204 Knee

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Author:
amills1
ID:
262868
Filename:
204 Knee
Updated:
2014-02-24 18:03:29
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204 Knee
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Description:
204 Knee (As of 2/21 all notes from PP, no precautions from KC yet)
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  1. Q angle land marks and WNL degree
    • ASIS-Mid patella-tib tuberosity
    • 15-18
  2. T/F Q angle is greater in men
    • False
    • greater in women
  3. To gain flexion at tibio femoral you do this glide
    posterior
  4. anterior glide to tibiofemoral increases what movement
    extension
  5. patellar femoral inferior glide increases
    flexion
  6. to gain extension at the patellar femoral you perform this glide
    superior
  7. describe the mechanics of screw-home mechanism (what moves on what and when)
    • occurs during last ~20 degrees of extension
    • during CKC the femur internally rotates on the tibia
    • medial condyle slides further posteriorly
  8. Patella function
    • increases level arm of quads
    • works as a fulcrum for the quads
    • redirects forces exerted from quads
  9. genu valgum WNL degree
    5-10
  10. ACL function
    • keeps femur from being displaced posteriorly from the tibia
    • keeps tibia from being displaces anteriorly on femur
  11. ACL attachments
    • attaches anterior surface of tibia just medial to medial meniscus
    • attaches posterior lateral femoral condyle
  12. PCL function
    • keeps femur from displacing anteriorly
    • keeps tibia from displacing posterior
  13. PCL attachments
    • attaches posterior tibia intercondylar area
    • attaches anterior femur on medial condyle
  14. Patella is not in grove during
    full extension 0-10 degrees
  15. During early ROM of flexion patella contacts which condyle first
    lateral
  16. with OKC this range of flexion the patella has most contact in grove
    60-90
  17. during OKC this range has the highest compression
    30/40-10
  18. during CKC in hyper flexion (90+) the patella has ____ contact on femur
    less
  19. Positions to avoid for PTC
    • squat past 40 degrees
    • SAQ over between 10 and 30/40 degrees
  20. What conditions cause patellar tracking problems
    • tight lateral retinaculum
    • tight itb
    • indirectly a coxa vara can due to causing a valgum
    • genu valgum
    • weak glute med/min and ERs
    • muscle imbalance (quad)
    • dislocation
  21. Which causes more lateral tracking of the patella and why? Genu valgum vs varum
    • genu valgum
    • increase in Q angle
    • the knee comes inward which makes the tib tubercle sit more lateral to the knee
    • this increases the Q angle
  22. approaches to addressing basic hypomobility
    • mobs
    • flexibility
    • muscle imbalances
    • correcting muscle length ratio
  23. if muscle is too short work in what range
    lengthened
  24. poor knee control in terminal stance is what muscles
    G/S
  25. difference between "joint effusion" and "patellar balloting"
    patellar balloting is a more significant amount of fluid
  26. Relating to repairs when is the ACL strongest
    right after surgery
  27. with TKA incision watching for these two things
    • proper healing
    • excessive tension during flexion especially with excessive swelling
  28. avoid using a ____ under ____ to avoid contracture
    pillow, knee
  29. only rehab an ACL in this range for OKC
    90-60
  30. only rehab an ACL in this range for CKC
    60-0
  31. avoid rehabing ACL in this range for OKC
    45-15
  32. t/f tension on healing tissue is bad
    • false
    • non excessive amount of tension promotes strong healing of ligaments and/or tendons
  33. With rehabing this injury you avoid doing OKC flexion
    PCL
  34. this is the most frequently injured ligament of the knee
    MCL
  35. this injury has healing lag behind clinical symptoms
    MCL
  36. patellar fracture rehab goals
    • patellar mobility
    • strengthening especially quads
  37. femur fx complcations
    • DVT
    • infection
    • delayed/non union
    • (ORIF is more common)
  38. this structure has poor blood supply except for the outer third
    meniscus
  39. meniscus repair precautions
    • restricted movement in first 6-8 weeks 0-90 OKC
    • restriction depends on location of tear/repair
    • early PWB
    • limit H/S (due to attachments on lateral meniscus
    • avoid full squats/lungers 6 months
    • slow progression of WB cutting/pivoting ex 4-9 months
  40. t/f besides ice articular cartilage is the most slippery material known to man
    • F
    • more slippery than ice
  41. PFP causes and interventions
    • static and dynamic structures
    • posture
    • stretching
    • ther ex
    • -VMO (debatable)
    • -CKC with alignment
    • -QS (quad sets), SLR, SAQ, CKC 
  42. lateral retinacular release indications
    • chronic PF pain and functional limitations without improvement after 6 months conservative treatment
    • documented patellar malalignment especially lateral glide and tilt
    • lateral subluxation/dislocation
  43. lateral retinacular release concerns
    • monitor swelling closely and adjust treatment accordingly
    • hemiarthrosis common post surgically
    • PF taping may help during return to function
  44. distal realignment of extensor mechanism indications and general info
    • recurrent dislocation/subluxation
    • large Q angle
    • PF arthrosis
    • tibial tubercle osteotomy
    • healing fracture precautions
  45. ACL stats
    • ~200,000 ACL injuries occur a year
    • ~100,000 reconstructions each year
    • females 2 to 8 times more likely
    • 70% occur as quick deceleration, hyper extension, or rotational injury
    • 30% from direct contact
  46. Autograft definition and location for ACLs
    • taken from patient
    • patellar tendon, h/s tendon, or quad tendons
  47. allograft definition and location for ACLs
    • patellar tendon
    • achilles tendon
    • semitendin
    • gracilis
    • posterior tibialis tendon
  48. Non neuro or biomechanical deficits for ACL injury
    • increase Q angle
    • femoral notch
    • estrogen
    • field
    • shoes
  49. neuromuscular and biomechanical deficits
    • weak h/s compared to quads; co-contraction
    • landing
    • jumping
    • changing direction
  50. neuromuscular and biomechanical training
    • active warm up
    • stretching exercises
    • strengthening
    • plyometric drills
    • agility drills
  51. effectiveness of training on ACL
    • several reports show decreases of serious ACL injuries from 72-89%
    • improvement in performance
  52. unhappy triad definition and etio
    • trauma or forceful twisting causing ACL, MCL, and medial meniscus to tear
    • knee popping heard upon injury
  53. unhappy triad interventions
    • ease into WB
    • PRICE
    • h/s and quad stretching
    • isom strengthening of quads and h/s 
  54. patella baja definition and etio
    • low lying patella 
    • congenital or acquired
    • HTO
    • improper TKA
    • proximal tibia trauma
  55. patella baja sns
    • pain with quad contraction
    • edema
    • joint stiffness
    • decreased patellar mobility
    • decrease patellar tendon tension
  56. patellar baja tx
    • PT
    • orthotics/brace
    • taping

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