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knee part 2
knee part 2
66
Anatomy
Graduate
09/30/2012

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Term
what is an example of a trauma that could cause patellofemoral pain syndrome
Definition
dashboard into patella
Term
what are insidious causes of PFP
Definition
body weight, weakness, work situation, training errors, shoes
Term
what weak muscles contribute to PFP
Definition
weak hip abductors/Ers llow femur to IR
Term
what training errors lead to PFP
Definition
terrain, distance/time, speed, force
Term
what are signs/symptoms of PFP
Definition
effusion, patellar facet tenderness, crepitus, pain with activity,LE malalignments
Term
what activities are often painful with PFP
Definition
sitting, stairs, incline/decline
Term
what LE malalignments are common with PFP
Definition
faulty patellar mechanics, tight retinacula, feet pronated, hips antetorsioned
Term
how to tell the difference between OA and PFP
Definition
OA leads to loss of knee extension.
Term
how common is knee crepitus
Definition
80% of adults over age 30 have knee crepitus. Of these, 20% have a problem.
Term
what should the path of the patella be as knee goes from flex to extend
Definition
S or straight. C = faulty
Term
what special tests implicate PFP
Definition
patellar compression, step up test, mcconnell isometric tests
Term
what closed chain exercises are good for someone with PFP
Definition
early ROM. Short squats
Term
why is it painful to flex the knee more in closed chain
Definition
increases quads force, which increases patellar force, which makes PFP more painful
Term
do open or closed chain exercises for PFP?
Definition
both
Term
when is the quads force on the patella greatest
Definition
60 deg knee flexion
Term
where is patellar surface area with the femur greatest
Definition
60 deg knee flexion
Term
can you separate vasti forces?
Definition
no. doesn't matter if you ER/IR with knee extension. You can't separate the quads because they all have the same insertion
Term
what can PTs do for PFP
Definition
modify activity, attenuate GRF with orthotics, address flexibility and patellar mobility, muscle imbalances, mobilization, bracing, taping
Term
what is chondroplasty
Definition
shaving off bad cartilage
Term
what is tibial tubercle realignment/transfer and lateral release
Definition
snip along lateral side at vastus lateralis tendon until patella releases and centralizes. Release the structures that are holding the patella laterally. Realignement is a more severe surgery. Rather than cutting the lateral retinaculum, they cut out a piece of the tibia and tendon, change its angulation, and reinsert it. They have to cut a section of bone out and then screw it back in place. The screws hold it until the bone heals (person will be immobilized)
Term
what is osteochondral microfracture
Definition
poke holes into the hyaline cartilage and subchondral bone to bleed out into joint and promote healing.
Term
what is osteochondral autograft transfer
Definition
take a graft to plug in a hole/fill in a defect that is within the area of contact for the joint
Term
what are post surgical considreations following chondroplasty
Definition
resume non-surgical/normal routine quickly
Term
post surgical considerations after TT and lateral release
Definition
short wait period (longer for TT), begin ROM, institute non-surgical program
Term
what is TT
Definition
tibial tubercle transfer
Term
post surgical considerations after chondral repairs
Definition
slow return dictated by surgeon. Protect the area by not putting too much joint surface pressure into the area too early on
Term
what is osteochondritis dissecans
Definition
osteochondral lesion
Term
what is the mechanism of an osteochondral lesion
Definition
traumatic detachment chondral segment
Term
what demographic is most likely to get osteochondritis dissecans
Definition
young, well developed male
Term
what is the classic site of ostechondritis dissecans
Definition
medial femoral condyle near the intercondylar notch
Term
what are signs/symptoms of osteochondritis dissecans
Definition
wilson test, xray/mri, tenderness at femoral condyle
Term
how to treat osteochondritis dissecans
Definition
surgical repair
Term
what is an osteochondral autologous implant
Definition
take some of your hyaline cartilage cells from somewhere, send them to a lab, put cells back down at surgical site, lay periosteal membrane on top.
Term
what are some extensor mechanism problems
Definition
fat pad, osgood-schlatter's, plica, IT band
Term
what usually causes fat pad syndrome
Definition
trauma
Term
what are signs/symptoms of fat pad syndrome
Definition
tender medial/lateral to patellar tendon in extension; pain with quad activation because it compresses the fat pad; hypertrophic fat ad
Term
how to treat fat pad syndrome
Definition
anti-inflammatory modalities, avoid aggravating activities, protective padding, injection with corticosteroids can confirm diagnosis and provide temporary relief, may require surgical removal
Term
what are signs/symptoms of osgood-shclater's
Definition
tender tibial tubercle, pain with quad resistance, squatting increases pain, tightness in quads/hamstrings/gastrocs
Term
how to treat osgood schlatters
Definition
stretch tight muscles, attenuate GRF, protective bracing, modify training habits
Term
how is osgood schlatters self-limtiting
Definition
problem is gone as soon as skeleton closes
Term
what braces are good for osgood schlatters
Definition
chopat = rubber tube that fits around knee and compesses patellar tendon to take pressure off tibial tuberosity. Horse shoe brace takes pressure off tibial tuberosity
Term
what is the MOI that causes medial patellofemoral plica
Definition
gradual onset that increases with flexion loading
Term
signs and symptoms of medial plica syndrome
Definition
ttp at medial femoral condyle, popping at medial aspect with F/E, medial tissue thickened, +plica test, mimics other conditions
Term
treatment of medial patellofemoral plica
Definition
treat with modalities to decrease inflammation and lengthen tissue, friction massag
Term
describe medial patellofemoral plica problems
Definition
plica thickens, ticks off tissue in area causing redness and swelling. Irritated by the plica band that rubs across the aspect of the medial femoral condyle. Thumps. Pain shuts the muscle down.
Term
what is jumper's knee
Definition
patellar tendonitis.
Term
what is the MOI for patellar tendonitis
Definition
gradual onset, increased pain with increased activity, training errors, jumping sports, after ACL
Term
what are S/S jumper's knee
Definition
tenderness to palpation at inferior patellar pole, pain with activation of quads, pain with stretch of quads, patellar tendon thickenting
Term
treatment for jumper's kene
Definition
rest, ROM, deal with inflammation, friction massage, progressive loading
Term
why do friction massage for patellar tendonitis
Definition
irritate the area to create inflammation to start off the healing process
Term
what are MOI for IT band syndromes
Definition
gradual onset of knee or hip pain, structural/functional dysfunction, activity changes, training errors, ilial rotations
Term
what are S/S of IT band friction syndrome
Definition
snapping lateral knee, pain lateral knee, + ITB compression test/Noble test
Term
how to treat ITB friction syndrome
Definition
anti-inflammatory modalities, ITB flexibility, friction massage, progressive loading, control foo mechanics, attenuate GRF, mobilize/manipulate pelvis
Term
what are knee immobilizers used for
Definition
restrict motion. Allow joint protection while healing.
Term
what are rehabilitative braces
Definition
allow protected motion during rehab. May have adjustable stops for ROM control.outcomes not clearly better with or without brace
Term
describe functional braces
Definition
increase stability for unstable knees.
Term
describe prophylactic bracing/taping
Definition
prevent or reduce severity of injuries. Allow normal function while limiting injury. Research not consistent.
Term
can neoprene stop varus/valgus forces on the knee
Definition
no.
Term
what is the literature consensus on bracing
Definition
in favor of rehab bracing for short term protection during healing. Divided over functional bracing and prophylactic bracing
Term
what to stretch to reduce moment arms around the knee
Definition
quads, hams, ITB, triceps surae, glutes/hip rotators
Term
what to mobilize to help the knee
Definition
patella, retinacula, scars, tibfib joint
Term
starting level closed chain exercises for the knee
Definition
modified wall slides, heel raises, stool scoots
Term
starting level open chain exercises for the knee
Definition
isometric hams/quads/glutes; SAQ; SLR; HS; AROM hip, knee ankle
Term
intermediate open chain exercises for the kene
Definition
SLR/PRE with weights
Term
intermediate closed chain exercises for the knee
Definition
wall slides, controlled step exercises, balance/proprioception, pyrometrics, lunges, weight training
Term
advanced exercises for the knee
Definition
closed chain: plyometrics, jumping, ball/foam roll, weight training, slide board, balance, work simulation, sport simulation
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