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Trauma + Orthopaedics > 2: Joint Disorders Of The Knee > Flashcards

2: Joint Disorders Of The Knee Flashcards

1
Q

How will OA of the knee present

A
  • Functionally-limiting knee pain
  • Worse on walking downstairs
  • Presents with ‘locking’ sensation of the joint
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2
Q

What causes meniscal tear

A

rotational injuries

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3
Q

What is a sign of meniscal injury

A

pain on palpating over the joint line

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4
Q

How will a MCL tear present

A

‘pop’ at the time of injury

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5
Q

What age group does Osgood-Schlatter disease occur

A

15-19y

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6
Q

How will Osgood-Schlatter disease present

A

anterior knee pain

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7
Q

What causes IT band syndrome

A

repeated flexion and extension of the knee

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8
Q

How will IT band syndrome present

A

lateral knee pain

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9
Q

How will patellofemoral pain syndrome present

A

anterior knee pain worse on ascending and descending the stairs

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10
Q

what is OA of the knee

A

degeneration of articular cartilage

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11
Q

what is the commonest form of OA

A

knee

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12
Q

in which gender is OA of the knee more common

A

female

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13
Q

how does the incidence of knee OA vary with age

A

increases with age

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14
Q

how can the aetiology of knee OA be divided

A

primary vs. secondary

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15
Q

what is primary knee OA

A

OA of the knee with no underlying cause

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16
Q

what is secondary knee OA

A

OA of the knee secondary to an underlying cause

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17
Q

what are 4 causes of secondary knee OA

A
  • Genus valgum
  • Genus varum
  • Meniscal tears
  • Cruciate ligament rupture
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18
Q

what are 5 modifiable risk factors of knee OA

A
  1. Occupation (repetitive bending/extension knee)
  2. Muscle weakness
  3. trauma
  4. Obesity
  5. Metabolic syndrome
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19
Q

what are 3 non-modifiable risk factors of knee OA

A
  1. Age
  2. Female
  3. Fhx
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20
Q

what are the symptoms of knee OA

A
  • Function-limiting pain
  • Worse on walking downstairs
  • Locking and catching sensation of the knee
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21
Q

how do you differentiate knee from hip OA

A

Knee OA is worse on walking downstairs

Hip OA is worse on walking upstairs

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22
Q

what sign is positive in knee OA

A

Patella apprehension test

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23
Q

briefly explain the pathophysiology of knee OA

A

‘wear and tear’ causes degeneration of the cartilage. This increases friction between bones resulting in inflammation due to TNFa, IL1 and IL6

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24
Q

What is the criteria to be able to diagnose knee OA clinically

A
  1. > 45y
  2. Activity-related joint pain
  3. No morning stiffness (or morning stiffness less than 30m)
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25
Q

What investigation may be used in knee OA

A

X-ray

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26
Q

What are signs of OA on x-ray

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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27
Q

What is first stage in management of knee OA

A

Conservative management

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28
Q

What conservative measures can be offered for knee OA (WETT)

A

Weight loss
Exercise + manual therapy
Thermotherapy
TENS

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29
Q

What is second line for knee OA

A

Oral Paracetamol or Topical NSAIDs. If ineffective, short-course oral NSAIDs with PPI

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30
Q

What is 3rd line for knee OA

A

Intra-articular corticosteroids

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31
Q

What is 4th line for knee OA

A

Surgery

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32
Q

What are the 3 types of surgery that can be offered for knee OA

A
  1. High tibial osteotomy
  2. Unicompartmental knee arthroplasty
  3. Total knee arthroplasty
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33
Q

What is a high tibial osteotomy

A

Re-aligns the leg by transferring body weight to unaffected lateral compartment

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34
Q

what are the indications for high-tibial osteotomy

A

Younger patient with isolated medial compartment unicompartmental disease

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35
Q

what is a unicompartmental knee arthroplasty

A

The portion of the femur and tibia/fibula in that compartment is replaced

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36
Q

when is a unicompartmental knee arthroplasty indicated

A

isolated disease to a single compartment

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37
Q

what is a total knee arthroplasty

A

a cap is placed over the end of the femur and tibia + fibula

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38
Q

what are the indications of total knee arthroplasty (TKA)

A

symptomatic knee OA

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39
Q

What is a meniscal tear

A

tear of the lateral and medial meniscus which lie between fibula and tibia (respectively) and the femur

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40
Q

Is the medial or lateral meniscus more frequently torn and why

A

medial - due to its relative immobility

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41
Q

How are meniscal tears first classified

A

whether the lateral or medial meniscus is affected

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42
Q

After establishing if they are medial or lateral, how are they classified

A

location of the tear within the meniscus

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43
Q

What is a ‘white’ tear

A

tear that occurs in the inner 1/3

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44
Q

Why is the inner 1/3 termed a ‘white tear’

A

as there is a poor blood supply (it is relatively avascular)

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45
Q

What is a white-red tear

A

tear in middle 1/3

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46
Q

What is the vascularisation of a white-red tear

A

poorly vascularised

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47
Q

what is a ‘red’ tear

A

tear in outer 1/3

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48
Q

what is the vascularisation of the outer 1/3 of the meniscus

A

highly vascularised

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49
Q

what is the third way to classify meniscal tears

A

type of tear

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50
Q

what are the two aetiologies of meniscal injury

A

degenerative or traumatic

51
Q

in which patients do traumatic meniscal tears occur

A

younger, active patients

52
Q

what causes traumatic meniscal tears

A

rotational injuries with axial loading

53
Q

what patients does degenerative injury of the menisci occur

A

older patients

54
Q

what causes degenerative injury of the menisci

A

caused by continuous work in a squatting position

55
Q

how will meniscal injury present

A
  • Pain on weight bearing

- Delayed knee effusion

56
Q

what movement will be limited in meniscal injury

A

Extension of the knee

57
Q

what is a sign of meniscal injury

A

Tenderness over the medial or lateral joint line

58
Q

what may a meniscus cause if it obstructs knee movement

A

‘locking’ sensation of the knee

59
Q

if the ‘red zone’ of the meniscus is injured what type of knee effusion is It

A

Haemoarthrosis

60
Q

If the ‘white zone’ of the meniscus is injured what type of knee effusion is it

A

Serous effusion

61
Q

What are two tests for meniscal injuries

A
  1. Appley’s

2. Mcmurray’s

62
Q

what its he unhappy triad

A

Pattern of injury that occurs on lateral ‘blow’ to the knee

63
Q

what is injured in the unhappy triad

A
  1. Meniscal tear
  2. MCL tear
  3. ACL tear
64
Q

explain why the medial meniscus is more commonly injured

A

The medial meniscus is ‘half-moon’ shaped. It is immobile and attached to the MCL. It is therefore not protected from shearing forces on internal rotation.

65
Q

explain why the lateral meniscus is not commonly indicated

A

Lateral meniscus is mobile, it easily dissipates sharing forces. It is protected during internal rotation by the cruciate ligament

66
Q

what is first-line investigation of meniscal tear

A

MRI

67
Q

if MRI is contraindicated, what investigation may be performed

A

Arthroscopy

68
Q

what is first-line management of meniscal tear

A

Conservative: ‘P.OL.I.C.E’ and NSAIDs

69
Q

what is surgical management of meniscal tears

A

Arthroscopy

70
Q

when is arthroscopy for meniscal injury indicated

A
  • Persistent disabling symptoms
  • Functional limitation
  • Complex tears
71
Q

what are 2 complications of meniscal tears

A

Secondary OA

Baker’s cysts

72
Q

What causes MCL ligament sprain

A

Excessive valgus stress

73
Q

What is the most common ligamentous injury

A

MCL sprain

74
Q

In which gender is MCL sprain more common

A

Females

75
Q

What are 3 causes MCL sprain

A
  1. Ski-ing with valgus stress
  2. Lateral blow to the knee from contact sports
  3. excessive valgus stress (often with slight flexion and external rotation)
76
Q

what is a RF for MCL injury

A

Althetes

77
Q

How will MCL injury present clinically

A

‘popping’ sensation, followed by knee swelling and ecchymosis

78
Q

Which injury is MCL sprain often associated with

A

tear of medial meniscus

79
Q

What are 3 signs of MCL sprain

A
  • pain on palpating over medial joint line
  • increased medial joint laxity
  • positive valgus stress test
80
Q

What is the unhappy triad

A

series of injures caused by traumatic lateral blow to the knee

81
Q

what injuries comprise the unhappy triad

A

MCL tear
ACL tear
Medial Meniscus tear

82
Q

what is the physiological action of the MCL

A

Prevents excessive valgus stress

83
Q

how are suspected MCL sprains investigated

A

MRI

84
Q

how is the severity of MCL injuries assessed

A

‘Grading’

85
Q

what is a grade I MCL tear

A

Small tears and stress of MCL

86
Q

what is grade II MCL tears

A

Larger, but incomplete tear

87
Q

what is grade III MCL tears

A

Complete tears

88
Q

what is first-line management for grade I MCL tears

A

NSAIDs

89
Q

what is first-line management for grade 2 and 3 MCL tears

A

NSAIDs and Bracing

90
Q

what is second-line management for MCL tears

A

Surgery

91
Q

what are the two types of MCL surgery

A
  1. Ligament repair

2. Ligament reconstruction

92
Q

what are the indications for ligament repair

A
  • Multiple ligamentous injury

- Instability despite conservative management

93
Q

what are the indications for ligament reconstruction

A
  • Chronic injury

- Insufficient tissue for repair

94
Q

What is osgood schlatter’s disease also referred to as

A

tibial apophysitis

95
Q

what causes osgood schalatter’s disease

A

over-use of the quadriceps muscle during periods of growth causing traction apophysitis of the patella tendon on its insertion of the tibial tuberosity.

96
Q

which age-group does osgood schlatter’s disease tend to occur

A

9-15y

97
Q

in which gender is osgood schlatters (tibial apophysitis) more likely to occur

A

male (3:1)

98
Q

what causes osgood schlatter’s disease

A

over-use of quadriceps tendon by running and jumping activities during ossification period (adolescence)

99
Q

how will osgood schlatter’s disease present clinically

A
  • anterior knee pain worse on activity

- proximal tibial swelling

100
Q

how can pain of osgood schlatter’s disease be reproduced in a clinical setting

A
  • pain will be reproduced on extension against resistance
101
Q

what type of structure is the tibial tuberosity

A

apophysis

102
Q

what is an apophysis

A

bony structure where tendon inserts

103
Q

what attaches to the tibial apophysis

A

patella ligament

104
Q

explain development of the tibial tuberosity

A

the tibial epiphysis consists of cartilage, with a primary ossification centre inside. It starts to ossify at 9-15y, forming tuberosity at 18y.

105
Q

why does tibial apophysitis occur between 9-15y

A

During 9-15y the tibial tuberosity has not ossified yet and hence is too weak to resist traction from the patella ligament (on repetitive movement) causing traction apophysitis

106
Q

how can osgood schlatter’s disease be diagnosed

A

USS

107
Q

how is osgood schlatter’s disease treated

A

Conservative - Ice, reduced physical activity, strengthening and stretching of the quadriceps

108
Q

what is the prognosis of osgood schlatter’s disease

A

Often resolves when bone maturity is reached

109
Q

Where does the IT band attach

A

Lateral femoral condyle

110
Q

What is IT band syndrome

A

Inflammation of the IT (illio-tibial) band caused by friction against lateral femoral condyle

111
Q

What is the epidemiology of IT band syndrome

A

Common injury. Most common in endurance athletes

112
Q

What causes IT band syndrome

A

Repetitive flexion and extension of the knee (eg. cycling, running)

113
Q

How will IT band syndrome present

A
  • Sharp pain in lateral knee when the foot strikes the ground
  • Dull ache at rest
114
Q

What test can be used for IT band syndrome

A

Noble’s test

115
Q

Explain Noble’s test

A

Patient lies on their side. Examiner flexes the leg with thumb over the lateral femoral condyle. Positive if pain is elicited

116
Q

Explain the pathophysiology of IT band syndrome

A

Over-use injury due to repetitive flexion and extension of the IT band. Thought to occur due to underlying weakness in the abductors.

117
Q

What is the IT band

A

Thickened band of fascia that is comprised of fibrous tissue from the tensor fascia lata and gluteus maximus. It projects from lateral thigh and inserts onto portion of tibial plateau termed Gerdy’s tubercle

118
Q

How is IT band syndrome diagnosed

A

Clinically (/diagnosis of exclusion)

119
Q

How is IT band syndrome managed

A

Conservative - rest, NSAIDs, physiotherapy

120
Q

What is the prognosis of IT band syndrome

A

40-80% of cases resolve in 4-8W

121
Q

What is patellofemoral pain syndrome

A

generalised knee pain over the patella or surrounding area

122
Q

What causes patellofemoral pain syndrome

A
  • trauma
  • muscle weakness
  • malorientation of the patella
123
Q

How does patellofemoral pain syndrome present

A

Anterior knee pain worse on ascending and descending the stairs

124
Q

Which structure is most likely to be damaged during a total knee arthroplasty

A

The common peroneal nerve

Trauma + Orthopaedics (11 decks)

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