quiz #3 – Knee

RICE

putting pillows underneath the knee

• true
• Quad sets, straight leg raises TKE, stretch gastroc, soleus, walk backwards, femur dorsal glides, patellar mobs

• true
• heel slides, knee flexion stretch, prone knee bands, table/stool scoots, bike, tibial dorsal mobs, CMP

true

• motion before strength – precursor to all other ambulatory movements
• no pain, no limp, match assistive devices
• want to be functional in all three planes

• want to work in all three planes
• multiple moving parts – arm and leg drivers, works balance or static leg

• if no soreness from last visit, modify exercises by one variable
• if soreness is present but gone after warm-up, stay put
• if soreness remains, increased swelling, backoff progression

2 – 70°

93° flexion

106° flexion

135° flexion

• primary restraint to anterior tibial translation
• Lockman's test; test only the integrity of ACL
• anterior drawer – shows integrity of all other ligaments capsule – rotate feet to look at other ligaments
• pivot shift – strictly anterior lateral rotary instability (ALRI)

• prevents posterior tibial translation – twice as strong as ACL
• posterior drawer test

• valgus restraint
• grades I, II, III – posterior oblique ligament, valgus opening in full extensions

mostly nonoperative, brace to protect range of motion

most common injuries and anterior lateral quad, anterior medial quad, and posterior lateral quad

protect draft, full and gentle range of motion by sixth week, quad function, minimize the swelling, normalize gait

• vigorous OKC the extension for six weeks
• hamstrings autographs – avoid vigorous resisted knee flexion until six weeks
• avoid twisting for six weeks

• two weeks;0– 90°
• three weeks; 0 – 120°
• six weeks; full flexion

• immediate weight-bearing – brace 0 – 90, locked in extension for ambulation
• after one week unlocked when quad control appears to allow normal gait

• protect graph from extreme forces
• gradually increase functional activities
• full range of motion, build a straight
• proprioception
• cardiovascular fitness

• avoid quick and uncontrolled twisting
• 10 – 12 weeks
• avoid extremes shearing stress

true

true

false – meniscal tears

true

weakest at about four weeks when patient thinks that they're fine

• bracing not a bad idea, but won't prevent injury
• over 100,000 injuries in US; 2-8 risks for females, most noncontact mechanism
• healing; 6-8 weeks= weak link because of vascular part hasn't grown all the way back yet, return to place six months – one year
• ACL prevention – strengthen hip and knee extensors, and hip abductors – avoidance, flexibility, strengthening, plyometrics, agility

• get full extension
• avoid hyperextension

active forcible flexion for six weeks

• gradual range of motion into flexion 0 – 60 for 1 to 2 weeks
• 90° 2 to 3 weeks,
• full range of motion six-day weeks

similar to ACL protocols, only opposite precautions

• radial
• longitudinal
• vertical
• bucket handle
• degenerative

• weight-bearing restrictions
• don't ruin the repair with sharing activities
• twisting or flexed the ambulation can disrupt repair

• ACL reconstruction
• arthritis
• malalignment

McMurray's test – does it show specific medial or lateral meniscus

• activity modifications
• NSAIDs
• injections
• surgery
• will mask, not heal

• white tears probably won't heal so removed torn portion
• red white and red tears can heal, the further out the increased ability to heal

can increase risk of arthrosis, total meniscectomy me increases joint load 300%

suture repair, all inside, protected weight-bearing, high repair rates

• 43 million Americans
• 100 types – OA= wear and tear, most common type
• geriatric role = 40 to 65%
• women are more than 60%, the less likely to have knee replacements

• effusion
• malalignment (varus)
• limited range of motion
• crepitus
• tenderness

• viscosupplementation
• arthroscopy
• cartilage transplants
• knee replacement surgery
• NSAIDs

• load sharing ( hip/gastroc/soleus strength
• extensibility ( hip – ankle foot)
• heel wedges/orthotics
• Unloader braces

only when nonsurgical interventions aren't alleviating pain and symptoms are bad enough to do surgery

• uni– compartmental arthroplasty
• patellofemoral arthroplasty
• bicompartmental arthroplasty
• total knee arthroplasty

• used for isolated medial> Lateral compartmental disease
• all ligaments need to be intact
• thin, elderly, females have best outcomes

• used for isolated patellofemoral arthritis -often get total knee arthroplasty after this procedure
• all ligaments must be intact

• used when medial compartment and the patellofemoral joint are involved – not done often because durability questioned
• all ligaments must be intact

three designs based on keeping PCL or not, all remove ACL – all outcomes are similar

• uses patients PCL to help balance knee
• small risk of late PCL rupture resulting in instability requiring revision

• typically easier to balance flexion and extension gaps
• with clunk with posterior drawer test
• risk of jumping the post and dislocation

• increase surface area to reduce contact stresses
• increase conformity to tibiofemoral articulation

• minimally invasive
• gender specific knee to pick different sizes

• within two weeks want; 5 – 90°
• within first six weeks want about 95% motion – 115°
• hip easier to cover than knee

• surgically pick procedures; used need rehab must, but be careful not to get the PF mad
• transplantation procedures; talk to physician but more than likely range of motion and weight-bearing restrictions

• quads and 60 – 70 year olds
• Patella under 40 year old

typically avulse from patella, paplable defect, extensor lag, operative treatment

• extensor mechanism
• cruciate injury
• meniscal tear
• osteochondral fracture

• instability and giving out
• extensor lag
• minimal defect if reduced

• medial patella femoral ligament
• bone bruise
• osteochondral fragment
• congenital/anatomical issue

• nonoperative – bracing, taping, therapy (VMO and abductor strengthening
• operative – fix what's broken, trend toward anatomical restoration of MPFL

• females age 10 – 17 have high-risk of dislocation
• first time this locators may likely the participatingin sports – afterwords happens more often
• risk factors; prior dislocation,younger age at initial injury, family history, hip dysplasia

• increased Q angle - leads to reflects lateral force on the patella
• patellofemoral bony constraints - trochlear depth, patella congruency
• TT-TG ( tibial tubercle trochlear groove distance) - increases distance protective against patellar instability

soft tissue and biomechanical issues – both can be a result of each other

• Wilk
• Merchant
• Fulkerson and Schutzer
• Insall

patellar compression syndromes, patellar instability, biomechanical dysfunction,direct patellar trauma, soft tissue lesion/overuse syndromes, osteochondritis, neurological disorders

decreased quad flexibility, hyper mobile patella, patella alignment (alta vs baja), week abductors and external rotators, altered biomechanical alignment, altered VMO response

avoid: patellar taping or bracing, bike, stairs or steppers, OKC exercises, squatting

• pain increases on stairs, squatting, stooping, painful crepitus
• patellar tilt higher with atrophy of VMO
• ROM and MMT: grossly within limits, decreased length of ITB/quads/hamstrings, and pain and week quads
• reflex and sensation normal
• tenderness over lateral and medial retinaculum, decreased medial glide of patella
• intervention; stretch tight lateral retinaculum structures, medial patellar glide and tilts, patellar taping, racing, stretching upper leg muscles, straighten quads (VMO, anti-inflammatory treatments
• avoid: bike, stairs or steppers, OKC exercises, squatting