Ther Ex 2 Knee

Front 1

Screw home mechanism

Back 1

-in WB, hip extension-femur internally rotates-knee extension; unlocks by hip flexion -femur laterally rotatin

Front 2

Mechanics of patellofemoral joint

Back 2

-with extension, it glides superiorly

-with flexion, it glides caudally

-may result in limited flexion or extensor lag

Front 3

Common fibular (peroneal) nerve

Back 3

it winds around fibular head, sensory loss & muscle weakness distal to site

Front 4

Saphenous nerve

Back 4

sensory nerve medial side of knee & leg

when injured may result in chronic pain syndromes

Front 5

Osteoarthritis

Back 5

-1/3 over age 65 show on x-ray;

-genu varum and valgus;

-knee instability; factors-excess weight; trauma; deformities; weakness of quads

-stiffness upon waking

Front 6

Rheumatoid arthritis

Back 6

-progresses to knee from hands and feet; bilateral swelling; genu valgum

-stiffness lasts all day

Front 7

Postimmobilization hypomobility

Back 7

adhesions may restrict caudle gliding of knee with flexion or extensor lag ( would need to strengthen quads)

Front 8

Common impairments of the knee

Back 8

capsular pattern-loss of more flexion than extension;

- with effusion knee assumes most lax position 25deg flexion;

-symptoms include pain, stiffness, weakness

Front 9

Protection Phase

Back 9

-control pain & protect joint by patient education & functional adaptations

-maintain soft tissue & joint mobility by passive, active assistive or active ROM and Gr 1 glides

-maintain muscle function & prevent patellar adhesions (setting exercises)

Front 10

Controlled motion and return to function phase

Back 10

-patient education

-decrease pain from mechanical stress

-increase joint play and range of motion

-improve muscle performance in supporting muscles

-improve cardiopulmonary endurance

Front 11

Procedures for repair of articular cartilage defects

Back 11

-Microfracture

-autograft transplantation

Front 12

Postoperative Management for repair of articular cartilage defects

Back 12

strict adherence to protected weight bearing (8-12 wks) braced in extension except during exercise

Front 13

Max protection phase

Back 13

1-4 weeks

Front 14

Items during the max protection phase

Back 14

-ROM AROM begin the day of surgery

-AP QS GS SLR heel slides knee flexion/extension -ice for swelling and pain management

-progress when close to 90° with minimal pain and swelling

-healed incision

-independent with assistive device

Front 15

Moderate protection phase

Back 15

4-8 weeks

-begin resistance exercises for strengthening such as close chain stationary cycling

-criteria to progress 0 to 110° strength to 70% minimal to no pain with ambulation

Front 16

Minimum protection/return to function phase

Back 16

8+ weeks

-strengthening exercises balance functional training cardiopulmonary conditioning to return to full functional level for 10 months to one year post op

Front 17

PF Pain Without Malalignment

Back 17

Soft tissue lesions- ex tendonitis, bursitis
Osteochondritis dissecans
Chondromalacia
Osteoarthritis
Osgood-Schlatter
Trauma

Front 18

Osteochondritis dissecans

Back 18

piece of cartilage and thin layer of bone break off of end of a long bone

Front 19

Chondromalacia

Back 19

damage to the cartilage under the patella

Front 20

Osgood-Schlatter

Back 20

self-limiting during adolescence; pain/prominent tibial tuberosity

Front 21

Treatment for patellofemal dysfunction

Back 21

-correct alignment
-strengthen weakness-esp hip abductors, external rotators, extensors, VMO
-stretch tight muscles- esp TFL, HS, quads, gastroc/soleus
-patellar glides & taping

Front 22

Mechanism of injury to ACL

Back 22

blow to lateral knee or externally rotated tibia on planted foot or hyperextension of knee

Front 23

Mechanism of injury to PCL

Back 23

blow to anterior tibia when knee flexed (dashboard of car or falling)

Front 24

Mechanism of injury to MCL

Back 24

partial or complete; valgus force

Front 25

Common Structural and Functional Impairments of ligament injuries

Back 25

several hours for joint to swell (unless blood vessels broken)
pain with ligament testing
instability if complete tear
when acute, can’t walk without assistance

Front 26

Postoperative Management of ACL reconstruction

Back 26

-Immobilization and bracing

-Precautions: NO SAQ (0-30 deg extension) for 6 weeks- open chain
NO Closed chain squatting 60-90 deg

Resistance ABOVE the knee until control established
If HS graft used, avoid HS strengthening early

Front 27

Bracing

Back 27

Rehabilitation bracing- hinged; range limiting; 1st 6 weeks; locked
Functional brace- high-demands sports or work-related activities
Weight-bearing considerations- by physician FWB by 4 weeks

Front 28

Exercises in max protection phase (1 to 4-5 wks) of ACL reconstruction

Back 28

-AP, muscle sets, e-stim to quads, 4 position SLR, heel slides in supine and standing, scooting forward on stool
-ROM ex:wall slides, heel prop, patellar mobilizations
-Progress when min pain & swelling, no extensor lag, 110 deg flexion, no joint laxity; 50-60% strength

Front 29

Exercises in mod protection phase (4-5 to 10-12 wks) of ACL reconstruction

Back 29

-Progress ROM, strengthening, closed chain & open chain with light resistance, single-leg exercises, activity specific training
-Progress when no pain or swelling, full ROM, 75% strength, no knee instability; functional hop test >70%

Front 30

Exercises in min protection phase (10-12 wks fwd.) of ACL reconstruction

Back 30

-PRE with eccentric training, advanced closed-chain strengthening (lunges, step ups and downs with resistance), balance and agility training, plyometrics
-Return to sports 6 months to 1 year following surgery
-No pain, full ROM, strength 80-90%; no instabiliaty, functional testing 85-90%

Front 31

Posterior Cruciate Ligament Reconstruction

Back 31

Precautions for __________
NO open chain active knee flexion(prone or standing for 6-12 weeks)
Resistance above the knee
NO knee flexion past 60-70 deg initially
NO HS resistance for 5-6 months

Front 32

Common Structural and Functional Impairments of meniscal tears

Back 32

Impairmintermittant catching/locking; pain with forced hyperextension or max flexion along joint line
+mcMurray or Apley’s compression/distraction test

Front 33

Precautions of meniscus repair

Back 33

-Progress more slowly for central zone repair or meniscus transplant (vs peripheral zone repair)
-If have clicking sensation, report it to surgeon
-No weight bearing flexion past 45deg for 4-5 weeks or beyond 60-70deg for 8 weeks
-Avoid twisting
-NO deep squats, lunges or pivoting for 4-6 months
-Avoid prolonged squatting with return to activity

Front 34

Partial Meniscectomy

Back 34

-Typically outpatient under local anesthesia, -WBAT, no immobilization
-No maximum protection phase
-Moderate protection phase 3-4 weeks
-Caution with high-impact weightbearing such as jogging or jumping

Front 35

Things to Increase Knee Extension

Back 35

-Gravity-Assisted Passive Stretching Techniques: prone hang, supine heel prop
-Self-Stretching Techniques: long sitting-towel roll under ankle, press above patella

Front 36

Things to Increase Knee Flexion

Back 36

-Gravity-Assisted Passive Stretching Techniques
-Self-Stretching Techniques:
gravity-assisted supine wall slides
self-stretching with the uninvolved leg
rocking forward on a step
sitting

Front 37

Open-Chain Exercises To Develop Control and Strength of Knee Extension (Quadriceps Femoris)

Back 37

Quadriceps setting (quad sets)
Straight-leg raise (SLR)
Straight-leg lowering
Multiple-angle isometric exercises
Short-arc terminal knee extension
Full arc extension

Front 38

Open-Chain Exercises To Develop Control and Strength of Knee Flexion (Hamstrings)

Back 38

Hamstring-setting (hamstring sets)
Multiple-angle isometric exercises
Hamstring curls

Front 39

Closed-Chain Exercises To Develop Control and Strength of The Knee

Back 39

Scooting on a wheeled stool
Unilateral closed-chain terminal knee extension
Partial squats, mini-squats, and short-arc training
Standing wall slides
Forward, backward, and lateral step-ups and step-downs
Partial and full lunges