521 Traumatic Knee

change in speed (acceleration/deceleration)

- hyperextension

- Varus/valgus forces

- anterior tibial movement

- femoral IR

Common MOI for ACL tear

plant and twist

Common MOI for meniscal tear

meniscal tear, osteochondral injury

catching, clicking, or locking in the knee often indicate what type of traumatic knee diagnoses?

ACL tear

80% of the time, when individuals experience this traumatic knee injury, they will be able to describe the feeling of something tearing

9

MCID for LEFS

LEFS, KOOS, IKDC

questionnaires used for knee

Observation

Hip A/PROM + overpressure

Ankle A/PROM + overpressure

Components of the regional trauma screen for the knee

palpation, special tests

Components of the local trauma screen for the knee

1. Age 55+

2. Isolated patellar tenderness

3. Tenderness of the fibular head

4. Inability to flex knee 90º

5. Inability to bear weight immediately after injury AND in ER (4 steps)

Ottawa knee rules indicate the need for a radiograph if the patient has ANY of the following after trauma:

rule out

Ottawa knee rules are used to rule in or rule out a fracture?

acute fall/blunt trauma + inability to ambulate

The Pittsburg Decision Rule indicates that a radiograph is required only for:

Younger than 12, older than 50

What ages is the pittsburg decision rule more specific to?

ACL/PCL/LCL/MCL tear

Meniscal tear

Dislocation/Sublux

Patellar tendon rupture

common traumatic diagnoses of the knee

meninscal tear

which of the common traumatic diagnoses of the knee can be either acute or degenerative?

lateral femoral condyle to the tibial plateau eminence

attachments of the ACL

anteromedial, posterolateral

2 bundles of the ACL

extension

the anteromedial bundle of the ACL is tightest in what knee position?

flexion

the anteromedial bundle of the ACL is tightest in what knee position?

genicular arteries

arterial supply to the ACL

anterior drawer test, lachman test, Lever's test, pivot shift

Special tests for ACL

anterior drawer: laxity (compared to other side

lachman test: laxity (compared to other side

Lever's test: heel doesn't pop up

Pivot test: clunking

positive test criteria for the ACL special tests

knee extension and tibial IR to quick knee flexion

pivot test position when testing the ACL

ruling in

are the special tests for the ACL better for ruling in or ruling out?

lateral

which meniscus is typically thicker

genicular arteries

arterial supply to the meniscus

ACL

what other structure is often torn along with the menisci

joint line tenderness at tibial plateau, locking, clicking

common symptoms of meniscus tears

Thessaly test, McMurray's test , Joint line palpation, Appley's test

special test for meniscus tears

Thessaly: pain

McMurray: pain

Joint Line palpation: pain

Appley's: pain increases with first part, decreases with second part

positive test criteria for meniscus tears

tibia IR + valgus force + knee flexion → extension

AND

tibia ER + varus force + knee flexion → extension

How do you perform the McMurray test?

20-30º

at what knee angle is the Thessaly test best performed at?

- McMurry + Joint line palpation

- Thessaly + Joint line palpation

Diagnosis of meniscus tears can be reinforced by what special test combinations?

rulign in

are the special tests for the meniscus better for ruling in or ruling out?

MCL

band of connective tissue from the medial femur to the tibia

LCL

band of connective tissue from the lateral femur to the fibula head

valgus

MCL resists what forces?

varus

LCL resists what forces?

1: minimal ligament damage, like a mild stretch, and associated with some pain. not tons of laxity

2: partial tear, causing some instability. still has firm end feel, but more tissue are fraying

3: complete tear, resulting in instability and loss of function

grades of MCL/LCL tears

varus/valgus stress tests

special tests for MCL/LCL tears

ruling out

are the special tests for MCL/LCL tears better for ruling in or ruling out?

posterolateral, anteromedial

2 bundles of the PCL

PCL

connects the medial epicondyle to the posterior tibial plateau

genicular artery supply

arterial supply to the PCL

flexed knee with PF foot, MVA accident

common mechanism of injury for PCL

posterior drawer test, sag sign, gravity sign, reverse pivot shift

special tests for PCL

ruling in

are the PCL special tests better for ruling in or ruling out?

tibial ER into knee flexion

position for reverse pivot shift in PCL testing

MCL, medial meniscus, ACL

the unhappy triad

lateral

most common direction for patellar dislocation

moving apprehension

special tests for patellar instability/dislocation

ruling out

is the moving apprehension test better for ruling in or ruling out

20-30º

what is the knee angle for the moving apprehension test

patellar tendon rupture

what is the likley diagnosis

significant pain, obvious deformity, superiorly displaced patella in extension

tell tell signs of patellar tendon rupture

getting a baseline for the injured knee (ROM, MMT [quads])

in the local exam after a trauma eval, what are some important steps to take on day 1

swelling and pain control, begin restoring knee F/E ASAP, education, heel slides, knee pull-backs, quad sets

after a trauma eval, what are some important intervention options to take on day 1

restore weight bearing, bracing, OKC and CKC strengthening, regional limitations, stability, valgus/varus correctives, jumping & landing correctives

after a trauma eval, what are some other important interventions to consider (after some progression)?