Structure
What type of joint is the patellofemoral joint?
plane synovial joint
What is the purpose of Hoffa's Fat pad?
"not glamorous" but serves a purpose→ innervated and vascularized to protect articular surface and will move into negative pressure areas as we move the joint
How do you measure Q angle? What value is associated with current PFPS?
The angle measured between a line from ASIS to mid point of patella and a line from mid point of patella to tibial tuberosity. >20 degrees
Posterior glide of tibia on femur
What muscle group works eccentrically to control knee flexion?
Quadriceps
What layer of the extensor mechanism is the patella located?
What direction is the base of the patella moving during medial rotation?
Base of patella moves laterally
Apex of patella is moving medially
Your patient comes in complaining of anterior knee pain. What are some differential diagnoses just based on pain location.
1. PFPS
2. Patellar subluxation
3. Patellar apophysitis
4. tibial apophysitis
5. Patellar tendinitis
Flexibility, running, strength, core, plyometrics
Your patient presents with R knee and leg radiating pain that is worse with walking, running, lunging with R leg posterior, and sitting. What is the potential cause and how would you treat?
femoral nerve mobility deficits
-->Sliders: lay patient prone and without arching the back: bend the knee and lift the head up, then lower the head and lower the leg
can progress to tensioners
At what ROM what the odd facet of the patella articulate with the femur?
135 degrees of flexion
As you flex the knee, which direction does the patella move?
inferiorly
What type of stress test would you do to assess for MCL?
valgus stress test with knee in ~30 degrees of flexion to target MCL
Which of the following is not recommended following ACL reconstruction:
-knee mobilization
-strength/ neuromuscular training
- CPM
- early full weight bearing exercises
- functional bracing
-early OKC and CKC exercises
-cryotherapy
- neuromuscular electrostimulation
CPM and functional bracing should not be used
--> early full weight bearing exercises, early open and closed kinetic chain exercises, cryotherapy and neuromuscular electrostimulation may be used according to individual circumstances
(from Manny's VERY IMPORTANT SLIDE)
You are questioning if you should refer a patient to get X rays following knee trauma. He is 25 years old, was only able to take 10 steps, could only flex to 90 degrees, and has tenderness all around the knee joint. Should you refer him?
no- Ottawa knee rules:
After Knee Trauma-
Age >55
Isolated patellar tenderness without other bone tenderness
Tenderness to fibular head
Inability to flex to 90°
Inability to bear weight immediately after injury and in ED (4 steps)
What is the purpose of the bony lip on the lateral femoral condyle?
to prevent the patella moving too far laterally or dislocating
What are all the functions of the hamstring muscles?
hip extensors, knee flexors, hip and knee rotators, knee extensors in CKC
Your patient presents with slight medial joint line tenderness. What special test would you want to perform and how would you do it?
McMurrays test for medial meniscus. Bring the knee into full flexion, palpate the joint line and add a varus stress with ER while bringing into knee extension. Assess for pain or clicking.
What are the return to sport criteria?
1. minimum 12 week post op
2. 90% or greater quadriceps index
3. 90% or greater on all hop tests
4. 90% or greater on KOS-ADL
5. 90% or greater on global rating score of knee function
(from Manny's VERY IMPORTANT SLIDE)
Why does a large Q angle create excessive compression?
Large Q angle will result in a laterally directed resultant force secondary to lateral pull of quadriceps pull
Creates excessive compression of lateral patellar facet against lateral femoral condyle
Why may someone present with medial knee pain during the Ober test?
due to the line of stress going through the IT band which connects the lateral hip to medial knee
Where is the external torque angle the greatest in OKC vs CKC?
When moving from 90 degrees of knee flexion in OKC to full knee extension, the torque is greatest between 45 degrees of flexion and 0 degrees of extension.
When moving from 0 degrees of knee extension in CKC to 90 degrees of knee flexion, the torque is greatest between 45 degrees flexion and 90 degrees of flexion.
What are some risk factors for ACL injury?
Increased Q angle
Day 21 of menstrual cycle
Female
Contact sports
Lack of sleep
Over-pronation
Decreased GL MED activation
Narrow intercondylar femoral notch
Prior ACL reconstruction
Tight hip external rotators
Dry weather
Artificial turf
What are the NMES parameters for muscle strengthening?
pulse frequency: 35-80 pps
Pulse duration: 150-200 for small muscles; 200-350 for large muscles
Amplitude: >10% of Maximum voluntary isometric contraction (MVIC) in injured; > 50% MVIC in uninjured
On:Off times and ratio: 6-10 s on, 50-120 s off (may reduce off time with repeated treatments)
Ramp time: at least 2 s
Treatment time: 10-20 min to produce 10-20 reps
Times per day: every 2-3 hours when awake
Which of the following has the most strain on the ACL?
1. passive flexion-extension of the knee
2. Simultaneous quads and hams contraction @60 degree
3. Isometric quads contraction @ 60 degrees
4.Simultaneous quads and hams contraction @15 degrees
5. Isometric quads contraction @90 degrees
4. Simultaneous quads and hams contraction @15 degrees
--> Greatest strain on ACL from 30 degrees to 0 degrees of flexion