MRAT - knee
Patellofemoral pain syndrome
-anterior knee pain with crepitus -positive *Clarke's sign* -abnormal bony contact between the laterally tracking patella and the femoral groove -*can be caused by weak VMO/tightness in ITB* -joint stiffness after sitting with the knee in a flexed position -postural alignment test : *static*-> Q-angle: ASIS-midpoint of patella, tibial tubercle *dynamic*-> Step-down test
ACL Hx
A sudden pop & anterior knee pain with posterior lateral joint line pain Instability of the knee is common
Sindig Larsen Johansson Disease
Apophysitis of the distal pole of the patella
Jumper's Knee
Associated with high quadriceps loading: jumping, squatting, and kneeling Overuse syndrome
Popliteal Bursae
Baker's Cyst
LACHMAN TEST
Best indicator of injury to ACL
Prepatellar Bursae
Between the skin & the anterior patella Housemaid's Knee
Superficial or Subcutaneous Infrapatellar Bursae
Between the skin & the tibial tuberosity Vicar's / Parson's Knee
Recurrent Patellar Sublaxation
Congenital (lateral lip is more prominent than medial) Weak VMO -->lateral displacement Inc. Genu Valgum/Varum/Recarvatum Ext. Tibial Torsion
Medial meniscus Tear MOI
Cutting injuries Tibial rotation while the knee is partially flexed during weight bearing (football, soccer)
Patellofemoral Pain Syndrome Sx
Diffuse aching anterior knee pain Worse after prolonged sitting, climbing stairs, jumping or squatting Catching sensation
assess the knock knee through? (genu valgum)
Distance between medial malleoli < 8cm
Plica
Embryological remnants that have remained in some people after birth Normally, they are reabsorbed by the time of birth Abnormal plica can mimic meniscus pathology
Bone-Patella-Bone (BTB) Graft
Gold standard tx for ACL injury Patellar tendon graft is harvested through a 3-4" long vertical incision based just along the medial (inside) border of the tendon
Chondromalacia patellae (runner's knee)
Involves a softening of the cartilage under the patella, which results in wearing away of this cartilage. MC site: ODD facet
Osteochondritis Dissecans
Localized segmental area of AVN of the end of a long bone Formation of dead subchondral bone covered with articular hyaline cartilage — subchondral separation MC in adolescents
assess the bow leg through? (genu varus)
Measured by both heel together Distance between knees < 6cm
A patient's severe knee sprain resulted from medial rotation of the femur on the tibia with simultaneous application of a valgus force while the foot was placed on the ground. Which structures are MOST likely to be involved?
Medial collateral ligament, medial meniscus and anterior cruciate ligament
Pellegrini Steida Disease
Myositis Ossificans of Medial Collateral Ligament of Knee
Theatre or cinema sign indicates
PFPS
Patellofemoral Arthralgia
Pain in the joint between the patella and the femur Anterior knee pain "pain under the knee cap"
lliotibial band friction syndrome
Pain over the lateral femoral condyle as the ITB crosses the bony prominence at 30° flexion Inflexibility of the ITB & adductor/abductor muscle imbalances lead to the dysfunction
Osgood Schlatter Disease
Partial/ separation or apophysitis of the tibial tubercle M>F; 10-14 y/o
Blount's disease
Progressive bow-leg deformity associated with abnormal growth of the posteromedial part of the tibia Common among overweight children
Lateral meniscus Tear MOI
Squatting Full flexion with rotation is the usual mechanism (wrestling)
True
T or F: PCL injuries are much less common than ACL injuries
Chondromalacia patellae causes
Tight iliotibial band Neuromas Bursitis Overuse Malalignment Core instability Patellar maltracking
ACL tear MOI
Usually cutting, deceleration, & hyperextension of the knee Low-velocity, noncontact, deceleration injuries and contact injuries with a rotational component
MCL tear MOI
Valgus stress (lateral blow) Impact force to the lateral knee | is often the mechanism of injury
PCL tear MOI
dashboard inury direct trauma to tibia with knee flexed In athletics, hyperflexion is a common means of PCL injury
Sindig Larsen Johansson Disease cause
excessive force exerted by the patellar tendon on the lower pole of the patella pain, which increases when the patellar is loaded during flexion, subpatellar swelling & functional limitation
Patella alta
high patella
Jumper's Knee site of tenderness
insertion of patellar tendon and tibial tubercle MC site of involvement is the inferior pole of the patella
LCL tear leads to?
knee dislocations
Patella baja
low patella
Osteochondritis Dissecans MC inv in knee joint
medial femoral condyle
ACL
most commonly injured knee ligament in athletics (football, soccer, downhill skiing)
Meniscal Tears is associated with?
pop after a specific inciting incident May cause true locking Frequently complain of knee stiffness