Knee (ACL, rotatory instability, patellofemoral instability, articular cartilage lesion, tendinopathy, apophysitis, bursitis)

ottawa knee rules

• age > _____

• tenderness at ____

• tenderness at _____

• inability to flex knee to ____ deg

• inability to WB _____ steps immediately after or in ____

55, head of fibula, patella, 90, 4, ER 

pittsburg knee rules

• ____ or ____ mechanism AND

• age younger than ____ or older than ____ AND/OR

• inability to WB ____ steps in ER

blunt trauma, fall, 12, 50, 4

ACL resists _____ of tibia, ____ of femur, secondarily resists ____

anterior translation, IR, valgus and varus

ACL copers

• isolated _____ inury

• > or = ___% KOS-ADLs

• > or = ____% global rating scale

• > or = ____% symmetry on timed hop

• < or = ____ recent episode of giving way

ACL, 80, 60, 80, 1

ACL non-copers can become ____ after ___ sessions

coper, 10

special tests for ACL

lachmans, anterior drawer, pivot shift 

Tx coper

• phase 1: resolve ____ and ____

• phase 2: ____ and ____ training

ROM, effusion, strength, neuromuscular

treat ACL non-coper

• surgical: allograft or autograft (_____, _____, _____)

• PT post surgery: depends on ____, ____ mo minimum

h/s, quad, bone patella bone, protocol, 9

ACL Pre-hab goals

• restore ____

• decrease ____ and ____

• restore ____ inhibition

• normalize ____

• ____ and ____ training

rom, swelling, pain, quad, gait, NM, strength

posteromedial rotatory instability = 

medial tibial plateau shifts posteromedial w valgus force 

posteromedial rotatory instability MOI

combined valgus and hyperext

structues injured with posteromedial rotatory instability 

MCL, ACL, posterior oblique lig

anteromedial rotatory instability =

medial tibial plateau subluxs anterior

anteromedial rotatory instability MOI

excessive valgus and ER of knee

anteromedial rotatory instability clinical presentation 

• pain in ____ and ____ of knee 

• ____ laxity at 30 deg flexion 

• excessive _____ of knee 

medial, posteromedial, valgus, ER 

structures injured with anteromedial rotatory instability 

MCL and posteromedial corner (posterior oblique lig, posterior horn of medial mensicus ) 

special tests for anteromedial rotatory instability 

anteiror drawer in ER

anterolateral rotatory instability = 

lateral tibial plateau subluxes anteriorly 

anterolateral rotatory instability MOI =

excessive varus and IR of knee

structures injured with anteolateral rotatory instability

ACL and/or anterolateral complex (ITB, lateral meniscus, anterolateral lig)

special rests for anterolateral rotatory instability

pivot shift, anterior drawer w IR, Jerk test, sidelying slocum

posterolateral rotatory instability =

lateral tibial plateau subluxes posteriorly

posterolateral rotatory instability MOI =

forcer hyperext ± tibial ER

structures injured posterolateral rotatory instability = 

posterolateral corner (LCL, popliteus mm, posterofibular lig) ± PCL 

clinical presentation of posterolateral rotatory instability

• ____ pain

• discomfort ____

• knee ____/____ feeling

• ____ and ____ trust during stance phase of gait

posterolateral, standing, hyperext, giving out, hyper ext, varus

special tests for posterolateral rotatory instability

posterolateral drawer, dial test, ER recurvatum test, reverse pivot shift

conservative Tx for posterolateral rotatory instability

• good outcomes with grade ___

• poor outcomes with grade ____

I and II, III

if ACL/PCL repair without posterolateral corner repair 

• increased force on ____ 

• ____ knee stability 

graft, decreased 

surgical tx of posterolateral rotatory instability

• ____ and ____ 6 wks

• ____ recovery

NWB, immobilizer, slow

patellofemoral instability leads to patellar ____/____, almost always ____ direction

dislocation, subluxation, lateral

risk factors for patellofemoral instability

• small ____

• shallow ____

• abnormal ____

• ____ imbalance

• generalized lig ____

• race

• ____ episodes

patella, trochlear groove, patellar position, muscular, laxity, prior

patellofemoral instability can be treated ____, but ____ tx for repeat instances 

conservatively, surgical 

surgery for repeat instances of patellofemoral instability

medial patellofemoral ligament reconstruction with or without Fulkerson osteotomy

medial patellofemoral ligament reconstruction: secure ____ to ____ and the _____ to resist ____

graft, patella, medial femoral condyle, lateral excursion

fulkerson osteotomy: move ____ more _____

tibial tubercle, medially

post op medial patellofemoral ligament reconstruction:

• _____

• ____ for quad activation

• no ____ patella glides

• return to sport ___-___ mo

• no ____ of graft site for 8wks

WBAT, NMES, lateral, 4.5, 9, isolated strengthening

post op medial patellofemoral ligament reconstruction and fulkerson medial posteotomy

• ____ x6 wks immobilization 

• same as ____

• no ____ strengthing for 4 wks 

• goal: full knee ___ and ____ activtion for func mobility 

NWB, MPLR, OKC strengthening, extension, quad 

articular cartilage lesion: ____ damage to ____

focal, articular cartilage

most common location of articular cartilage lesion

medial femoral condyle and patella

articular cartilage lesion MOI: ____ traume or ____ trauma

acute, repetitive minor

clinical presentation of articular cartilage lesion

• ____ if following acute trauma associated with osetochondral fx

• ____ onset

• pain aggravated by ____

• intermittent ____/____

• Hx ____ or locking

• possible ____ tenderness

hemarthrosis, insidious, repetitive impact, pain, swelling, catching, joint line

diagnosis of articualr cartilage lesion is typically done with ___ or ____

MRI, arthroscope 

articular cartilage lesion Tx considerations

• size of ____ and type of ____

• protection of ___ or ____ tissue

• usually significant ____ and ____ restrictions

lesion, surgery, graft, healing, ROM, WB

surgical treatment of articular lesion (3 types)

microfracture, osteochondral autograft transfer, autologous chondrocyte

articular cartilage lesion - microfracture 

• for ____ lesions 

• small ____ in subchondral bone 

• allows ____ formation (weaker than ____) 

• RTS ___-___ mo 

full thickness, holes, fibrocartilage, hyaline, 8, 9 

articular cartilage lesion - osteochondral autograft transfer

• plug of ____ healthy cartilage, bone is harvested from ____ portion of joint

• RTS ____-____ mo

• healing time is ____

pts own, NWB, 7, 10, slow

ideal candidate for osteochondral autograft transfer: _____, ____ demand pt with unifocal femoral condyle lesion

young, high

autologous chondrocyte implantation for articular cartilage lesion

• small patch of ____ is harvested

• chrondrocytes are ____ in lab

• ___-___ wks later, chrondrocytes are reintroduced

• RTS ___-___ mo

articular, multiplied, 6, 8, 14, 18