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59 Cards in this Set
- Front
- Back
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What are the two joints of the knee complex? |
1. Tibiofemoral 2. Patellofemoral |
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What kind of joint is the Tibiofemoral Joint?
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Hinge joint-made form the femoral condyles and tibial plateaus
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Which condyle of the femur is longer? |
The medial condyle-the medial tibial plateau is also longer |
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What is the function of the meniscus? |
Shock absorber, helps conform femoral condyle to tibia |
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Which side of the knee do more injuries occur? |
The medial side, more WB. |
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What is the name of the structure that runs from the patella to the tibia? |
The patellar tendon |
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Screw-home mechanism
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Locking mechanism of the knee; terminal ext/lock - femur ext and IR (CP), opposite for OP. Stabilizer.
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What structures provide the most stability to the knee? |
The ligaments! **The cruciates give most stability |
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How does the patellofemoral joint move? |
Via patellar tracking mechanics **Maltracking usually occurs laterally |
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What is the open packed position of the patella?
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Slight flexion
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During knee flexion, which way does the patella track? |
Inferiorly **opposite for knee extension |
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What are some causes of patellar malalignment/tracking? |
1. Increase Q angle 2. Muscle and fascial tightness 3. Hip muscle weakness 4. Lax medial retinaculum 5. Insufficient VMO muscle |
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All maltracking of the patella is which way? |
Almost always laterally! |
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How does an increased q angle cause maltracking of the patella? |
Causes a valgus moment and lateral pull on knee cap |
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How does muscle tightness cause maltracking of the patella? |
Tight IT band pulls cap laterally |
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At what angle does patellar contact occur? Compressive forces?
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At 45-60 degrees flexion; it is the most stable in groove Compressive forces = full ext
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what muscles are involved in the last ten degrees of extension closed chain?
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The gastro and hamstrings. Have to get the last few degrees of extension for the screw home mechanism
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What nerve is most often injured? |
The common fibular(peroneal)nerve **It lies very superficial, lateral and below the fibular head |
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How is the common fibular nerve damaged? |
With prolonged bed rest in sidelying position |
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What are some conditions that cause Joint Hypomobility? |
OA, RA, Post-immobilization |
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What symptoms do patients experience in the knee with OA?
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Articular cartilage destruction Medial joint pain
**Excessive weight, weak quads, tibial rotation, and joint trauma can cause OA |
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What is an articular cartilage defect? |
Lesion of WB portion of femoral condyles, trochlear groove, sub-patellar facets |
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What are the two ways to repair an articular cartilage defect?
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1. Microfracture
2. Osteochondral Transplantation 4-6 wks NO WB, knee / immob 6-9 mos return to PLOF |
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Microfracture Articular Cartilage Repair |
Surgeon creates a fracture into bone marrow to stimulate fibrocartilage adhesion. **used with smaller lesions |
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Osteochondral Transplantation Articular Cartilage Repair |
Bone from Tibia is placed on injured sites |
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What are indications for a total Knee Arthroplasty? |
Severe WB pain, Advanced arthritis, Marked valgus/varum, failed surgery |
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What are some complications from a Total Knee Arthroplasty? |
Infection, Impaired extension/flexion motion, premature implant wear/loosening, DVT |
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A uni, bi, tri Total Knee Arthroplasty replaces what?
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Uni=med fem cond Bi=tib plateau and fem conds Tri=The femoral condyles, tibial plateau, and the patella
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What does PFPS stand for? |
Patellofemoral Pain Syndromes |
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What are some causes of PFPS due to malalignment/biomechanical dysfunction? |
1. Increased q angle 2. genu valgum 3. tight lateral retinaculum 4. weak vmo 5. incompetent medial patellofemoral ligament 6. Patella alta/baja |
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What are some genetic predispositions to patellar instability? |
Shallow trochlear groove Hyperflexibility Abnormal q angle |
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What are some trauma causes to patellar instability? |
Direct blow, Forceful quad contraction during hip ER knee flexion and foot planted |
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During dislocation of patella, what tears? |
The medial retinaculum |
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What are some causes of PFPS without malalignment? |
1. Soft tissue lesions 2. osteochondritis dissecans 3. traumatic patellar chondromalacia 4. PF osteoarthritis 5. Apophysistis 6. Trauma |
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What are some common impairments with PFPS? |
Retropatellar pain Patellar crepitus Subpatellar fat pad irritation Valgus collapse Tight lateral retinaculum Tight muscles |
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What are the activity limitations of PFPS? |
Prolonged WB or sitting, squatting, kneeling, or stairs |
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Acute phase of PFPS |
Pain Control Modalities Bracing or patellar taping Rest and activity modification Muscle setting Gentle ROM |
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Subacute/Chronic Phases of PFPS? |
Pt. ed. Increase tissue flexibility Improve muscle strength Improve neuromuscular control Patellar taping Joint Mobs |
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What are the most common patellar instability surgical options? |
1. Medial PF ligament repair or reconstruction 2. Lateral retinacular release |
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What are the indications for medial patellofemoral ligament repair and lateral release? |
Patellar realignment, surgical stabilizatoin |
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What are the indications for tibial tubercle transfer?
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Recurrent patellar dislocations, painful lateral tracking, chondral deficits, abnormal lateral groove, tubercle distance
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What are the three surgical interventions done with tibial tubercle transfer? |
1. Tibial tubercle osteotomy 2. Elevation of the tibial tubercle 3. Medialization of patellar tendon |
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What is the postoperative management post tibial tubercle transfer? |
ROM limited |
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How does the ACL get injured? |
Valgus force, tibia ER in closed chain **hitting from the side towards the medial side with the foot planted, ER in closed chain |
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How does the PCL get injured? |
direct blow on front side of tibia **dashboard blow |
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How does the MCL get injured? |
Valgus force **very painful |
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How does the LCL get injured? |
Varus force **very rare |
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What is the terrible triad? |
Medial meniscus, ACL, MCL |
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How do ligaments get injured in the female athlete> |
Valgus collapse, Decreased knee flexion with cutting, weaker hip/knee stretch, smaller acl |
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What is the nonoperative management with ligament injuries?
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Improve joint mobility and protection (brace)
Improve muscle performance and function Progress to functional training |
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What are the three types of bone grafts?
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1. bone-tendon-bone autograft
2. semitendinosus gracilis autograft 3. allograft (cadavears) |
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What are the indications for an ACL repair? |
Giving way Recurring instability Active individual Multiple structure injury (terrible triad) |
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What are ACL exercise Precautions |
1. progress gradually with hamstring graft 2. cautious flexion with hamstring; extension with patellar tendon 3. no anterior translation in CC 4. avoid 60-90 strengthening in CC 5. Avoid 0-30 strengthening in Open chain |
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What are the indications for a PCL repair? |
Complete tear or avulsion PCL |
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What are precautions with PCL repair? |
1. avoid posterior shear stress 2. avoid knee flexion strengthening 3. avoid high resistance hamstring training 4. functional brace with high demand activities |
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What are indications for a meniscus repair? |
Lesion in vascular 1/3 outer meniscus Locked knee posterior horn lesion |
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What are indications for a partial meniscectomy |
Lesion unable to be repaired Extends into center 1/3 avascular meniscus |
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What are the precautions for partial meniscectomy? |
None! just progress in pain free range |
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What are the five criteria for ambulation without AD? |
1. Minimal to no pain or joint effusion 2. Full, active knee extension with supine SLR 3. 0-90 degrees ROM 4. Quad strength 4/5 5. No gait deviations |
