Primary stabilizer of the knee against anterior translation
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Terms in this set (88)
Positive special tests in PCL tear-Sag sign -Posterior drawer test (most sensitive)Diagnosing PCL tearAP and lateral xrayTreatment for PCL-protected weight bearing -rehab -functional bracing -PCL reconstruction or repairValgus stabilizerMCLMechanism of injury to MCLValgus force to the lateral kneeVarus stabilizerLCLMechanism of injury to LCLVarus force to the medial kneeName the condition: -may be able to ambulate -localized swelling -stiffness -medial or lateral side pain (6-8 hours after injury) -ecchymosis and small effusion -tendernessCollateral ligament tearPhysical exam findings of torn Collateral ligaments-full extension and at 30 degree flexion -laxity in full extension = more extensive injuryGrade 1 collateral ligament tearInterstitial 0-5 mm joint openingGrade 2 collateral ligament tearPartial 6-10 mm joint openingGrade 3 collateral ligament tearComplete >10 mm joint openingWhat nerve to assess with collateral ligament tears?Peroneal nerveGold standard diagnostic for collateral ligament tearMRITreatment of collateral tear-extra articular and adequate blood supply so heal non-surgically -hinged knee brace -Grade 3 LCL injuries = surgeryFibrocartilaginous pads that function as shock absorbers between the femoral condyle spine and tibial plateausMenisciMost common indication for knee surgeryMeniscal tearName the condition -twisting injury -pop with posterior knee -pain to medial or lateral side (worse with twisting or squatting) -locking, catching, popping -swelling/stiffnessMeniscal tearPositive special tests with meniscal tear-McMurray test -Apleys compression test -Thessaly testWeight bearing AP view with knee in 45 degrees sensitive for OA. When is recommended?>40 yoTreatment of meniscal tears-RICE, oral analgesics -surgery: arthroscopic debridement and repairCommon bursa injuries in knee-prepattelar -Pes anserineWhat bursa becomes inflamed from direct blow or repetitive trauma to anterior kneePrepatellarWhat bursa injury occurs in patients with early OA and long-distance runnersPes anserineDome shaped swelling over anterior aspect of knee when inflamed and fluid filledPrepatellar bursitisPes anserine bursitis can compress what nerve and cause numbness distal to patella?SaphenousTreatment for bursitis-NSAIDs, ice, activity, US, phonophoresis, stretching, steroid injection -Abx for septic bursitis -surgery I &DMost common benign synovial cyst in the kneePopliteal cyst (bakers cyst)Bakers cyst is associated withDegenerative meniscal tear RAName the condition -fullness of swelling in posterior knee -no history of trauma -asymmetry in popliteal fossa -effusionbakers cystDiagnostic for bakers cyst-US localize location and extentTreatment for popliteal cystConservative Surgery to treat underlying cause of fluidDiffuse aching anterior knee pain that increases with activities that place additional loads across patellofemoral knee jointPatellofemoral painPatellofemoral pain worsens withRunning, ascending, descending stairs, kneeling or squattingCause of patellofemoral painOveruse and overloading jointtype of patellofemoral pain resulting from softening and breakdown of articular cartilage on backside of patella that leads to inflammation of synovium and pain in boneChondromalacia patellaName the condition -diffuse, aching knee pain -sense of instability or retropatellar catching -pain often develops after increase in activity or weight training -patellar squinting -genu valgus and foot pronation -patellar tracking with ROM -J signPatellofemoral painJ signMovement of patella more than 1 cm with extension of kneePositive special tests with patellofemoral pain-patellar apprehension test -paternal tiltTreatment of patellofemoral pain-conservative -quad strengthening, quad and hamstring flexibility -surgerySpectrum of pathologic conditions that are defined by abnormal motion of the patella as it glides over distal femurPatellar maltracking and dislocationInstability with patellar maltracking is often in what direction?Lateral - ranges from subluxation to dislocationPositive special test for patellar maltracking and dislocationApprehension sign (with attempts to move patella laterally)Physical exam findings of malalignment-gait with inward or knock knee alignment -high riding patella or lateral trackingHigh riding patellapatella altaTreatment of acute patellar maltracking syndrome-extended immobilization -conservativeTreatment for chronic patellar maltracking syndrome-quad strengthening and flexibility -brace with J buttress -PT, taping, e-stim -surgeryOveruse and overload syndrome associated with jumping or kicking sportsPatellar/ Quad tendonitits "Jumpers Knee"Name the condition -anterior knee following exercise or after sitting -tenderness -pain with descending stairs, running, jumping, squatting -swelling -crepitus, increased heat -ROM normal but painful with resisted full extensionPatellar/Quad tendonitisCalcifications at tendon insertion in knee xraypatellar / quad tendonitisTreatment of patellar / quad tendonitis-conservative (3 days to 6 weeks) -surgeryWhat treatment do you NOT do in patellar/ quad tendonitis?SteroidDisruption of extensor mechanism of knee as a result of a fall on a partially flexed kneepatellar/ quadricep ruptureWho is at risk of patellar/quad rupture?Quad: white men 40-60 Patellar: middle aged African American menName the condition -immediate onset of pain -walking limited -giving away -large effusion -palpable defect -INABILITY to extend knee against gravity or perform straight leg raisePatellar/quadricep ruptureDiagnostic for patellar/ quadricep rupture-AP and lateral xray -US -MRITreatment for patellar/ quad rupture-conservative knee immobilizer -surgeryOveruse and overload in growing child resulting from repetitive stress when too-tight quadriceps "pulls" on the apophysis of the tibial tubercle during time of rapid growthOsgood-schlatter diseaseWho is Osgood Schaltter disease most common in?11-13 Active in sports Boys more commonIs ROM restricted with osgood Schlage's diseaseNoXray findings of osgood Schlatter-small spicules of heterotropic ossification can be seen anterior to tibial tuberostiyTreatment for osgood schlatter-conservative -patient educationCondition that results from repetitive small stresses on subchondral bone that disrupts blood supply to area and osteonectrotic bone separates from surrounding viable bone over timeOsteochondritis dissecansName the condition -gradual onset of knee pain -knee effusion -catching and locking -walking with foot rotated outward -tenderness -medial femoral condyleOsteochondritis dissecansPositive special test for Osteochondritis dissecansWilson testTreatment of Osteochondritis dissecans-conservative -surgeryDisplaced patella fracture disrupts what mechanism of kneeExtensorTreatment for patella fracture-knee immobilization with cylindrical cast, knee ranger -surgery for displacedDistal femur fractures are common inYounger patients with high energy injuries Old patients with osteoporosisWhere are distal femur fractions located/Supracondylar or intercondylarTreatment of distal femur fractureConservative: non weight bearing (6 weeks) Surgery: displaced requires ORIFtibia plateau fracture occurs after what type of injuryValgus force that causes the lateral femoral condyle to impact tibial plateauTibial plateau fractures are associated with-meniscal injury -collateral ligament injury -compartment syndromeTreatment for tibial plateau fracturesConservative: non weight bearing 8-12 weeks Surgery: displaced requires ORIFMost common form of knee arthritisOsteoarthritis3 compartments of knee impacted by OA-medial (most common) -lateral -patellofemoralPhysical exam findings of osteoarthritis-varus or valgus deformity -effusion -tenderness joint line to Pes anserine bursa -thinking and osteophytes -crepitusXray findings of osteoarthritis-joint space narrowing -deformity -asymmetric joint space narrowing -subchondral sclerosis -periarticular cysts -osteophytes