AT Chapter 20

_____ typically results from either rotation or direct trauma that compresses the articular cartilage between the medial or lateral femoral condyles and the tibial plateau.

An osteochondral fracture

Identify a true statement about the mobilization techniques used for rehabilitation of the knee.

Constant passive motion machines are commonly used to maintain motion in a pain-free arc.

True or false: In joint contusions of the knee, effusion often takes place rapidly.

False

What happens when an athlete's shoe sticks to the ground while playing?

It increases the risk of injury to the anterior cruciate ligament.

Sunny, a long jumper, injures his right knee during practice. Amelie, his physical trainer, positions Sunny's injured knee in approximately 30 degrees of flexion. She uses one hand to stabilize his right leg by grasping the distal end of his thigh. She uses her other hand to grasp the proximal aspect of the tibia and attempts to move it anteriorly. In this scenario, in order to detect the kind of injury sustained by Sunny, Amelie conducts the _____ test on him.

Lachman drawer

Identify a scenario that exemplifies the assessment of a current knee injury.

Laura, an athletic trainer, asks an injured player if he/she heard a noise or felt any sensation at the time of injury.

Which of the following indicates patellar tendinopathy?

Point tenderness with palpation on the posterior aspect of the inferior pole of the patella.

Identify an example that illustrates a lateral collateral ligament sprain.

Ryan, a baseball pitcher, exhibits some joint laxity with a varus stress test at 30 degrees.

Which ligament stabilizes the tibia against excessive internal rotation and serves as a secondary restraint for valgus or varus stress with collateral ligament damage?

The anterior cruciate ligament

_____ test is designed to determine anterolateral rotary instability of the knee.

The pivot-shift

A characteristic of a grade 2 medial collateral ligament sprain of the knee is _____.

a complete tear of the deep capsular ligament

A grade 3 knee sprain leads to _____.

a severe initial pain

External rotation of the tibia is controlled by the _____.

biceps femoris

A(n) _____ is composed of pieces of synovial tissue separated by a thin film of fluid.

bursa

A characteristic of a grade 3 medial collateral ligament sprain is _____.

complete loss of medial stability

A feature of the menisci is that they _____.

cushion any stress placed on the knee joint

Like the cause of Osgood-Schlatter disease, the cause of Larsen-Johansson disease is believed to be _____.

excessive repeated strain on the patellar tendon

In the context of the knee joint, the distal end of the _____ expands and forms the convex lateral and medial condyles.

femur

A characteristic of grade 1 knee sprain is that it _____.

has a firm endpoint with little or no instability

_____ is a lateral aspect of the bony structure of the knee that should be palpated to detect a fracture or dislocation.

head of fibula

Ken is a soccer player. While tackling, he loses balance, lands on his right knee, and sustains a knee injury. He is immediately examined by an athletic trainer. In this scenario, in order to assess the injury, the athlete trainer should ask Ken _____.

if he could move his knee immediately after the injury

In the context of drawer test at 90 degrees of flexion, Slocum's test should be performed with a patient's leg rotated _____.

internally 30 degrees and externally 15 degrees

The Q angle of the knee is measured with the _____.

knee fully extended and then flexed at 30 degrees

Sarah loses her balance and falls while riding a horse. She lands on her right knee and injures it. When an athletic trainer conducts a varus stress test on her at 30 degrees, he detects some joint laxity. Moreover, when he flexes and internally rotates the injured knee, he palpates a defect in that area. In this scenario, Sarah has possibly sustained a(n) _____ ligament sprain.

lateral collateral

Prophylactic knee braces are worn on the lateral surface of the knee to protect the _____ collateral ligament.

medial

The _____ attaches above the joint line on the medial epicondyle of the femur and below on the tibia, just beneath the attachment of the pes anserinus.

medial collateral ligament

In the context of osteochondritis dissecans, more than 85 percent of the fragments occur in the lateral portion of the _____ condyle.

medial femoral

In the context of knee joint injuries, the synovial fold most subject to injury is the _____ plica.

mediopatellar

If an osteochondral microfracture is _____, the patient should be non-weight bearing or light touch-down weight bearing for 6 to 8 weeks.

on the femoral condyles

If an osteochondral knee fracture occurs _____, the patient should be in a brace locked in full extension but weight bearing as tolerated for 8 weeks.

on the patella

The _____ aids the knee during extension by lengthening the lever arm of the quadriceps muscle.

patella

The main blood supply to the knee comes from the _____ artery.

popliteal

The two shallow concavities on the flat tibial plateau that articulate with their respective femoral condyles are divided by the _____.

popliteal notch

Functional knee braces are used to _____.

protect a surgically reconstructed anterior cruciate ligament

A characteristic of the knee is that it _____.

provides mobility in locomotion

Flexibility can be regained during rehabilitation of an injured knee by _____.

putting efforts to achieve full range of motion on the first day of rehabilitation

The function of a bursa is to _____.

reduce the friction between anatomical structures

The knee is not a true hinge joint because _____.

rotation of the tibia is an essential component of its movement

Identify a feature of grade 2 knee sprain.

soft endpoint

The amount of gliding of the medial tibial plateau as compared with the lateral tibial plateau relative to the femoral condyles is referred to as

translation

A grade 2 medial collateral ligament sprain of the knee can be managed by _____.

using a postoperative knee-immobilizing splint for 2 to 5 days

Identify the tests that are intended to reveal laxity of the medial and lateral stabilizing complexes, especially the collateral ligaments. (Check all that apply.)

- Valgus stress test - Varus stress test

Identify the intrinsic factors that make females more susceptible to non-contact anterior cruciate ligament sprain than males. (Check all that apply.)

-Psychological factors -Physiological factors

Identify the true statements about functional knee braces. (Check all that apply.)

-They are worn to provide support to the unstable knee on return to activity. -All functional braces are custom-fitted to some degree.

Match the types of traction (in the left column) with their descriptions (in the right column).

1. Translational traction - It is involved in forward, straight-line running. 2. Rotational traction - It occurs in pivoting or making a cut.

_____ test is similar to the flexion-rotation drawer test, but it is done in a side-lying position.

Losee's

True or false: Osteochondral fracture of articular cartilage and underlying bone on the weight-bearing surface of the femur, tibia, or under the patella creates fragments of bone and/or cartilage that are of the same size and depth.

False

_____ is a painful condition involving partial or complete separation of a piece of articular cartilage and subchondral bone.

Osteochondritis dissecans

Identify a true statement about the practice of eccentric muscle contraction exercises during the rehabilitation of an injured knee.

They should be routinely incorporated through both isotonic and isokinetic exercises.

True or false: In the context of the knee, the amount of anterior translation is determined by the integrity of the anatomical restraints that normally restrict excessive translation.

True

True or false: Injured structures in the knee joint will not heal fully until they are subjected to normal tensile forces and strains.

True

True or false: Strong quadriceps activation during eccentric contraction is a major factor in anterior cruciate ligament sprain injury.

True

A medial aspect of the bony structure of the knee that should be palpated to detect a fracture or dislocation is _____.

adductor tubercle

A construction worker slips from a ladder and lands on a concrete floor. Consequently, he injures his left knee. He is rushed to the hospital, where a physician conducts the Lachman drawer test on him. The worker responds positively to this test. In this scenario, the worker has damaged the _____ ligament of his left knee.

anterior cruciate

In the context of the drawer test at 90 degrees of flexion, anterior translation of the tibia when the leg is externally rotated is an indication that the _____ ligament is torn.

anterior cruciate

The _____ ligament comprises three twisted bands: the anteromedial, intermediate, and posterolateral bands.

anterior cruciate

The pivot-shift test is most often used in chronic conditions and is a sensitive test when the _____ ligament has been torn.

anterior cruciate

To form the suprapatellar pouch, the joint capsule of the knee extends upward underneath the patella _____.

anteriorly

A characteristic of a grade 1 medial collateral ligament sprain of the knee is that _____.

the joint is stable during valgus stress tests

A feature of a grade 3 medial collateral ligament sprain is that _____.

there is loss of motion because of effusion and hamstring guarding

The medial meniscus has a much higher incidence of injury than does the lateral meniscus because the coronary ligament attaches the medial meniscus peripherally to the _____.

tibia

In the context of the patellofemoral stress syndrome, the tendency of the patella toward lateral tracking may be a result of _____.

tightness of the iliotibial band

A blow struck against the _____ of the quadriceps group, which is primarily involved in locking the knee in a position of full extension, can result in a disabling condition.

vastus medialis

True or false: In full extension of the knee, the posteriolateral portion of anterior cruciate ligament is loose, and it becomes taut during flexion.

False

Match the nerves (in the left column) to the parts of the knee innervated by them (in the right column). Instructions

1. The tibial nerve - Most of the hamstrings and the gastrocnemius 2. The common peroneal nerve - The short head of the biceps femoris 3. The femoral nerve - The quadriceps and the sartorius muscles

Match the types of tests for assessment of knee joint instability (in the left column) to their descriptions (in the right column).

1. The posterior drawer test - It is performed with the knee flexed at 90 degrees and the foot in neutral. 2. The posterior sag test - With the patient supine, both knees are flexed to 90 degrees. 3. The external rotation recurvatum test - The athletic trainer grasps the great toe and lifts the leg off the table.

Match the regions of the joint capsule of the knee (in the left column) with the anatomical structures that reinforce them (in the right column).

1. The posterolateral corner - The iliotibial band, the popliteus, the biceps femoris, the lateral collateral ligament (LCL), and the arcuate ligament 2. The posteromedial corner - The medial collateral ligament, the pes anserinus tendons, the semimembranosus, and the posterior oblique ligament 3. The anterolateral corner - The iliotibial band, the patellar tendon, and the lateral patellar retinaculum 4. The anteromedial corner - The superficial medial collateral ligament and the medial patellar retinaculum

List in order, from the beginning, the steps of the flexion-rotation drawer test.

1. The lower leg is cradled with the knee flexed between 15 and 30 degrees. 2. At 15 degrees, the tibia is subluxated anteriorly with the femur externally rotated. 3. As the knee is flexed to 30 degrees, the tibia reduces posteriorly and the femur rotates internally.

Match the knee actions (in the left column) to the muscles that initiate them (in the right column).

1. Knee flexion - The biceps femoris, semitendinosus, semimembranosus, gracilis, sartorius, gastrocnemius, popliteus, and plantaris muscles 2. Knee extension - The quadriceps muscle of the thigh, consisting of three vasti—the vastus medialis, vastus lateralis, and vastus intermedius—and by the rectus femoris 3. Internal rotation - The popliteal, semitendinosus, semimembranosus, sartorius, and gracilis muscles

Match the sexes (in the left column) to the normal Q angles associated with them (in the right column).

1. Males - 10 degrees 2. Females - 15 degrees

Match the ailments of the knee (in the left column) to their descriptions (in the right column).

1. Osgood-Schlatter disease - It is an apophysitis characterized by pain at the attachment of the patellar tendon to the tibial tubercle. 2. Larsen-Johansson disease - It occurs at the inferior pole of the patella.

Match the types of patellar malalignments (in the left column) with the ratios of patellar tendon length to the height of the patella (in the right column).

1. Patella alta - Greater than 1:1 2. Patella baja - Less than 1:1

Match the types of patellar malalignments (in the left column) with their characteristics (in the right column).

1. Patella alta - The patella sets in a more superior position than normal. 2. Patella baja - The patella sets in a more inferior position than normal.

Which of the following has been used successfully for treating patellar tendinitis?

Deep transverse friction massage

_____ results from lateral deviation of the patella as it tracks in the femoral groove

Patellofemoral stress syndrome

Identify a true statement about rehabilitative knee braces.

They allow protected motion of either operative or nonoperative knees.

A characteristic of the menisci is that they _____.

deepen the articular facets of the tibia

A large number of medial meniscus lesions are the outcome of a sudden, strong internal rotation of the _____ with a partially flexed knee while the foot is firmly planted.

femur

In collateral ligament stress tests for detecting knee joint instability, to test the medial side of the leg, the athletic trainer holds the ankle firmly with one hand while placing the other hand over the head of the _____.

fibula

The most common synovial fold is the _____ plica.

infrapatellar

The posterior drawer test, the external rotation recurvatum test, and the posterior sag test indicate possible injury to the _____ ligament.

posterior cruciate

A grade 1 medial collateral ligament sprain of the knee can be managed by _____.

practicing isometrics