Key Concepts: Management of Knee Conditions EXAM 2

atrophy

quadriceps

Knee joint effusion is associated with rapid _____ and difficulty with recruitment of the _______ muscle.

intra-articular

The presence of a joint effusion suggests an ______ disorder

- Cruciate ligaments

- Menisci

- Cartilage

- Bone

- Acute postoperative period

The presence of a joint effusion what suggest what intra-articular disorders

3+

Knee Joint Effusion scale

• excess of fluid that makes it impossible to stroke the medial fluid away

2+

Knee Joint Effusion scale

• medial fluid returns to its position without performing downward sweep

1+

Knee Joint Effusion scale

• large bulge

trace

Knee Joint Effusion scale

• a small bulge on the medial aspect of the knee

0

Knee Joint Effusion scale

• no fluid wave while performing a downward stroke

flexed

The 'position of comfort' for the knee is slightly ______

- Patient education: don't use a pillow under your knee

- Manual joint mobilization

- Knee extension exercises

It is imperative to restore full terminal knee extension in acute and post-op injury management as soon as possible through……….

Knee joint torque of affected side/knee joint torque on unaffected side.

What is the Quad index

- Quadriceps inhibition

- Lack of knee extension mobility

In acute injury and post-op patients are often unable to fully extend their knee against gravity. This is due to…..

Knee extension range at rest (passive) on the table - knee extension range during a SLR (active)= degree of lag

quadriceps/extension 'lag' =

- Reduce knee joint effusion

- Improve knee extension mobility

- NMES

- Blood flow restriction training: Able to achieve strength and hypertrophy using only 30% of 1RM.

- Multi-angle quad isometrics

Key points about Restoring Quad Strength in the Acute Phase

The quadriceps is one of the primary movers and stabilizers of the knee joint

What role does the quadriceps play in knee function?

An isokinetic dynamometer

What is considered the gold standard for measuring quadriceps strength?

Hand-held dynamometers

What is a practical alternative to isokinetic dynamometry?

Rep-max testing on a knee extension machine, typically from 90° to 45° of knee flexion

What clinical strength test can be used as another substitute for quadriceps strength measurement?

harmful and should be avoided

What was the traditional belief about open-chain knee extension exercises

Squats, step-ups, and leg press exercises

Which closed-chain exercises were traditionally thought to be sufficient for quadriceps strengthening?

Individuals may demonstrate normal side-to-side strength during closed-chain exercises (e.g., leg press) while still having significant deficits during open-chain knee extension

What have studies shown about strength deficits in closed-chain versus open-chain exercises?

Hip extensors and calf muscles can compensate and contribute to knee extension

Why can closed-chain exercises mask quadriceps weakness

They can identify and address isolated quadriceps deficits that may not be apparent during closed-chain testing or exercise

Why are open-chain knee extension exercises important in rehabilitation?

joint effusion

pain

What are 2 common causes of quadriceps inhibition

90° to 45° of knee flexion

What knee flexion range is recommended for rep-max testing on a knee extension machine

Important knee stabilizers

Importance of Kinetic Chain for knee injuries:

• calf muscles

no

Does open chain quadriceps strengthening harm the graft after ACL reconstruction

no (must progress gradually)

Does open chain quadriceps strengthening cause patellofemoral pain?

It places less strain on the patellofemoral joint

Why is the 90°–45° range preferred early after surgery

weight bearing

In general, is weight bearing or non-weight bearing preferred after a knee injury

Terminal knee extension mobility and quadriceps strength

What two impairments are especially important to address to improve gait mechanics?

Compensatory movement patterns adopted during the acute phase that should be normalized during rehabilitation

What are "knee avoidance behaviors"?

They control the position of the pelvis and femur from the top down

What role do the hip muscles play in knee function

Dynamic knee valgus

What knee position is associated with ACL injuries and patellofemoral pain syndrome?

increase dynamic knee valgus during a single-leg squat

How does limited ankle dorsiflexion affect knee mechanics

single leg squat

During what movement task has limited dorsiflexion been shown to increase dynamic knee valgus?

pronation

valgus

Excessive foot ______ may contribute to knee injuries, and also leads to dynamic knee _____

running

Common goal for patients with knee disorders