Exam 3 (Knee Exam)

IT band

What is important for lateral stability of the knee

autograft

What is it when you use your own tissue during a surgery

tibiofemoral joint, because its made entirely by muscles and ligaments

What is one of the most frequently injured joints in the body and why?

lateral collateral ligament

What is shorter and stronger then the MCL and has NO attachment to the lateral meniscus?

lateral meniscus

What is smaller and more mobile, the lateral or medial meniscus?

angle between the quads and patellar tendon

What is the Q angle?

popliteal space

What is the area behind the knee that contains important neves and blood vessels. Diamond-shaped with 3 hamstring muscles and gastrocnemius creating the borders

MRI

What is the best test to check for knee injuries?

sesamoid bone

What is the bone called that "floats"

equal loss of flexion and extension (limited range of motion of the knee)

What is the capsular pattern of the knee joint?

25 degrees flexion

What is the degrees flexion of the knee joint in open pack position? (think yoga lady)

lateral retinaculum

What is the fibrous tissue on the lateral side of the knee joint. Is an extension of the fibrous aponeurosis (tendon) of the vests lateralis muscle. Indirect attachment from IT band.

bursa

What is the knee joint structure that is a fluid-filled sac to reduce friction in the joint?

knee joint

What is the largest joint in the body

ACL

What is the most common ligament injured?

tight IT band and lateral retinaculum

What prevents medial gliding of the patella

posterior cruciate ligament (PCL)

What prevents the tibia from displacing posteriorly on the femur and tightens during flexion?

middle range

What range during a lift is when you will create the greatest power?

tight ankle PF

What results in over-pronation with DF causing lateral displacement of tibial tuberosity

true

true or false: the outer portion of the meniscus has some blood supply, making healing of tears possible

genu varum

:"bow legs" seen in conjunction with coxa valgus. knees are wider than feet

gait training and exercise instructions

After a TKA, patients routinely receive ______ _________ and ________ ________________ while hospitalized.

B.

All of the following are true statements about th knee extensors, except: A. the quads commonly work as decelerators, preventing the knee from buckling when the foot strikes the ground B. the insertion site of the normal vastus medalis oblique is the lateral border of the patella C. the rectus femoris is the only quadricep muscle that crosses the hip joint D. the muscles that make up the quads are the rectus femoris, vastus intermedius, vastus lateralis, and the vastus medialis

B.

All of the following are true statements about the IT band except: A. it supports the extensor mechanism and is an important lateral stabilizer of the patellofemoral joint B. it inserts on the tibial tuberosity C. it is capable of flexing and extending the knee D. it originates above the hip joint as a wide facial band

osgood-schlatter disease

Common overuse injury in adults. Caused by stress on patellar tendon on the tibial tuberosity. Can cause avulsion fractures or tendon inflammation due to location at a growth plate.

patellofemoral pain syndrome

Common problem causing anterior knee pain. Results of: increased Q angle, patella alta, quadriceps weakness or tightness, weakness of hip ER and ABD and excessive foot pronation

vascular(outer 1/3), middle avascular, avascular (inner)

From the outer to the inner of the meniscus name its level of vascularity.

line from ASIS to midpoint of the patella or line from the tibial tuberosity to the midpoint of the patella

How is the Q angle measured?

decrease weight to avoid bad form

If a patient is sacrificing form during a lift what would you do?

with flexion ER of femur with extension IR of femur

In closed kinetic chain determine when the femur externally and internally rotates

with flexion IR of tibia with extension ER of tibia

In open kinetic chain determine when the tibia externally and internally rotates

femur, tibia, patella

In tricompartmental knee arthroplasty what 3 joint surfaces are replaced?

prevent graft from excessive stretches

What is the primary precaution post ACL injury or TKA?

13 to 19 degrees

What is the range of the Q angle in normal individual in knee extension?

iliotibial band

What is the thick, strong band of tissue connecting tensor facia later to femur and tibia?

ACL, MCL, and medial meniscus

What is the unholy triad consist of?

posterior cruciate ligament (PCL)

What keeps the femur from displacing anteriorly on the tibia and tightens during flexion?

anterior cruciate ligament (ACL)

What keeps the tibia from being displaced anteriorly on the femur and tightens during extension?

sesamoid bone

What kind of bone is the patella? (meaning flat)

biaxial synovial modified hinge joint

What kind of joint is the tibiofemoral joint?

Tight RF and HS

What leads to compensations at the patella

osteoarthritis

What leads to development of a genu VARUM deformity and has risk factors such as excess weigh, joint trauma/overuse, more in female and older age

insufficient VMO strength

What leads to poor medial patellar stability

non=operative moderate to return phase

What phase is it within a ligament injury when MCL: cross-fiber massage on MCL. Because of its blood flow supply the MCL can normally heal on its own.

chondromalacia patella

What predisposes the patient to degenerative arthritis or degeneration of the cartilage. Causes trauma, surgery, prolonged or repeated stress, or lack of normal stress such as during periods of immobilization

anterior cruciate ligament (ACL)

What prevents femur from being displaced posteriorly on the tibia and tightens during extension?

Tight HS

What results in patellofemoral compression

a.

What would be best to do first with hamstring injury: a. passive flexion and extension with hip in 0 degree flexion b. passive flexion and extension with hip in 90 degree flexion

improve endurance

When you increase reputations before increasing resistance you are working on what?

medial menisci

Which is torn more frequently. The medial or lateral menisci?

A.

Which of the following activities/exercises has been shown to increase patellofemoral compression? A. repetitive squatting B. walking on level surfaces C. performing long arc quads D. limiting stair climibng

Attaches to the medial condyles of the femur and tibia

medial collateral ligament (MCL) where does it attack?

patellofemoral dysfunction

nonoperative management of what include the following: Strengthening thoughts: Minimal patellar contact in trochlear groove at 0 to 15 degrees. Greatest patella stress is at 60 to 75 degrees of flexion to avoid restive strengthening in the range

findings associated with patellofemoral pain

patella alta, genu valgus, over-pron, weakness hip ER/abd, increased Q angle, squinting patella, coxa varus, tight IT band and tibial tuberosity is laterally displaced are all findings associated with what?

open chain

patients experience less pain with faster speeds and lighter resistance in what chain?

genu recurvatum

positioning of the tibiofemoral joint in which the extension goes beyond 0 degrees (hyperextension of the knee) (Jordan has a bad case of this:))

anterior cruciate ligament

prevents anterior displacement of the tibia on the femur

posterior cruciate ligament

prevents posterior displacement of the tibia on the femur

lateral collateral ligament

provides stability in the frontal plane

medial collateral ligament

provides stability in the frontal plane and fibers of the meniscus attach to this ligament

true

true or false: a woman is 3 times more likely to tear her ACL than a man?

true

true or false: as the knee extends, the patella slides in superior direction

true

true or false: on the leg the base is actually on the top and the apex is on the bottom

true

true or false: open chain resistance has shown to be more effective to increase quad strength than closed chain single-leg squat in pt with ACL injury

true

true or false: quad lag have full passive extension but not full active extension

true

true or false: the inner portion of the menisci are avascular (meaning no blood supply)

false

true or false: to most efficiently stretch the medial hamstrings, the hip should be placed in internal rotation and flexion

false

true or false: we want to do lateral gliding of the patella after a patellofemoral injury

true

true/false: the q angle is greater in females due to a wider pelvis

origin: ischial tuberosity insertion: anteromedial surface of proximal tibia nerve supply: sciatic nerve action: hip extension and knee flexion

what is the origin, insertion, nerve supply, and action of the semiteninosus?

true

true or false: the menisci is what provides shock absorption in the knee

thick hyaline cartilage

What is the posterior surface of the patella covered with?

13

How many bursa does the knee joint have?

patellar tendonitis

"Jumpers knee" Caused by overuse of stress or sudden impact associative with repetitive jumping. Common in basketball players, high jumpers, and hurdlers. Signs and symptoms include tenderness at the patellar tendon exacerbated by tight quads. Prevention by hamstring and quad flexibility and strengthening. Specific intervention include anterior tibias and stengthening

genu valgum

"Knock knees" seen in conjunction with coxa varus. the feet are more lateral then knees

popliteal cyst

"bakers cyst" synovial hernia or bursitis involving the posterior aspect of the knee

prepatellar bursitis

"housemaids knee" Occurs when there is constant pressure between the skin and patella. Commonly seen in carpet lawyers and is the result of repeated direct blows or sheering stresses on the knee

screw-home mechanism

(internal/external rotation) During the last 20 degrees of knee extension. Characteristic motion in the normal knee, in which the tibia externally rotates and the femur internally rotates as the knee approaches extension.

ballottement test

**This one is important on probably on boards** Purpose: Test for knee swelling Patient: Supine PT: Quickly push the patella posteriorly with 2- 3 fingers Positive Finding: Patella bounces off trochlea with a distinct impact

D.

All of the following are true statements about the Q angle except: A. another name for the Q angle is quadriceps angle B. landmarks for measurement include the ASIS, center of the patella, and the tibial tuberosity C. females typically have larger Q angles then males D. a decreased Q angle can result in increased pressure o fate lateral facet of the patella against the lateral femoral condyle

C.

All of the following are true statements about the knee ligaments, except: A. the posterior cruciate ligament resists posterior translation of the tibial relative to a fixed femur B. the posterior cruciate ligament resists the extremes of knee flexion C. the lateral collateral ligament is the primary restraint to valgus force D. the anterior cruciate ligament resits the extremes of knee extension

d.

All of the following are true statements about the patellofemoral joint except: A. patella alta refers to the placement of the patella in an elevated (superior position) B. the facet medial to the medial facet is frequently the first part of the patella to be affected in premature degeneration C. the patella enhances the torque-producing capability of the quads D. in patella baja, there is an increased risk for disloaction

D.

All of the following are true statements about the tibiofemoral joint, except: A. it is formed between the tibia and femur B. the femur usually meets the tibia with a normal genu valgum C. the joint has little inherent stability D. the anterior cruciate ligament resists anterior translation of the femur on the tibia

C.

All of the following are true statements with regard to an ACL injury except: A. mechanisms include sudden deceleration, an abrupt change of direction, and a fixed foot B. the classic sign of an ACL rupture is an acute hemarthrosis C. ACL injuries typically occur in isolation D. The lachman test will be positive if the ACL is ruptured

A.

All of the following exercises are closed chain exercises EXCEPT: A. straight leg raises B. step-ups C. mini-squats D. side lunges

C.

All of the following injuries may occur with an ACL injury EXCEPT: A. medial meniscus tear B. MCL tear C. PCL tear

1.Attaches to the anterior medial surface of the tibia just medial to the medial meniscus 2. runs superior and posterior direction 3. attaches to the posteriorly on the lateral condyle of the femur

Anterior cruciate ligament (ACL) name where it attaches to (both sides) and how it runs

ACL repair exercise precautions

Avoid activities that place stress on the tibia in an anterior direction: avoid closed-chain strengthening of quads between 60 to 90 degrees of knee flexion. Avoid any resistance to the distal tibia during quad strengthening.

non-operative PCL precautions

Avoid isolated open-chain knee flexion exercises (HS curls) Focus on strentheing of quads to compensate

full extension for weight bearing for 3 weeks but unlocked for exercise

Bracing in meniscal tears is what and lasts for how long

patellofemoral angle. angle between quads and patellar

Define Q angle

the graft

During the first 6 to 8 weeks of surgical management of a ligament injury what is most vulnerable to excessive loads

meniscal repair exercise precautions

During weight-bearing activities, such as lunges and squatting, don't perform knee flexion beyond 45 degrees for 5 weeks. Avoid twisting motions during weight bearing. No HS curls until 8 weeks

extracapsular ligaments

Includes the medial (tibial) collateral ligament and lateral (fibular) collateral ligament. Provides the medial and lateral stability. Both tighten during extension and slacken during flexion

increased Q-angle

Increased what appears with wide pelvis, femoral anterversion, coxa vara, genu valgum, laterallyd ispaced tibial tuberosity, and over-pronation

patellar alignment

Influenced by the line of pull from the quadriceps and the attachment to the tibial tuberosity. Could be caused by increased Q-angle, muscle and facial tightness, hip muscle weakness, and lax medial capsular retinaculum or weak VMO

PCL injury

Injured by a forceful blow to the anterior tibia while the knee is flexed, (dashboard injury or fall onto the knees)

iliotibial band friction syndrome

Irritation as the IT band passes over the lateral femoral condyle at 30 degrees of flexion. The IT band attaches to the patella and lateral retinaculum, so it may cause anterior/lateral knee pain. Preventing by stretching TFL and gluteus maximus

plica syndrome

Irritation of remnants of embryological synovial tissue around the patella. Signs and symptoms include pain upon palpation on medial aspect of patella

continous passive motion

Is used per surgeons discretion in the recovery room or within a day of surgery. Research has not demonstrated any long term benefits to gains in ROM and function mobility

weakness of hip abductors and external rotators

Weakness of what will result in hip adduction and genu valgus

lateral reticular release

Knee immobilization after surgery in full extension with cryo-cuff, WBAT with crutches. When control of the quads is sufficient to hold the knee in full extension, use of the knee immobilizer and crushes are discontinued

pes anserine

Latin for "goose foot" Made up o the sartorial, gracilis, and semitendinosus muscles (SGT)

A.

Mrs. Smith is a 59 year old woman with a diagnosis of RA. Which of the following is a common impairment at the knee joint? A. loss of knee flexion B. difficulty standing from a seated position C. inability to climb stairs D. difficulty with ADLs

PCL repair

Not as frequent as ACL tears. Gradual increase of weight bearing using crutches. Avoid open-chain, active knee flexion against the resistance of gravity for to 12 weeks. During squatting exercises, avoid excessive trunk flexion and place resistance to hip musculature proximal to the knee only

ligament injuries

Occur more frequently in 20 to 40 years olds due to sports injuries, but can occur in individuals of all ages.

MCL injury

Occurs from values forces across the medial joint line

1. attaches to the poster side of the tibia 2. runs superior and anterior direction 3. attaches to the anterior femur

Posterior cruciate ligament (PCL) Where does it attack to on both sides and how does it run?

anterior drawer test

Purpose: Test ACL stability Patient: Hooklying PT: Stabilize the foot and place both hands around the posterior surface of the tibia. Attempt to move the tibia anteriorly. Positive Finding: Increased anterior displacement of tibia

lachman's test

Purpose: Test ACL stability Patient: Supine Test position: Patient's leg is tested 30 degrees of knee flexion. PT: One hand stabilizes the femur and the other hand attempts to displace the tibia anteriorly. Positive Finding: Increased anterior displacement of tibia

varus test

Purpose: Test LCL instability Patient: Supine Test position: Patient's leg is tested in 0 degrees of extension and 30 degrees of knee flexion to "unlock" the knee with hip abducted. PT: Pressure is placed on lateral tibia with support on media femur. Positive Finding: Knee joint gapping on the lateral aspect

valgus test

Purpose: Test MCL instability Patient: Supine Test position: Patient's leg is tested in 0 degrees of extension and 30 degrees of knee flexion to "unlock" the knee with hip abducted. PT: Pressure is placed on medial tibia with support on lateral femur. Positive Finding: Knee joint gapping on the medial aspect

posterior drawer test

Purpose: Test PCL stability Patient: Hooklying PT: Stabilize the foot and place both hands around the anterior surface of the tibia. Attempt to move the tibia posteriorly. Positive Finding: Increased posterior displacement of tibia

posterior sag sign

Purpose: Test PCL stability Patient: Supine with hip & knee flexed 90° PT: Observe if tibial displacement occurs. Positive Finding: Increased posterior displacement of tibia

noble's compression test

Purpose: Test for IT band friction syndrome Patient: Supine Test Position: Flexed at least 60 degrees with pressure over lateral femoral condyle at the insertion of the distal IT band PT: Extend the patient's knee Positive Finding: Pain where IT band slips anteriorly over the femoral condyle (about 30 degrees flexion)

McMurray's test

Purpose: Test meniscus (ER tests medial, IR tests lateral) Patient: Supine Test Position: Patient's knee is fully flexed with hip IR or ER performed PT: Place hand on medial/lateral joint line (depending on which meniscus is being tested). Passively extend the knee with the hip in the rotated position. Positive Finding: Click or pop sound with pain

apley's test

Purpose: Test meniscus (ER tests medial, IR tests lateral) Patient: Prone with knee flexed 90 degrees PT: Performdistraction combined with rotation of the tibia followed by compression with hip rotation. Positive Finding: Click or pop sound with pain

arthroscopic debridement

Removes loose bodies that may cause swelling and intermittent locking of the knee

articulation of patella and femur

What is the patello-femoral joint made of?

PCL repair

Similar to ACL management,b ut resistance training to improve strength of the hamstrings is delayed until 2 to 3 months and is progressed cautiously. Return to activity 9 months to 1 year

chondromalacia patella

Softening and degeneration of the cartilage on the posterior aspect of the patella. Causes anterior knee pain. Caused by abnormal tracking of the patella within the patellofemoral groove, causing the patellar articular cartilage to become inflamed.

maximum protection phase

Some of the main points in what phase of recovery for TKA is to attain 90 degrees of passive knee flexion and full knee extension. *AAROM and AROM SLR in supine and prone (postpone in sidelying)

rheumatoid arthritis

The early stage of this manifests in the hands and feet first. Joints become warm and swollen with limited motion. Development of genu VALGUM deformity

biceps femoris, semitendonosis, and semibranosus

The hamstrings are all two joints and do hip extension and knee flexion. What are they?

biceps femoris, semiteninosus, and semimembranosus

The hamstrings consists of what three muscles? The order of them from lateral to medial initials are BTM, indicates their arrangement at the bottom of the thigh.

Total Knee arthroplasty

The primary goals are to improve patients physical function and quality of life. Typically the ACL is excised during this. There is cemented (used most often) WBAT with full weight-bearing over 6 weeks and then uncememented which varies between TDWB and WBAT for 4 to 8 weeks

true

True or False: if a patient can't fully extend the hip, the knee can't full extend

false

True or False: posterior cruciate ligament tears are more common anterior cruciate ligament tears

true

True or false: Mcl are managed non operatively because of the high supply of blood

true

True or false: The tibial tuberosity is further lateral in extension....therefore, external rotation of the tibia occurred with open chain knee extension.

true

True or false: There are NO universal knee precautions

true

True or false: as the knee flexes the patella enters the intercondylar groove and slides in an inferior direction

true

True or false: fibers from the medial meniscus are attached, so injury to one can result in injury to both

true

True or false: regular participation in physical activity has been recognized as being beneficial in the management of knee OA

true

True or false: the central portion of a meniscus is essentially avascular and therefore does not have the potential to heal

true

True or false: you cannot regenerate cartilage in osteoarthritis or at all.

true

True or false: you should post-pone straight leg raises in side lying position for 2 weeks after cemented arthroplasty and for 4 to 6 weeks after cementless/hybrid arthoplasty

LCL injury

Usually only as a result of traumatic virus force across the knee

FWB by 4 to 8 weeks when adequate quad control

Weight bearing in meniscal tears is what and lasts for how long

tibiofemoral and patellofemoral joints

What 2 main joints is the knee joint made of?

semitendinosus, gracilis, and sartorius

What 3 muscles are considered part of the res anserine muscle group?

knee and patellar problems

What are altered Q angles associated with?

quadriceps

What are the anterior stability of additional muscle support for the knee joint?

gracilis and sartorius

What are the medial stability of additional muscle support for the knee joint?

flexion/extension, internal/external rotation

What are the motions of the knee?

gastrocnemius, and hamstrings

What are the posterior stability of additional muscle support for the knee joint?

patello-femoral joint

What are these functions of? increasing the mechanical advantage of the quadriceps muscle and protecting the knee joint

biomechanics factors

What category is the risk factor for the female that includes awkward or improper dynamic body movements, deceleration and change of direction, and neuromuscular control of the joint

environmental factors

What category is the risk factor for the female that is the use of knee or ankle braces that may improve performance but increases the risk of injury

anatomical factors

What category is the risk factor for the female that the femoral notch size, ACL size, LE alighment

hormonal factors

What category is the risk factor for the female when the hormone receptor sites for estrogen dn progesterone have been found in the ACL

E.

What condition(s) increase the risk of patellofemoral pain syndrome? A. genu varum B. squinting patella C. femoral anterversion D. over-pronation E. all of the above

patellofemoral angle

What does the "Q angle" stand for?

the patella slides within the trochlear (intercondylar) groove

What does the patella slide within?

sciatic nerve divides into the tibial and common peroneal nerve

What does the sciatic nerve divide into just proximal to the popliteal fossa?

rectus femoris

What has action at the hip and knee and is the main quad antagonist to the hip. (only quad muscle that does hip flexion because it crosses both)

transfer training to avoid pivoting on affected LE

What is an important point for non-operative maximum protection phase of ligament injuries in the knee

patella alta

What is considered a "high patella"

patella baja

What is considered a "low patella"

extensor lag

What is defined as decreased active knee extension (active range is less than passive range) Caused by weakness of the quads and/or lack of superior gliding of the patella

tensor facia latae

What is the lateral stability of additional muscle support for the knee joint?

popliteus

What is the only muscle that "unlocks" the knee

origin: ischial tuberosity insertion: posterior surface of medial condyle of tibia nerve supply: sciatic nerve action: hip extension and knee flexion

What is the origin, insertion, nerve supply and action of the semimembranosus?

origin: ischial tuberosity (long head) and lateral lip of linea aspera (short head) insertion: fibular head nerve supply: long head-sciatic nerve. short head- common perineal nerve action: hip extension(long head) knee flexion (both heads)

What is the origin, insertion, nerve supply, and action of the biceps femoris?

origin: medial and lateral femoral condyles insertion: posterior calcaneus nerve supply: tibial nerve (S1, S2) action: knee flexion and ankle plantar flexion

What is the origin, insertion, nerve supply, and action of the gastrocnemius?

origin: lateral femoral condyle insertion: posterior medial tibial condyle nerve supply: tibial nerve action: initiates hip flexion by unlocking the knee

What is the origin, insertion, nerve supply, and action of the popliteus?

origin: aiis insertion: tibial tuberosity nerve supply: femoral nerve action: hip flexion and knee extension

What is the origin, insertion, nerve supply, and action of the rectus femoris?

connected to the tibia by the patellar tendon (a.k.a. ligamentum patellae)

What is the patello-femoral joint connected by?

patella alta

Which one is most likely to dislocate the patella alta or patella baja?

cruciate ("cross") ligaments

Within the joint capsule, they cross; named for their tibial attachments. They include the ACL and PCL

genu valgus

ankle more lateral than normal

genu varus

ankle more medial than normal

menisci

consists of a medial and a lateral. Are 2 half-moon, wedge-shaped fibrocartilage disks located on the superior tibia.

lateral meniscus

deepens the joint surface and absorbs shock

medial meniscus

deepens the joint surface and absorbs shock

genu recurvatum

knee joint is more than zero degrees of extension

Attaches to lateral condyle of femur and fibular head

lateral collateral ligament (LCL) where does it attach?

TKA Exercise Precautions

• Avoid SLR's in sidelying positions for 2 weeks after cemented arthroplasty & 4-6 weeks after cementless/ hybrid arthroplasty to avoid varus/ valgus stresses to the knee • Monitor integrity of surgical incision during knee flexion exercises (limit excessive tension) • Postpone unsupported or unassisted WBing activities until sufficient strength in quads & HS for knee stabilization • Do not place a pillow under the patient's knees in supine or seated with the leg elevated to prevent knee flexion contracture

non-operaitve ACL precautions

• Avoid open-chain terminal knee extension exercises (last 40°) with resistance. • Avoid squatting the first 60° from full extension. • Focus should be on strengthening hamstrings to compensate for torn ACL.