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88 Cards in this Set
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most specific MCL test
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valgus at 30 flexion (> 5mm)
if > 10mm, check acl valgus in full extension checks acl and pcl too |
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most specific LCL test
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varus at 30 flexion
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initial PCL test
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posterior drawer
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most specific PCL test
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posterior sag
if laxity with ER, evaluate post lat corner |
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most specific ACL test
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Lachman with empty end feel
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Post lat corner tests
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posterior drawer increased at 30 and normal at 90
*increases accuracy in prone |
testing in prone does what?
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If ER is increased with 30 AND 90 flexion, check what?
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PCL
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initial meniscus tests
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Thessaly
Meniscus pathology composite score |
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most specific meniscus test
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History of catching/locking
jt line tenderness pain with force hyper extension pain with max knee passive flexion pain / click with McMurrays if 5/5, 92% PPV if 3/5, 75% |
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which Acl test is not good with hamstring guarding?
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pivot shift
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tibial ER tightens what lig?
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pcl
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when do you use Estim for quad strength?
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15-20% deficit
shown to be beneficial in gaining strength faster than volitional exercise |
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Estim setting for quad
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Russian
burst modulated 2s ramp 10s contraction 50s rest |
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effects of eccentric exercise
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greater changes in neural activation and muscle hypertrophy
**also useful if pt is too weak for concentric! |
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some fibers of ACL go to what?
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anterior horn of medial meniscus
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which meniscus is less mobile?
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medial.
may contribute to higher incident of injury |
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What muscles can create movement in the menisci?
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semi membranosus = medial
popliteus = lateral |
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Ottawa knee rules (100% Sn)
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- tenderness of fibular head / patella
- age > 55 - inability to flex to 90 - inability to bear weight any 1 positive = Xray |
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Pittsburgh Knee Rules
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Blunt trauma and 1 of the following:
age <12 or >50 unable to walk 4 steps in ER |
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which portion of the MCL restrains valgus stress?
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Superficial
Deep MCL provides meniscus support/control |
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when does greatest amount of posterior tibial translation occur?
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70-90 degrees
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Most anterior shear in what position?
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terminal knee extension, final 40 degrees
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posterolateral bundle
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taut in extension
primary restraint to ant translation until 20 degrees flex |
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anterior medial bundle
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tight in flexion (ant drawer)
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immediate swelling
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Intra joint pathology
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hours after swelling
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jt surface strain
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case: 14yo male with anterior knee and thigh pain, obese, excessive ER, loss of IR
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SCFE
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case: 6 yo with hip and knee pain
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may be legg calve perthes
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TX for scfe?
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refer for urgent hip films!
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ACL + meniscus repair precautions
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No weight bearing flexion past 45 for first 4 wks
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ACL + CHONDRAL LESION
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No weight bearing for first 3-4 wks
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phases of cartilage healing
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proliferation 0-4 wks
transition 6-12 wks remodeling 12-26wks maturation 26-52wks |
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What is Sindig Larsen johansson?
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traction apophysitis of inferior patellar pole
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Slocum test
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like anterior drawer but in slight internal rotation to test anterior medial laxity
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Micro fracture is preferred for what size lesion?
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< 2cm
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this factor is predictive of development meniscus tear after acl injury
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time from initial acl injury
2-5 years increased odds by 2.2 of meniscus tear |
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when will swelling present with meniscus tear?
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6-24 hrs after injury
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peripheral third of the menisci is vascular or avascular?
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vascular
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semi membranosus is attached to .....
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medial meniscus
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popliteus is attached to ...
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lateral meniscus
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segond fracture
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ACL avulsion fracture from anterior tibia
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Hughstons test
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post lateral instability
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best test for chronic pcl tears
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reverse pivot shift
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age range for SCFE
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older 8-17 years
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age range for Legg Calve Perthes
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younger 5-12 years
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Sage sign
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Lateral patellar instability > 25-50% patellar width
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Dial test + at 30 degrees
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posterior lateral corner injury
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dial test + at 30 AND 90 degrees flexion
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corner injury AND PCL.
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sxs of peroneal n injury
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altered sensation to dorsum of foot and weak ankle Doris flexion
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What direction do you mob the tibia to increase flexion?
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posterior tibia glide
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Major requirement for Unicompartmental knee replacement
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ACL
BMI < 32 |
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acl fixation
if the femoral tunnel is placed too far ... then knee flexion will be limited |
too far anteriorly
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Acl is weakest at what time?
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12 wks
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Hoffas syndrome
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infra patellar fat pad irritation
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onset of jt clicking post op meniscus repair. ....
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could indicate failure
should report immediately to surgeon |
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progression of chondral options
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1. debridement & lavage
2. microfracture 3. autologous chondrocyte implantation 4. osteochondral grafting |
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post op meniscus
overall restrictions |
limit high loading, deep knee flex and full squatting for at least 4-6 mos
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initial presentation of post op meniscus
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Locked in ext with brace and crutches
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when should someone have full PROM after meniscus repair?
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5-6 wks
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post op meniscus
how long partial wt bearing? |
4 wks
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when can a post op meniscus start running?
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4-6 mos
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return to sport for meniscus
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6-12 mos
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phases of strengthening for post op meniscus
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non wt bearing 1-2 wks
wt bearing 3-4 wks non wt bearing resistive 5-6 wks |
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microfracture creates what kind of cartilage?
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fibrocartilage
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indications for microfracture
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small lesion < 2 cm
grade 3-4 lesion without bone loss |
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by what wk is a microfracture def rc t completely filled in?
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12 wks
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oats stands for what?
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osteochondral auto graft transplant
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also called mosiacplasty
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start partial wt bearing when with OATs?
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begin partial wt bearing 2-4 wks, based on size of lesion and number of plugs used
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post op OATS
when can you progress to full wt bearing? |
8 wks
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initial WB status for OATs
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depends
toe touch or partial WB for PF, toe touch immediately |
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post op OATs
when can you do toe/calf raises? |
AFTER mini squats and leg press
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when should someone have full ROM post op OATS ?
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by the end of second phase transition phase (-12wks)
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when can a post op OATS return to low impact sports?
skating, cycling, rollerblading |
6-8mos
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What is aci?
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autologous chondrocyte implantation
type 2 hyaline cartilage |
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indications for ACI
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well contained lesion
2-10 cm do NOT involve subchondral bone |
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contradiction for ACI
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bipolar lesions or bone loss
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process for ACI
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1. biopsy
cells grow for 6 wks 2. implant and patch |
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if pt reports catching or clicking post op ACI
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Usu resolves, not serious
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post op ACI considerations
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pt positioned according to lesion for first 4 hours
protect wt bearing for 4-6 wks |
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What 2 things during the initial phase are most important? ACI
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controlled PROM
gradual weight bearing progression |
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wks 7-12 ACI
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pt achieves full ROM
progress wt bearing from partial to full |
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wks 15-18 post op ACI
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stiffness of the cartilage resembles that of the surrounding tissue
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post op ACI
when do you return to low impact activities? progress to moderate impact? |
low impact 5-6 mos
mod impact 7-9 mos |
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indications for OATS
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unipolar, but BONE LOSS
1-2 cm ideal |
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describe oats
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single procedure, to take cartilage plug to fill area with BONE LOSS
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ACL tests
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Anterior drawer (78, 86)
Lachman (96, 100) Pivot Shift (24, 98) |
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increase in anterior drawer with tibia in IR
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compromise of lateral capsule or an
ANTEROLATERAL INSTABILITY |
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if anterior drawer increased with tibia in ER
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compromise of medial structures (mcl, medial capsule, post oblique ligament)
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