Term
| when someone's knee is swollen, why does it look swollen above the knee? |
|
Definition
| synovial joint space continues above the knee |
|
|
Term
| what type of joint is the tibiofemoral joint |
|
Definition
|
|
Term
| what is the normal range of extension - flexion of the tibiofemoral joint |
|
Definition
|
|
Term
| what is the normal range of medial rotation of the tibiofemoral joint |
|
Definition
|
|
Term
| what is the normal range of lateral rotatoin of the tibiofemoral joint |
|
Definition
|
|
Term
| what are the functions of the tibiofemoral joint |
|
Definition
|
|
Term
| what is medial/lateral rotation of the tibiofemral joint? |
|
Definition
| tibial rotation. Tibia rotating on the femur |
|
|
Term
|
Definition
| small points facing to the sides. On condyles |
|
|
Term
| what attaches to the lateral femoral epicondyle |
|
Definition
| lateral collateral ligament and popliteal muscle |
|
|
Term
| when looking at knee ROM, what should be the center fo the axis of measurement/rotation |
|
Definition
|
|
Term
| how much knee flexion is needed for gait |
|
Definition
|
|
Term
| how much knee flexion is needed for stairs |
|
Definition
|
|
Term
| how much knee flexion is needed for sitting |
|
Definition
|
|
Term
| how much knee flexion is needed for bicycling |
|
Definition
|
|
Term
| what is the normal angle of the knee in the frontal plane |
|
Definition
|
|
Term
| how much valgus is called valgus |
|
Definition
|
|
Term
| how much valgus is called varus |
|
Definition
|
|
Term
| is the medial or lateral femoral condyle surface area larger |
|
Definition
| medial femoral condyle has larger surface area |
|
|
Term
| in open chain, what causes screw home mechanism locking? |
|
Definition
| tibial external rotation. In open chain, you're moving the tibia on the femur. As you go up into extension, the locking mechanism occurs as the quad pulls tibia up in space to 0 deg extension. Motion on lateral condyle finishes first, but there's still room to go on medial condyle so quads continue to pull. As movement continues on medial side, tibia externally rotates. |
|
|
Term
| what unlocks the screw home mechanism in open chaing |
|
Definition
| relaxation/eccentric control of quads |
|
|
Term
| what locks the screw home mechanism in closed chain? |
|
Definition
| femoral internal rotation. The quads lift a person up into extension by pulling the femur on top of the tibia. As you go up into extension, the knees extend to 0 deg, the motion on the lateral side of the knee stops first. The tibia is fixed on the ground and the femur is moving on top of the tibia. The femur will medially rotate to put the tibia in relative external rotation. |
|
|
Term
| what unlocks the screw home mechanism in closed chain |
|
Definition
| popliteus muscle laterally rotates the femur to unlock the knee |
|
|
Term
| what is the close pack position of the knee |
|
Definition
| full extension with lateral tibial rotation (screw home position) |
|
|
Term
| what makes full knee extension its close packed position |
|
Definition
| most congruent joint surfaces, least amount of joint space, tightest ligaments |
|
|
Term
| what is the resting position of the knee |
|
Definition
|
|
Term
| what is the capsular pattern of the knee |
|
Definition
|
|
Term
| at what position are both bands of the ACL relaxed |
|
Definition
|
|
Term
| what position do people assume when the knee swells |
|
Definition
|
|
Term
| what to ask for in the history portion of the examination |
|
Definition
| mechanism of injury; past medical history/other episodes; 24 hour cycle; pain location/type/aggs/alleviating factors/functional limitations/shoe wear, assistive devices, bracing, orthotics/other pertinent history, meds, diagnostic tests, training history, surface conditions |
|
|
Term
| what to ask about catching in the knee |
|
Definition
| where is the knee when this happens? |
|
|
Term
| what to ask about the knee giving away |
|
Definition
| where does it happen? Can you catch yourself? |
|
|
Term
| what happens when the knee gives way |
|
Definition
| painful structure gets a lot of stress, shuts the muscles off |
|
|
Term
| what to ask about shoe wear? |
|
Definition
| does a different pair make it better or worse? |
|
|
Term
| what are the ligament injury grades? |
|
Definition
|
|
Term
| describe a trace liganemt injury grade |
|
Definition
| normal joint play. 1-2mm or so. Different for different joints |
|
|
Term
| describe a grade I ligament injury |
|
Definition
| mild injury with integrity maintained. 0-25% injury. Up to 5mm. Pain. Solid end feel |
|
|
Term
| describe a grade II ligament injury |
|
Definition
| moderate injury with partial integrity loss. 25-75% of the structure is injured. 6-10mm of movement. Painful with either solid or muschy end feel |
|
|
Term
| describe a grade III ligament injury |
|
Definition
| severe injury with complete rupture. 75-100% of the structure injured. >10mm. There may be no pain because the whole thing's torn. There is nothing left that's connected. |
|
|
Term
| Medial collateral ligament is the primary restraint for what? |
|
Definition
| valgus stress at 0 degrees. |
|
|
Term
| MCL is a secondary restraint for what |
|
Definition
| anterior displacement, rotation, hyperextension |
|
|
Term
| the deep fibers of the MCL attach to what structure? |
|
Definition
|
|
Term
| what is the functional interference of the MCL? |
|
Definition
| inability to turn quickly |
|
|
Term
| where is the posterior oblique ligament? |
|
Definition
| behind the MCL. Goes from femoral condyle to medial tibial condyle. External to the semimembranosus |
|
|
Term
| what is the primary restraint of the posterior oblique ligament? |
|
Definition
| restrains valgus in flexion and hyperextension |
|
|
Term
| what is the secondary restraint of the posterior oblique ligament |
|
Definition
| valgus stress at 0 degrees. |
|
|
Term
| when the knee is in flexion, is the MCL or posterior oblique ligament a greater restraint to valgus force? |
|
Definition
| posterior oblique ligament |
|
|
Term
| what is the mechanism that causes medial knee joint instability? |
|
Definition
| valgus force in weightbearing. Force comes into the lateral side of the knee. Knee pops open medially. |
|
|
Term
| how to test for medial joint instability |
|
Definition
| generally, the same way it was injured. Apply valgus force |
|
|
Term
| what ligaments are tested when you apply a valgus stress to the knee at 0 deg extension |
|
Definition
|
|
Term
| what ligaments are tested when you apply a valgus stress to the knee at about 30 deg flexion |
|
Definition
|
|
Term
| what other tests might be positive with medial joint instability? |
|
Definition
|
|
Term
| will there be joint line tenderness with medial joint instability |
|
Definition
|
|
Term
| what kind of force can injur medial knee ligaments in open chain? |
|
Definition
| medial force to the ankle |
|
|
Term
| when will there be pain with medial knee instability |
|
Definition
| end range flexion/extension |
|
|
Term
| what will the ROM be like with medial joint instability |
|
Definition
| significantly restriceted with grade II-II tears |
|
|
Term
| what intervention to do for Grade I medial jiont instabilty of knee |
|
Definition
| treat for pain and swelling. May choose to brace to reduce pain. RICE, estim, ultrasound |
|
|
Term
| describe a grade I medial joint instability |
|
Definition
| medial swelling. It hurts when they walk, run, turn. Structure is intact, only need to control pain and swelling. |
|
|
Term
| what to do if someone has a grade II or III medial joint instability |
|
Definition
| try to approximate ends of tissue, immobilize, and refer to orthopod |
|
|
Term
| do all grade II, III medial knee instabilities require surgery |
|
Definition
|
|
Term
| should early weightbearing be considered in medial knee instability and why/why not? |
|
Definition
| yes. Helps maintain quadriceps |
|
|
Term
| why should someone with grade II/III medial jiont instbaility wear a brace |
|
Definition
| helps prevent excess motion |
|
|
Term
| how long should someone with Grade I tear wait to return to activity |
|
Definition
|
|
Term
| how long should someone with Grade II tear wait to return to activity |
|
Definition
|
|
Term
| how long should someone with Grade III tear wait to return to activity |
|
Definition
|
|
Term
| are there more medial or lateral instablities? |
|
Definition
| more medial instability injuries |
|
|
Term
| what are the 2 main lateral ligaments of the knee? |
|
Definition
| lateral collateral ligament and arcuate ligament |
|
|
Term
| what is the lateral collateral ligament's primary restraint |
|
Definition
|
|
Term
| what is the LCL's secondary restraints |
|
Definition
| anterior displacement, rotation, hyperextension |
|
|
Term
| where is the popliteus tendon compared to the LCL |
|
Definition
| popliteus is under the LCL |
|
|
Term
| what is the functional interference of the LCL? |
|
Definition
| inability to turn quickly |
|
|
Term
| what is the primary restraint of the arcuate ligament |
|
Definition
|
|
Term
| what are the secondary restraints of the arcuate ligament |
|
Definition
| varus at 0, hyper extension |
|
|
Term
| what type of stress will result in lateral instability of the knee |
|
Definition
| Varus force in weightbearing |
|
|
Term
| what ligaments are implicated in a positive varus test at 0 degrees |
|
Definition
|
|
Term
| what ligaments are implicated in a positive varus test at about 30 degrees |
|
Definition
| LCL, arcuate, posterior-lateral capsule |
|
|
Term
| what other tests might be positive with lateral joint instability |
|
Definition
|
|
Term
| what is a mechanism of injury for a lateral instability caused in open chain |
|
Definition
| lateral force of the ankle |
|
|
Term
| what is another mechanism of lateral instability in closed chain other than varus force to the knee |
|
Definition
| as the person hits the ground, the thigh externally rotates and puts extra stress on outside of knee as foot goes into inversion |
|
|
Term
| could a grade III lateral joint instability require surgery |
|
Definition
|
|
Term
| are lateral joint instabilities commonly injured with ACL, PCL |
|
Definition
|
|
Term
| when might ACL injuries include LCL/arcuate |
|
Definition
|
|
Term
| what are the primary restraints of the ACL |
|
Definition
| anterior displacement, rotation (primarily IR), hyperextension |
|
|
Term
| what are the secondary restraints of the ACL |
|
Definition
|
|
Term
| is the ACL inside or outside the synovial cavity |
|
Definition
|
|
Term
|
Definition
| part of the ACL is taut throughout knee ROM |
|
|
Term
| what is the functional interference of the ACL |
|
Definition
| essential for higher level functions like running, cutting |
|
|
Term
| is there more strain on the ACL in tibial internal or external rotation |
|
Definition
|
|
Term
| why do you need to be sure the screw home mechanism works properly in patients after ACL reconstruction |
|
Definition
| in screw home mechanism, tibia rotates laterally, taking some stress off of ACL |
|
|
Term
| is the ACL inside or outside the joint |
|
Definition
|
|
Term
| what are mechanisms of injury that cause straight anterior instability |
|
Definition
| PA force on tibia or AP force on femur in weightbearing with flexion; hyperextension |
|
|
Term
| what tests are often positive for straight anterior instabilities |
|
Definition
| Lachmans, anterior drawer, varus/valgus |
|
|
Term
| what test is often negative with straight anterior instability |
|
Definition
|
|
Term
| what structures are injured with straight anterior instability |
|
Definition
|
|
Term
| what are mechanisms of injury that cause anteromedial rotary instability |
|
Definition
| weightbearing valgus with tibial lateral rotation; valgus blow while cutting |
|
|
Term
| how do you know if you have an anteromedial rotary instability |
|
Definition
| when you pull the tibia toward you, you expect both tibial condyles to come toward you. If medial comes more htan latearl, that's anteromedial rotary instability. |
|
|
Term
| what structures are injured with anteromedial instability |
|
Definition
| MCL, ACL, POL, sometimes medial meniscus |
|
|
Term
| what is the unhappy triad |
|
Definition
| MCL, ACL, medial meniscus |
|
|
Term
| what else should be checked along with anteromedial rotary instability |
|
Definition
|
|
Term
| what tests are usually positive for anteromedial instabilities |
|
Definition
| Lachmans, slocum in 15 deg tibial ER, sometimes pivot shift, sometimes McMurry |
|
|
Term
| why does tibial lateral rotation harm the ACL when the knee is weightbearing in valugs |
|
Definition
| if we move the tibia laterally, it takes the ACL and wraps it around the inside of the lateral femoral condyle, increasing strain on it. |
|
|
Term
| describe anteromedial instabilities and ACL tears |
|
Definition
| If a person plants her foot and doesn't go into screwhome with tibial ER at full extension, the ACL is stressed. Then if the tibia Ers and the femur Irs, the ACL is wrapped around the lateral femoral condyle. Stresses the ACL. |
|
|
Term
| what are mechanisms for anterolateral rotary instabilities |
|
Definition
| noncontact deceleration that pulls tibia forward on planted foot; cutting toward same side, putting extended leg on ground,tibia goes into relative IR |
|
|
Term
| what structures are damaged in anterolateral instability |
|
Definition
|
|
Term
| what tests are positive in anterolateral instabilities |
|
Definition
| slocum drawer IR, pivot shift, flexion rotation drawer |
|
|
Term
| are anterior instabilities usually caused by contact? |
|
Definition
|
|
Term
| how do stiff landings cause anterior instabilities? |
|
Definition
| knee is near extension and falling backward as you land. Quads take the tibia and yank it forward, popping ACL |
|
|
Term
| why are weaker quads more likely to tear ACL |
|
Definition
|
|
Term
| are girls or boys more likely to have anterior instabilitie |
|
Definition
|
|
Term
| why does a slightly flexed knee put ACL more at risk than fully extended knee |
|
Definition
| If knee is slightly flexed, it puts the knee out of screwhome. The Tibia rotates more medially, so ACL is in line so that if the tibia is pushed forward or if femur is stretched back, it is a direct force on the ligament. |
|
|
Term
| describe valgus collapse position of the knee |
|
Definition
| if my right foot comes forward and I plan tmy foot, flex my knee, get extra valgus, the tibia will relatively ER and the femur will relatively IR. An extra force across posterolateral to anteromedial will cause the tibia to ER. ACL wraps around lateral femoral condyle |
|
|
Term
| where do ACL replacements come from |
|
Definition
| allograft = cadaver, autograft = self, synthetic |
|
|
Term
| what is a primary ACL repair |
|
Definition
| taking the 2 ends of the ACL and sweing them back together. High failure rate because they're easy to tera |
|
|
Term
| is accelerated rehab good for ACL reconstruction? |
|
Definition
|
|
Term
| describe accelerated rehab for ACL reconstruction |
|
Definition
| immediate weight bearing, full extension day 1. by 2 weeks: if flexion 100, guided exercise/strength. 4 weeks unlimited ADL. Light sports by 8 weeks |
|
|
Term
| compare return to light sports time for accelerated vs non-accelerated ACL rehab |
|
Definition
| 8 weeks for accelerated, 6 months non-accelerated |
|
|
Term
| how can you reduce anterior knee pain following ACL reconstruction |
|
Definition
| get to full knee extension as quickly as possible. Return to screw home mechanism to protect graft |
|
|
Term
| at what point is the ACL graft weakest |
|
Definition
|
|
Term
| what is the general protection phse for the ACL |
|
Definition
|
|
Term
| when are ACL grafts strongest? |
|
Definition
| 1-1.5 years after surgery. Still never as strong as original |
|
|
Term
| what to do to avoid future problems and avoid extra tension on ACL |
|
Definition
| return to screw home mechanism asap |
|
|
Term
| what closed chain exercises to avoid post surgery and why |
|
Definition
| squats beyond 60 degrees. Want to avoid anterior glide of the tibia created by the quads |
|
|
Term
| should you avoid all closed chain knee extension exercises? Why or why not? |
|
Definition
| need to do both open and closed chain quads exercises because the quads lag behind everything else. |
|
|
Term
| what open chain exercises should be avoided following ACL reconstruction |
|
Definition
| terminal extension, SAQs. From 15 deg short of extension, there is a 60% increase in quads force required to pull the knee into extension. Pulls too much on ACL |
|
|
Term
| what muscle should be emphasized to provide active stabilization of the knee following ACL reconstruction |
|
Definition
|
|
Term
| when would you need to slow the progressive resistive exercises for the hamstrins? |
|
Definition
| if the graft came from the hamstrings |
|
|
Term
| what are common problems following ACL reconstruction |
|
Definition
| graft failure, patellar tendonitis, anterior knee pain |
|
|
Term
| what is an uncommon poblem following ACL reconstruction |
|
Definition
|
|
Term
| describe how a cybex can be used in ACL reconstruction rehabilitation |
|
Definition
| cybex can give posterior force to proximal tibia to keep from putting stress on ACL as you do TKEs. Can change levers to do concentric quads up and concentric hams down, but can't use the same levers to resist up and down. |
|
|
Term
| when can you return to cutting after acl reconstruction |
|
Definition
|
|
Term
| what are the primary restraints of the PCL |
|
Definition
| posterior tibial motion, hyper extension, rotation, anterior femoral motion |
|
|
Term
| what are the secondary restraints of the PCL |
|
Definition
|
|
Term
| is the PCL inside or outside the synovial cavity |
|
Definition
|
|
Term
| is the PCL tense in extension or flexion of the knee |
|
Definition
|
|
Term
| what is the functional interference of the PCL |
|
Definition
| squat, descend stairs, run backward |
|
|
Term
| what is posterior tibial motion? |
|
Definition
| pushing tibia front to back |
|
|
Term
| where is the center of rotation of the knee and what does that mean? |
|
Definition
| resides in the PCL. PCL assists in locking the knee into screw home |
|
|
Term
| what are mechanisms of injury resulting in posterior instability |
|
Definition
| tibia forced posteriorly. Hyperextension. Hyperflexion |
|
|
Term
| when might a tibia be forced posteriorly |
|
Definition
| car crash, dashboard knocks tibia posteriorly |
|
|
Term
| give an example of a hyperextension injury resulting in posterior instability |
|
Definition
| gymnast lands in hyperextension and tears ACL and PCL |
|
|
Term
| give an example of hyperflexion injury causing posterior instability |
|
Definition
| drop down and sit on your heels |
|
|
Term
| what ligaments are implicated in a positive posterior drawer test |
|
Definition
|
|
Term
| what is a mechanism of injury for posterolateral rotary instability |
|
Definition
| varus force to knee in hyperextension |
|
|
Term
| what test would be positive with posterolateral rotary instability? |
|
Definition
| external rotation recurvatum test |
|
|
Term
| what ligaments are implicated with positive external rotation recurvatum test |
|
Definition
| arcuate, LCL, popliteal tendon |
|
|
Term
| with PCL reconstruction, what muscle do you want to train to assist the PCL |
|
Definition
| quads: assist the PCL to help shift tibia forward |
|
|
Term
| when to do surgical reconstruction of PCL. |
|
Definition
| rarely. Usually does well with conservative treatments. Reconstruct if gross instability present. |
|
|
Term
| is it better to do early or postoponed repairs on PCL |
|
Definition
|
|
Term
| what are signs and symptoms of ligament injuries |
|
Definition
| fast effusion, giving way, positive instability testing, may have tenderness at involved structures |
|
|
Term
| how to treat Grade I ligament injurie |
|
Definition
| modify activities, treat pain and swelling, return to activity |
|
|
Term
| how to treat grade II ligament injuries |
|
Definition
| protect to allow healing, friction massage, careful return to activity |
|
|
Term
| how to treat grade III ligament injuries |
|
Definition
| may require surgical intervention. Rehab for dynamic stability |
|
|
Term
| do MCL/LCL or ACL/PCL have better blood supply |
|
Definition
| MCL/LCL have better blood supply than ACL/PCL |
|
|
Term
| how are MCL/LCL usually treated |
|
Definition
|
|
Term
| how to protect ligament injuries |
|
Definition
| brace? Surgery? Stabilize to prevent further damage |
|
|
Term
|
Definition
|
|
Term
|
Definition
| when it's safe to control size/quality of scar tissue and prevent adhesions |
|
|
Term
| when to add in strength following ligament injuries |
|
Definition
| when structures around the joint are stable. Start with isometrics then leg press, quads, hamstrings, calf raises. Then low grade weightbearing activities that allow activity |
|
|
Term
| how to improve proprioception following ligament instabilities |
|
Definition
|
|
Term
| how to determine what biomechanical corrections should be made with ligament instabilities |
|
Definition
| look at posture, see that they are using all muscles correctly |
|
|
Term
| what are mechanisms of meniscal injruy |
|
Definition
| squat to standing with valgus/tibial lateral rotation; insidious with long-term compression |
|
|
Term
| describe the squat to standing that tears meniscus |
|
Definition
| in full squat position as femoral condyles come down, they compress meniscal structures against the tibia. Medial meniscus is caught. As person stands up, puts more weight on that side, rotates and twists, it can tear. |
|
|
Term
| what are signs and symptoms of meniscal injuries |
|
Definition
| pop, catching/locking, effusion, giving way, anterior/medial joint line tenderness |
|
|
Term
| what are the 3 special tests for meniscal injury |
|
Definition
| mcmurry, apleys compression, bounce home |
|
|
Term
| what is the difference between catching and locking |
|
Definition
| catching is momentary, locking gets stuck |
|
|
Term
| what is the role of the meniscus |
|
Definition
| increases contact area, decreasing pressure and reducing risk of OA |
|
|
Term
| is medial or lateral meniscus more commonly injured |
|
Definition
|
|
Term
| where is the blood supply of the meniscus |
|
Definition
|
|
Term
| as age increases, how does likelihood for meniscal injures change |
|
Definition
| increases. Repair and healing decreases. Stiffness increases, shocak absorption decreases |
|
|
Term
|
Definition
| mostly, yes. There are nerves in the outer portion. There is also less blood supply in the middle. |
|
|
Term
| how does the middle area of the meniscus get its nutrition? |
|
Definition
| from compression/movement of the joint |
|
|
Term
| what is the most common meniscal tear |
|
Definition
| bucket handle in the posterior horn of the medial meniscus |
|
|
Term
| what are options for meniscal surgeries |
|
Definition
| open, scope. Inside-out or outside-in. |
|
|
Term
| if you see a meniscal injury,what do you do |
|
Definition
| activity modification, resolve swelling, restore ROM/strength, MD referral? |
|
|
Term
| what to do immediately after meniscal repair |
|
Definition
| protect the repair. Control motion with brace locked at 0, slowly increase. Begin isometrics. Slowly increase motion with bike swinging back and forth |
|
|
Term
| what to do 4-8 weeks following meniscal repair |
|
Definition
| increase motion, increase WB, slow increase with passive resistive exercises and conditioning |
|
|
Term
| what to do >8 weeks after meniscal repair |
|
Definition
| progress all ROM, strengthening, functional activities while staying out of fully flexed positions. |
|
|
Term
| when to return to activities following meniscal repair |
|
Definition
|
|
