Differential Diagnosis & Assessment of Knee EXAM 2

- OA

- Degenerative meniscal tears

- Anterior knee pain

- Tendinopathies

What are common Atraumatic Knee Conditions

- Ligamentous (ACL) reconstructions

- Meniscal surgery

- Total knee arthroplasty

- Fracture ORIF

- Tendon repair

- Cartilage/OCD surgery

What are common Post-operative knee conditions

- Lumbar Spine

- Hip

Where can Referred Musculoskeletal Pain to Knee come from

- "Do you currently or have you ever experienced knee swelling?"

- "Does you ever experience times when you are unable to fully straighten or bend your knee?"

- "Does your knee buckle or give way?"

Special Questions for the Knee

- joint effusion implicates intra-articular structures

- Edema (fluid outside the joint): PFPS, contusions

what types of conditions can result in swelling of the knee

- Meniscal tear

- Loose bodies (OCD)

what types of conditions can result in locking of the knee

- Ligamentous instability

- Quad inhibition

what types of conditions can result in the knee giving way (buckle)

- LCL

- Meniscal

- Patellar dislocation

- Fracture

what are lateral knee structures/conditions that can be affected by traumatic injury

- Degenerative meniscal

- PFPS

- ITB Syndrome

- OA

- HS Tendinopathy

what are Atraumatic pain conditions that can occur to the lateral knee

- Quad Contusion

- Quad tendon rupture

what are traumatic pain conditions that can occur to the superior knee

Quad tendinopathy

what are Atraumatic pain conditions that can occur to the superior knee

- MCL

- Meniscal

- Patellar dislocation

- OCD

what are traumatic pain conditions that can occur to the medial knee

- Degenerative meniscal

- Pes Anserine

- OA

what are Atraumatic pain conditions that can occur to the medial knee

- Fracture

- Patellar tendon rupture

what are traumatic pain conditions that can occur to the inferior knee

- Patellar Tendinopathy

- Osgood Schlatter

- OA

what are Atraumatic pain conditions that can occur to the inferior knee

- Hamstring tear

- Gastroc tear

- Meniscal tear

- Posterolateral corner-injury

what are traumatic pain conditions that can occur to the posterior knee

- Hamstring tendinopathy

- Gastroc tendinopathy

- Degenerative meniscal/OA

- Baker’s cyst

what are Atraumatic pain conditions that can occur to the posterior knee

- Patellar dislocation

- Patellar fracture or contusion

what are traumatic pain conditions that can occur to the anterior knee

- PFPS

- OA

what are Atraumatic pain conditions that can occur to the anterior knee

- Lower Extremity Functional Scale (LEFS)

- Knee Outcomes Score (KOS) (ADL)

- International Knee Documentation Committee (IKDC) 2000

- Patient Specific Functional Scale (PSFS)

Commonly Used Patient Reported Outcomes Measures (Knee)

- LE pain

- may use IKDC for Ligamentous/meniscal dxs

- ceiling and floor effects.

what are the indications for the Lower Extremity Functional Scale (LEFS)

Knee injuries, older less physically active individuals

what are the indications for the Knee Outcomes Score (KOS) (ADL)

7.1 (PFPS)

what is the MCID for the Knee Outcomes Score (KOS) (ADL)

Knee injuries, young, athletic population

what are the indications for the International Knee Documentation Committee (IKDC) 2000

9 points

what is the MCID for the International Knee Documentation Committee (IKDC) 2000

For any region, any age

what are the indications for the Patient Specific Functional Scale (PSFS)

2 for Average Score

3 for single activity

what is the MCID for the Patient Specific Functional Scale (PSFS)

LEFS

- Score is out of 80

- Higher scores are better (less disability)

- Ceiling effect

Patient Specific Functional Scale (PSFS)

- Allows pt to select main functional complaints

- Should blind them to original scores at follow-up

- 10 is the best score; 0 is worst

- Level walking

- Hop test

Commonly Used Performance Based Measures for the knee

Difficulty Walking, any LE injury

what are indications for the Level Walking performance-based measure

ACL injury, could use with any young active individual

what are indications for the Hop tests performance-based measure

Level Walking test

- Time measured in seconds, Walking on 13 m indoor carpeted walkway

- at comfortable pace, 1.5 m acceleration/deceleration distance allowed

1.2 seconds

what is the MCID for the Level Walking test

Distance measured for Single Leg Performance: Single Hop, Triple Hop, Triple Crossover

what is the procedure for the performance of the Hop tests

7% Change

what is the MCID for the Hop tests

1.Patient will be able to squat with < 1/10 pain in the right knee within 3 weeks

2.Patient will improve LEFS score > 9 points within 3 weeks

what are good short-term goals for knee pain/function

1.Patient will be able to run for 2 miles with 0/10 pain within 6 weeks

2.Patient will improve LEFS score by > 50% within 6 weeks

what are good long-term goals for knee pain/function