Knee

3 jts at knee

-tibiofemoral

-patellofemoral

-proximal tibfib

arthrokinematics at tibiofemoral jt OKC flx

-concave tibia on femur

-post roll and glide

arthrokinematics at tibiofemoral jt CKC flx

-convex femur on concave tibia

-post roll and ant glide

•Flexion is accompanied by ___ of the tibia and ___ glide of patella

IR

inferior

•Extension is accompanied by ____ of the tibia (last 30°) and ____ glide of patella

ER

superior

capsular pattern tibiofemoral jt

FLX>EXT

OP position tibiofemoral jt

25-40 deg flx

CP position tibiofemoral jt

full ext + ER

patella tracking during ext

superior (2-3 in)

patella tracking during LAQ

lateral medial lateral

patella is most medial at ___ deg

30

patella at 0-10 deg flx

-no contact then slight contact w inferior pole

-minimal pain for PFPS

patella at 10-90 dg flx

-contact at medial and lateral facets and move inf to sup along facet

-can load different parts of patella here (more SA=less pain)

patella at >90 deg flx

-increased load on odd and lat facet and patellar tendon

-SA dec and inc load on contact areas (more pain)

proximal tibfib jt may be involved in ___ knee pain

lateral

ways to assess mobility at prox tibfib jt

anterolateral and posteromedial

2 tx options for prox tibfib jt

-treat hypomobile glide (comp to uninvolved)

-AL for flx and PM for ext

ottawa knee rules

-over 55 y/o

-TTP fibular head

-patellar tenderness

-inability to flx >90

-inability to WB 4 steps

(+ for ANY means refer for imaging)

pittsburg knee rule

-blunt trauma or fall as MOI

*PLUS

-age >50 or <12

-inability to WB 4 steps

both CPR are very sensitive and ___ may be more specific to knee fx

pittsburg

red flags

-infection

-PAD

-DVT

-compartment syndrome

-cancer

American College of Rheumatology Clinical Criteria for Knee Osteoarthritis

-knee pain PLUS 3/6 of these

-age over 50

-stiff >30 min

-crepitus w knee motion

-bony TTP

-bony enlargement

-no palpable warmth

mobs to improve extension

-ant glide tibia on femur

-post glide femur on tibia (small limit)

-prone ant tibial glide (large limitation)

-ext w overpressure mob (post capsule stretch)

-sup glide of patella

-PM tibfib glide

mobs to improve flx

-post glide tibia on femur

-TF traction + post glide

-MWM knee flx

-inf patellar glide

-AL tibfib glide

•Describe a patient with a capsular limitation at the tibiofemoral joint. Use specific numbers (there is more than 1 right answer, but check your ratio)

•Stiffness with firm capsular endfeels, flexion to 100° and extension to -12° (loss of flexion is greater than the loss of extension).

•For a patient with knee extension limitations of 5° (-5° knee extension), what position would likely be best?

•Posterior glide of femur on tibia

•What mobilizations would be contraindicated for a patient 1 week s/p ACL-R?

•Anterior tibial glide, especially grade III and IV (avoid anterior tibial translation);

-traction/distraction grade II or III