sprain, Complete rupture Medial gapping when knee extended during valgus stress test typically indicative of additional injury (e.g., anterior cruciate ligament sprain).

Question 31

what pathology? - pronounced pain and tenderness to palpation medial knee - bruising and effusion may be somewhat variable. - compared to the unaffected limb, significant laxity will be noted during valgus stress testing with the knee slightly flexed (e.g., 5 to 10 mm of medial gapping).

Answer 31

grade II MCL sprain

Question 32

what pathology? - tenderness to palpation, - minimal bruising, and effusion. - compared to the unaffected limb, no significant difference will be noted during valgus stress testing with the knee slightly flexed.

Answer 32

grade I sprain of the MCL

Question 33

what does 10 degree extension lag mean? | what causes it?

Answer 33

passive knee extension is 10 deg greater than active knee extension - Inhibition of the quadriceps is a common rationale, including pain and effusion.

Question 34

what pathology? - general term describing pain or discomfort in the anterior knee - repetitive overuse disorder resulting from increased force at the patellofemoral joint. - mistracking of patella within intercondylar groove, typically lateral tracking - associated with muscle tightness, muscle imbalance, excessive pronation, increased Q angle, knee hyperextension, and inherent patellofemoral joint characteristics - pop usually younger, recreational runners, women - knee pain with prolonged sitting with knee flexion, going down stairs, squatting, jumping - occasional buckling of knee

Answer 34

Patellofemoral syndrome, runners knee, movie goers knee

Question 35

what pathology? | softening of the articular cartilage of the patella

Answer 35

chondromalacia patella

Question 36

what impact does increased Q angle have on knee?

Answer 36

increased angle alters the quadriceps line of pull in such a way that the patella tends to track more laterally along the femoral groove.

Question 37

possible interventions for Patellofemoral syndrome?

Answer 37

- orthotic arch support to correct pronation - Patellar taping to improve patellofemoral alignment to use during strengthening - VMO strengthening

Question 38

biceps femoris action?

Answer 38

both heads: flex and laterally rotate the knee joint. | long head also extends and laterally rotates the hip joint.

Question 39

biceps femoris origins? insertion?

Answer 39

long head origin: ischial tuberosity | short head origin: linea aspera of femur Both heads insert: lateral side of the head of the fibula.

Question 40

Anterior trunk bending during foot flat phase reason? | intervention?

Answer 40

anterior trunk bend- commonly used to bring the line of force in front of the knee to compensate for weak knee extensors - strengthen quads

Question 41

Triceps surae weakness during gait?

Answer 41

can result in inadequate knee extension in stance

Question 42

what is likely injured? - knee flexed and object forcefully strikes proximal anterior tibia displacing it posteriorly - MVA dashboard injury, athletics, falling up the stairs

Answer 42

PCL

Question 43

what is likely injured? - noncontact deceleration producing valgus twisting injury eg. athlete quickly pivoting in opposite direction - hyperextension - severe medial tibial rotation

Answer 43

ACL

Question 44

what is likely injured? - lateral patellar dislocation during powerful contraction of quad in combo with sudden flexion and external rotation of tibia on femur

Answer 44

medial patellofemoral ligament

Question 45

what is likely injured? - severe trauma resulting in dislocation of tibia on femur - fracture distal femur with posterior displacement of short distal fragment

Answer 45

popliteal artery

Question 46

what is likely injury? - pain over lateral knee due to irritation of distal portion IT band as it rubs against lateral femoral condyle - overuse injury with repetitive flexion and extension of knee - common in long distance running athletes

Answer 46

IT friction syndrome