Knee Anatomy
sartorious, semitendinosus, and gracilis
What degrees do you perform varus and valgus stress tests at?
0 & 30
What is the unhappy triad?
ACL, MCL, and lateral meniscus
What is jumpers knee and how would you rehab it?
patellar tendonitis
eccentric exercises
What is considered a hypomobile patella?
less than 1 quadrant of displacement
Why are the cruciate ligaments considered intraarticulate but extrasynovial?
they are within the joint capsule, but contain a sheath around them so are not floating in the synovial fluid.
What are the two tests for a PCL tear? What position do you perform them in?
posterior drawer and posterior sag both at 90 degrees
You get a positive valgus stress test at 0 degrees.. what all is likely torn?
MCL and most likely ACL
How do you fix a bakers cyst?
Treat what is wrong intraarticularly
What three things does having a larger Q angle predispose you to?
subluxation / dislocation of patella
patellofemoral pain syndorme
chondromalacia
What nerve innervates all the hamstring muscles except the short head of the biceps femoris?
bonus: what nerve innervates the short head of the biceps femoris?
tibial nerve
bonus: common peroneal
What are three tests for mensical tears?
thessalys, mcmurrays, apleys grind and distract, eges
What issue often results in joint mice? Where else in the body do you see this (2 other areas)?
osteochondritis dessicans
talus and elbow
Your patient has a tibiofemoral dislocation.. at least what three things are torn?
ACL, PCL, and one of the collaterals
Explain the screw home mechanism.
there is a slight external rotation of the tibia on the femur during the last few degrees of knee extension
What is different about the MCL vs the LCL (other than location)?
MCL has two parts; a deep portion that attaches to the medial meniscus and a superficial portion
Your athlete hyperextends their leg on the soccer field and goes down. One of their teammates comes up to you saying they heard a loud pop. What test do you perform and what is your diagnosis? What is the likelihood your athlete needs surgery?
lachmans at 20-30 degrees and anterior drawer at 90 degrees
ACL tear
high
What is caused by compression fro a direct blow to the knee resulting in shearing or forceful rotation?
chondral/osteochondral fracture
Your athlete has pain with sitting, squatting, and descending stairs. You perform a lateral pull test and notice her patella is tracking poorly. What condition does she likely have? What 2 things could be causing this? What would you have her do in order to fix it?
patellofemoral pain syndrome
weak VMO or tight lateral structures (1/3 of IT band attaches to the patella)
SLR making sure to fire VMO
Explain the difference between the medial meniscus and the lateral meniscus.
medial is C shaped and larger - a small part of a large circle (also deep MCL attaches here)
lateral is O shaped and smaller - a large part of a small circle
Give 3 things the menisci do for the knee joint.
shock absorption, weight distribution, lubrication, nourishment, and stablization of the knee by deepening articulation
No.. he likely has a torn PCL and therefore would have a posterior sag. So when you go to put him in position for the lachmans test his tibia would sag back resulting in movement as you moved the tibia forwards making you think that you got a positive lachmans.
Explain when you would get the two different types of surgery for a meniscal tear and explain the recovery for both.
if you get a tear in the outer 1/3 of the meniscus you can get a meniscal repair. this surgery would be followed by a long period of NWB because the menisci take a long time to heal since they don't have great blood supply.
if you get a tear in the inner 2/3 you can either leave it or get a meniscectomy. you would likely only get a meniscectomy if they had a bucket handle tear where their knee is catching or locking up. after this surgery patient would be walking the day after, but would likely experience arthritis down the line.
Your athlete goes down on the field after a cutting move. As you run up to her she rolls over. You notice rapid swelling in the pouch. You perform your ligamentous stress tests but nothing comes back positive. What is likely wrong with her and what other test should you perform?
patellar dislocation with spontaneous relocation
patellar apprehension test
You have a 13 year male old athlete who has pain over top of the tibial tuberosity. What condition do they have? What caused it? What is the treatment?
Bonus: what is the other condition in the knee that is similar to this one and where does it originate from?
osgood schlatters - apopysitis at tib tub
growth spurt causing poor tractioning of patella tendon
rest
bonus: sinding larsen-johansson