Term
| Primary stabilizer of the knee |
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Definition
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Term
| Results from a rotational (twisting) or hyperextension force, often full tears, tears the meniscus |
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Definition
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Term
|
Definition
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Term
| Multiple ligament disruption resulting in limb threatening emergency |
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Definition
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Term
| Pt with: knee giving way from twisting/hyperextension injury, audible pop heard, activity partcitipation inability, hemarthrosis in 24 h, |
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Definition
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Term
| (+) lachman test at 25-50 degrees |
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Definition
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Term
| (+) anterior drawer test at 90 degrees |
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Definition
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Term
|
Definition
ACL tear
flexion, valgus force with knee in extension while foot is internally rotated results in a clunk |
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Term
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Definition
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Term
| Untreated ACL injury adverse outcomes |
|
Definition
| recurring instability results in subsequent meniscal tears and OA, agility sport participation ineligibility |
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Term
|
Definition
1. Rest, ice, NSAIDS, Narcotics, Crutches (NWB - TT- PWB- FWB)
2. Knee Brace- helpful for older/less active patients
3. PT- Full Flexion and Extension(more important)
4. SX- B-PT-B; HS Graft |
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Term
| Which movement in rehab is more important for ACL tear |
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Definition
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Term
| If unable to perform rehab |
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Definition
| ACL reconstruction is not recommended |
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Term
| When can arthrofibrosis occur with an ACL tear |
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Definition
| after ACL tear or post operatively after ACL reconstruction |
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Term
| Adverse outcome of ACL reconstrucion when a portion of the patellar tendon is used for the ACL graft |
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Definition
| Fracture of the femur/ patellar graft site |
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Term
| Pt with: an ACL tear or with post traumatic knee effusions |
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Definition
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Term
| Strongest ligament in the knee |
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Definition
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Term
| Primary restraint to posterior translation of the tibia relative to the femur |
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Definition
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Term
| Originate on the medial intercondyler wall of the femur and inserts on the posterior aspect of the tibia running in an oblique direction |
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Definition
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Term
| 4 injury patterns suggestive of PCL injury |
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Definition
1. Dashboard injury
2. Fall onto a flexed knee
3. hyperflexion injury
4. Hyperextension injury- ACL then PCL tear |
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Term
| (+) posterior drawer test |
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Definition
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Term
| (+) quadriceps drawer test |
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Definition
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Term
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Definition
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Term
| Adverse outcomes of PCL tears |
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Definition
| unrecognized dislocated knee may cause limb threatening vascular injury, recurrent instability leading to subsequent meniscal tears and OA |
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Term
|
Definition
1. resolve swelling ans restoring ROM
2. Strenghtening exercises- emphasis on quadriceps exercise
3. Functional bracing |
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Term
| Tx of failed non operative PCL Tx |
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Definition
| PCL reconstruction to restore function, instability is improved but tibial translation remains increased |
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Term
| PCL tear with neurovascular compromise or deficit or PCL tear with possible surrounding ligamentous structure damage |
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Definition
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Term
| outside the joint and Stabilize in knee against valgus/varus stress |
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Definition
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Term
| inside the joint and stabilize the knee posteriorly and anteriorly |
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Definition
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Term
| Valgus force without rotation such as in football clipping injury |
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Definition
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Term
| Pure Varus force to the knee |
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Definition
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Term
| Able to ambulate post injury and return to play, small effusion and ecchymosis develop |
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Definition
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|
Term
| Swelling in and around injured ligament, TTP along entire course of ligament |
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Definition
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|
Term
| Best palpated with valgus stress in slight flexion |
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Definition
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Term
| examined in the figure 4 position |
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Definition
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|
Term
| Laxity in full extension indicates |
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Definition
| a more extensive injry to the ACL/PCL |
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Term
|
Definition
| ACL/PCL tear rather than MCL/LCL tear |
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Term
LCL/MCL tear grade:
Grade I
Grade II
Grade III |
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Definition
I = opening of 5 mm
II = b/t these two
III = 10mm |
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Term
| Pellegrini- Stieda avulsion Fx |
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Definition
|
|
Term
| Adverse outcomes in any knee ligament tear |
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Definition
| Chronic instability, pain, further meniscal tear may lead to OA |
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Term
|
Definition
Non-operative
I = resolve in couple weeks, RICE with crutches, NSAID
II = Brace, weight bearing as tolerated
III = brace (3-4mo), gradual return to weight bearing over 4-6 wks
PT - early ROM, quadriceps, hamstring progressive resistance |
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|
Term
|
Definition
I and II = non operative
III = associated with posterior capsule tear, SX to avoid later instability |
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|
Term
LCL/MCL tear with hemarthrosis
Significant effusion
Instability |
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Definition
|
|
Term
| failure to respond to non-operative Tx for anything |
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Definition
|
|
Term
| Occur in association with ACL / MCL tears |
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Definition
|
|
Term
| significant twisting action to knee, older patient complains after rising from squatting position, ambulate post injury and continue participation, locking, catching, popping, twisting/squatting pain |
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Definition
|
|
Term
| incarcerated meniscal tissue leading to locked knee |
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Definition
|
|
Term
|
Definition
| Urgent orthopedic evaluation for special MCL tear |
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Term
| MC finding is tenderness over the medial/lateral joint line |
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Definition
|
|
Term
Timing of effusion:
LCL/MCL
Meniscus
PCL/ACL |
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Definition
|
|
Term
| crystal arthropathy or infection Dx |
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Definition
|
|
Term
| most tears are central and cannot heal Waiting too long can result in lost opportunity SX repair |
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Definition
|
|
Term
| MCL tear Tx - absence of mechanical Sx |
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Definition
RICE
weight bearing as tolerated
NSAIS/Tylenol/ASA (Anti-inflammatories)
PT |
|
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Term
| MCL tear Tx - traumatic tear, young patient, older pt refractory to non-SX Tx |
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Definition
Aggresive Tx
Activity restriction
SX debridement/repair |
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Term
| MCL tear with traumatic effusion, mechanical Sx, ligamentous instability, refractory to non-SX Tx, persistent joint line tenderness |
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Definition
|
|
Term
| Osteonecrosis, subchondral bone, MC in knee (medial)/talus/distal humerus, repetitive stress, disrupt blood supply, separated from viable bone by fibrous tissue, Shear forces Fx bone, fragment becomes loose body |
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Definition
| Osteochondritis Dessicans (OCD) MOA |
|
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Term
| insidious knee pain, catching/locking post over-lying cartilage disruption, Pinpoint TTP- MC site on b/t medial condyle and medial to inferior pole of patella |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| This condition: Best seen on tunnel and lateral X-ray view, MRI visualize overlying carilage, MRI for staging of lesion |
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Definition
|
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Term
| Adverse outcome of unTx/unsuccessfully Tx OCD, Adverse outcome Tx and complications |
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Definition
| form loose bodies, leaving defects in articular surface, leads to OA - cartilage replacement - infection, further damage, failure |
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Term
| OCD Tx-MC in kids/bones not matured |
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Definition
| non-operatively= activity modification (avoid: running, jumping), crutches, immobilization for refractory/non-compliant pt |
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Term
| OCD Tx- Adults/bones matured/total separation of articular cartilage |
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Definition
SX=
Stable lesion, cartilage intact- microfracture, leave cartilage alone
Unstable lesion- internal fixation
Loose Fragment- remove fragment, debride articular surface defect |
|
|
Term
OCD < 1cm in child
OCD > 2 cm in child
OCD 1-2cm in child
OCD after physis has closed |
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Definition
non-operative Tx
progressive problems - redflag
Tx based Sx/xrays
further evaluation |
|
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Term
| MC form of knee arthritis, MC is medial compartment, results in bowleg/genu varum |
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Definition
|
|
Term
| Strong Hx or trauma, ligament tears, intra/extra articular Fx |
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Definition
|
|
Term
| pain on wt bearing, buckling/giving way, difficulty going up and down stairs, limited ROM at flexion/extension extremes, mimick meniscal tear, pain with rest/sleeping if severe |
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Definition
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|
Term
| Varus/valgus/windswept knee deformity, ROM loss parallels progression, crepitus, Fairbank signs on radiograph |
|
Definition
|
|
Term
|
Definition
Anti-inflammatory
glucosamine/chondroitin pills
Rest/ice/heat
PT- ROM/strengthening
Braces
Ambulation aids
Injections- viscosupplement/ corticosteroids |
|
|
Term
|
Definition
Arthroscopy
Mosiacplasty
Cartilage transplantation
High Tibial Osteotomy (HTO)-realignment
Arthroplasty |
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Term
| Pt with: OA paint at rest/ severe decreased ROM/significant functional limitations |
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Definition
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|
Term
| 1+ patellar secondary ossification centers fail to fuse, MC at superolateral pole, fibrous tissue joins unfused fragments, incidental finding, progress to anterior knee pain |
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Definition
|
|
Term
| follow direct/ indirect trauma/ insidious anterior knee pain development, increased stress of quadricps on patella/squatting/standing up increases pain, prominence over superolateral pole of patella, TTP over prominence |
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Definition
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|
Term
| Xray: AP/axial best views, rounded fragments, oblique lucency line |
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Definition
| Bipartite Patella Radiograph findings |
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Term
|
Definition
Activity modification - crutches/knee immobilizer
NO SX |
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Term
| Pt with: Bipartite patella Dx / failure of non-SX Tx |
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Definition
| Referral for Bipartite Patella |
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Term
|
Definition
| Pre-patellar, Supra-patellar, Infra-patellar, Pes Anserine, Iliotibial tract |
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Term
| line by synovial tissue, produce small amount of fluid, decrease friction b/t structures |
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Definition
|
|
Term
| Chronic pressure/friction, thickening of synovial lining, excessive fluid forms, local pain and swelling |
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Definition
|
|
Term
| dome shaped swelling, anterior aspect of knee, b/t skin and bony patella, Chronic kneeling, carpenters/carpeters/mason workers |
|
Definition
| Prepatellar bursitis(Housemaids Knee) |
|
|
Term
| anterior surface, lower part of femur, deep to quadriceps femoris |
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Definition
|
|
Term
| b/t upper tibia and patellar ligament |
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Definition
|
|
Term
| Pt with pain: under insertion of sartosius/ gracilis semitenidinosus, just below medial tibial plataeu |
|
Definition
|
|
Term
| Pt With: Early OA in medial compartment of knee |
|
Definition
|
|
Term
| Pt with: Pain in lateral knee-superior joint line, repetitive knee flexion/extension, found in long distance runners/cyclists |
|
Definition
| iliotibial tract bursitis |
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Term
| pain with activity/direct pressure, more severe with activity after sedentary periods, limp when arising from a chair, pinpoint pain, swelling, xray: AP/Lat to r/o bony conditions |
|
Definition
|
|
Term
|
Definition
Activity modification
Anti-inflammatories
U/S, phonophoresis
Stretch/strengthen- quadriceps/hamstring/IT band
Injection
SX only for severely refractory cases |
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|
Term
| Pt with: non-operative refractory bursitis, ligament/tendon insufficiency |
|
Definition
|
|
Term
| aching anterior knee pain, increases with running/going up, down stairs/kneeling/squatting, knee joint overuse/overload, patellar malalignment may be present, chondromalacia is an inaccurate term, patellar undersurface degenerative changes |
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Definition
| Patellofemoral pain syndrome/ retropatellar pain syndrome/ anterior knee pain |
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Term
| MC Sx - diffuse aching anterior knee pain, Worse with: long periods of sitting (theater sign), climbing stairs, jumping, squatting, retropatellar catching no swelling, no Hx of trauma, sudden increase in activity level/wt training |
|
Definition
| Patellofemoral pain syndrome Sx |
|
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Term
| Examine wt bearing stance and ambulation - increased femoral anteversion, Genu valgum- inadequate vastus medialis obliquus muscle development, increased Q angle, (+) patellar apprehension sign, xray: axial/sunrise views are most helpful |
|
Definition
| Patellofemoral Pain Syndrome PE |
|
|
Term
| Patellofemoral Pain Syndrome Tx |
|
Definition
Activity modification
Closed chain PT- squats (individually modified to avoid knee pain)
Avoid full arc quadriceps exercises
Anti-inflammatories
Knee sleeve with patellar cutout/strap
Wt loss
Injections- judiciously |
|
|
Term
| Pt with: persistent retropatellar pain syndrome pain/effusions/patellar instability |
|
Definition
| Referral for retropatellar pain syndrome |
|
|
Term
Normal flexion/extension Q angle for:
Men
Women |
|
Definition
Men
Ext: <14
Flex: <8
Women
Ext: <17
Flex: <9 |
|
|
Term
Pt with:
abnormal motion, recurrent subluxation, recurrent dislocations, usually lateral direction with minimal trauma of patella, knee usually maintained in a flexed position, patella reduces spontaneously, pain from MPFL tear, retropatellar pain |
|
Definition
Patelofemoral instability and malalignment
Pain with stairs/squatting/sitting
Non SX:
Initial: compressive dressing/ protective splint with knee in extension (immobilizer/ROM brace locked in extension), Ice, analgesics, activity modification
When pain is gone, begin PT (ROM/strengthening)
Chronic maltracking/instability includes quadriceps strenthening/flexibility
SX: non-SX fail, extensor mechanism realignment w/ MPFL repair(Fulkerson Procedure)/arthroscopy with lateral retinaculum release / Arthroplasty |
|
|
Term
Pt with:
Causes are from patella alta/shallow
trochlear groove/ flat patella under surface/lateral tipped patella/ "loose ligaments" |
|
Definition
Patelofemoral instability and malalignment
Initial: compressive dressing/ protective splint with knee in extension (immobilizer/ROM brace locked in extension), Ice, analgesics, activity modification
When pain is gone, begin PT (ROM/strengthening)
SX: non-SX fail, extensor mechanism realignment w/ MPFL (Fulkerson Procedure)/arthroscopy with lateral retinaculum release / Arthroplasty |
|
|
Term
PE findins of:
(+) J sign, lateral translation over half the width of the patella, TTP over MFPL, Tightness of the lateral retinaculum |
|
Definition
Patelofemoral instability and malalignment
Initial: compressive dressing/ protective splint with knee in extension (immobilizer/ROM brace locked in extension), Ice, analgesics, activity modification
When pain is gone, begin PT (ROM/strengthening)
SX: non-SX fail, extensor mechanism realignment w/ MPFL repair(Fulkerson Procedure)/arthroscopy with lateral retinaculum release / Arthroplasty |
|
|
Term
| Patelofemoral instability and malalignment Adverse outcomes |
|
Definition
| Anterior knee pain, quad weakness, recurrent patellar instability, reduced activity, patellofemoral arthrosis, residual parellofemoral pain, recurrent instability |
|
|
Term
|
Definition
Patelofemoral instabiilty and malalignment Tx
Patellar relignment |
|
|
Term
Pt with:
overuse/overload syndrome at quadriceps tendon insertion (Superior/inferior patellar pole), <40y/o = Jumper's Knee, anterior, tenderness at bony attachment of the quadriceps tendon/infrapatellar tendon, infrapatellar bursa, ROM motion normal with pain on extension, quadriceps atrophy, Heterotrophic ossification/ osteophytes at the upper/lower pole of the patella, MRI when all imaging failed |
|
Definition
Patellar/ Quadriceps tendinitis;
3 aspects:
1. relative rest, vary 3days - 3wks, knee immobilizer, NSAID, NO INJECTIONS-rupture
2. regain pain free ROM, flexibility, strength, U/S, phonophoresis, knee sleeve with patellar cutout/compression strap
3. gradual activity resumption with continued PT exercises, heat before/ice after activity |
|
|
Term
| Common findings of all knee injuries: |
|
Definition
Hurts right after activities
Hurts with squatting/kneeling/sitting/climbing stairs |
|
|
Term
Pt with:
rupture of extensor mechanism
Patellar/quadriceps tendinitis recalcitrant to non-SX managment |
|
Definition
|
|
Term
Pt with:
Same MOA as PCL tear, caused by quadriceps forcibly contracting to break the impact of a fall, can walk but unstable, INABILITY to EXTEND KNEE against gravity/ ABNORMAL STRAIGHT-LE RAISE TEST; Xray: Lat view = patella alta/patella baja |
|
Definition
Quadriceps and patella tendon ruputure-->patella based off the Bluman-Satts Line
complete rupture=SX
Partial Tear = immobilization |
|
|
Term
| Usually a direct blow from a MVA/indirect mechanism of a fall, can walk but unstable, deformity present, Xray shows abnormality |
|
Definition
Patellar Fx
Complete = SX
Incomplete = immobilization |
|
|
Term
| Quadriceps and patella tendon rupture adverse outcomes without SX/Delay in Tx |
|
Definition
No SX= deficient extensor mechanism
Delay=muscle contraction increases difficulty of SX |
|
|
Term
| Pt with Sx/PE consistent with extensor mechanism rupture |
|
Definition
| Referral and evaluation for SX |
|
|
Term
Pt with:
Inflammation of folds in synovium due to overuse/trauma, "bowstring" over the femoral condyle, painful snapping/popping over anterior/anteromedial knee, buckling (no giving way), palpated as a thickened band |
|
Definition
Plica Syndrome
Initial: decrease inflammation and thickening plica, anti-inflammatories, activity modification, Injections= Dx and Tx, PT flexibility/strengthening
SX- persistant, recalcitrant cases require arthroscopic resection |
|
|
Term
Plica =
Distinct v. Minor
Medial |
|
Definition
5-normal fold in synovium
Distinct = suprapatellar, medial, infrapatellar
From medial joint capsule to medial anterior fat pad, MC one inflammed |
|
|
Term
| Adverse outcomes of Plica Syndrome |
|
Definition
Repeated injections - accelerated destruction of articular cartilage and sepsis
SX complicated by infection/stiffness |
|
|
Term
Pt with:
Continued discomfort and instability with plica syndrome PE and Sx findings |
|
Definition
|
|
Term
Pt with:
Pain out of proportion to injury,pain with passive stretching of involved muscles, decreased sensation, loss of posterior tibial and dorsalis pedal pulses |
|
Definition
Compartment Syndrome - Acute Leg Pain
Filet Mignon- SX |
|
|
Term
DDx of Acute Leg Pain
MC compartment affected by compartment syndrome acute leg pain |
|
Definition
Compartment Syndrome
Constusions
Medial gastroc tear
Rupture popliteal cyst
Anterior |
|
|
Term
Muscles/nerve of:
Anterior compartment
Lateral compartment
Deep Posterior compartment
Superficial Posterior compartment |
|
Definition
Deep peroneal/ TA,EHL,EDL,Peroneus tertius
Superficial peroneal nerve/ PL, PB
Tibial Nerve/ popliteus, FHL, FDL, TP(sometimes seperate compartment)
Tibial nerve/ Gastrocnemius, Soleus, Plantaris |
|
|
Term
| diastolic pressure - intracompartmental pressure <= 30 mmHg/ >=40mmHg within area |
|
Definition
| Compartment Syndrome - Filet Mignon - SX |
|
|
Term
| Failure to recognize/immediately Tx a compartment syndrome- Adverse outcomes |
|
Definition
tissue necrosis and permanent contracture, pain, weakness, neurologic injury
Pulses and sensation may be intact with this condition |
|
|
Term
| Can result in compartment syndrome- subset of Acute leg pain, pain with active/passive muscle contraction |
|
Definition
| Contusion analgesics, Rest, Ice,elevation, ROM modification, calf stretching, stengthening |
|
|
Term
Pt with:
pain is located proximally and medially over leg, medial proximal calf pain, pt presents in plantar flexion to avoid tension on injured muscle, (-) single-leg toe raise, (+) ecchymosis in 24 h |
|
Definition
Medial gastrocnemius tears
analgesics, RICE, calf stretching, strengthening |
|
|
Term
Pt with:
bulge on posteromedial aspect of knee, fluctuate in size, associated with RA/SLE, meniscal tears, swelling/fullness in popliteal fossa with pain/tenderness, rupture causes severe medial calf pain, decreased ankle ROM- mistaken for a DVT |
|
Definition
Rupture of popliteal cyst (Baker's Cyst); Aspiration provides transient relief
Arthritic Cysts - Knee replacement
Cyst excision |
|
|
Term
|
Definition
Baker's Cyst-Aspiration provides transient relief
Arthritic Cysts - Knee replacement
Cyst excision |
|
|
Term
| MC found b/t semimembranosus muscle and medial head of gastrocnemius muscle, mechanical signs of intra-articular irritant, if aspiration chosen- approach with caution due to close proximity of neurvascular structures in the area in addition to difficult aspiration due to viscosity of substance |
|
Definition
Baker's Cyst-Aspiration provides transient relief
Arthritic Cysts - Knee replacement
Cyst excision |
|
|
Term
| Adverse outcomes of Popliteal Cyst |
|
Definition
Rupture=pain in posterior calf -->DVT
Mass effect can compress surrounding neurovascular structures-->sensory/motor deficits |
|
|
Term
| Adverse outcome of Popliteal Cyst Tx |
|
Definition
| injury to neighboring nerves/blood vessals, reoccurance |
|
|
Term
Pt with:
Constitutional Sx of cancer |
|
Definition
|
|
Term
Pt with:
pain >2-3wk, Stress Fx/Exertional Compartment Syndrome/Shin splints/Caludication |
|
Definition
Chronic Leg Pain- Tx based on Specific condition
Stress Fx- Rest, activity modification, cast immobilization/PWB
Exertional Compartment Syndrome;
Non SX- d/c or reduce activity
SX- fasciotomy
Neurgenic Claudication;OTC analgesics/NSAID, steroid injections, Lumbar flexion exercises, SX decompression
Vascular Claudication; Vascular SX |
|
|
Term
Pt with:
pain initially with exercise, progress to pain with walking/at rest, localized to one area, >6wks post Sx-->Bony callus, Xrays appear normal for >=3wks after injury, |
|
Definition
Stress Fx:
Most patients - rest
Mild Pain - activity modifications
Significant pain - cast immoblization/PWB
Low impact exercise- Bicycling/Swimming
Recovery usually ~ 2mo
BEWARE OF DREADED BLACK LINE |
|
|
Term
| Next Step w/ Stress Fx pt with normal radiographs and no activity/occupation with increased stress |
|
Definition
| Repeat Radiographs at 3-4wk after initial exam |
|
|
Term
| Dx imaging of choice for need to know pt with stress Fx (atheletes/occupation) |
|
Definition
|
|
Term
| Pt with: Activitty induced increase in tissue pressure, leg pain, paresthesias radiating into foot, Hx: lots of running/walking, pain with activity, but once stopped goes away (~30min), NO PAIN at REST, dorsiflexor weakness, first web space paresthesias / plantar paresthesias |
|
Definition
| Exertional Compartment Syndrome; Non SX- d/c or reduce activity SX- fasciotomy (anterior nerve involvment/ Deep Tibial nerve) |
|
|
Term
| Best way to measure is indwelling catheter |
|
Definition
Exertiaonal compartment syndrome
>40 mmHg ~30 min to RTN |
|
|
Term
| gradual onset of posteromedial pain in the distant 1/3 of the leg, inflammation of perriosteum, secondary to repetative muscle contraction, TTP- posterior medial crest, Dx of exclusion |
|
Definition
| Shin Splints- Don't be a pussy |
|
|
Term
| discomfort secondary to neurogenic/vascular etology, parethesias and dysesthesias |
|
Definition
|
|
Term
| Spinal stenosis, caused by ischemia due to cauda equina syndrome- postures that mechanically compress the nerve roots with resultant paresthesias/dysethesias; Pain begins in buttocks and spreads to the legs while walking, Sx worsen with walking down inclines/loridotic posture/Sx resolve afer sitting down/lying down, progress proximal to distal, pain does not go away when stop walking, weakness/reflex changes develop after activities-provoke leg pain, Xray shows degenerative changes |
|
Definition
| Neurgenic claudication; OTC analgesics/NSAID, steroid injections, Lumbar flexion exercises, SX decompression |
|
|
Term
| PVD and compromised blood flow with walking, starts distally and radiates proximally, pain subsides when walking stops, diminished pulses below the waist, redness and pallor changes with limb elevation, Dopplerr Studies/Arteriography demonstrate abnormality |
|
Definition
| Vascular Claudication; Vascular SX |
|
|
