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MSK Week 4 2017/18 > 3: Soft tissue injuries of the knee > Flashcards

3: Soft tissue injuries of the knee Flashcards

1
Q

Name six important soft tissue structures of the knee which must be considered when talking about knee injuries.

A

Medial and lateral menisci

Medial and lateral collateral ligaments

Anterior and posterior cruciate ligaments

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2
Q

What are the prominences of the femur and tibia which articulate with the menisci?

A

Medial and lateral condyles

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3
Q

What is the area between the tibial condyles called?

A

Intercondylar region

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4
Q

The menisci only have a ___ blood supply, so central tears tend not to heal.

A

peripheral

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5
Q

Compare the mobility of the medial and lateral menisci.

A

Medial meniscus is fixed

Lateral meniscus is mobile

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6
Q

Which menisci is under more stress - medial or lateral?

A

Medial meniscus

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7
Q

What sort of stresses do the

a) MCL
b) LCL
c) ACL
d) PCL ligaments resist?

A

a) Valgus stress

b) Varus stress

c) Internal rotation and tibial anteversion

d) Hyperextension of knee

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8
Q

What sorts of instability result from tears of the

a) MCL
b) ACL
c) PCL?

A

a) MCL tear - valgus instability

b) ACL tear - rotatory instability

c) PCL tear - recurrent hyperextension, difficulty descending stairs

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9
Q

What sort of meniscal tear produces locking of the knee?

A

Bucket handle meniscal tear

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10
Q

50% of patients with an ACL rupture will also have a ___ tear.

A

meniscal

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11
Q

Are medial or lateral meniscal tears more common?

A

Medial tears x10 more common than lateral ones

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12
Q

What is the name for a surgical removal of all or part of a torn meniscus?

A

Menisectomy

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13
Q

If a locked knee isn’t resolved, what may the patient develop?

A

FFD

(fixed flexion deformity)

stiffening of the joint and muscles, inability to flex properly

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14
Q

Is there any evidence to show that operating on degenerative meniscal tears bears any benefit?

A

No, compared to placebo there’s no difference

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15
Q

What are the grades of ligament injury and what do they describe?

A

Grade I - sprain - some fibres torn, but overall structure is fine

Grade II - partial tear - some fascicles torn

Grade III - total tear

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16
Q

How is the MCL usually torn?

What is the outcome of treatment (bracing, early motion, physio)?

A

Extreme valgus stress e.g slide tackle in sport

Outcome usually good, tear resolves itself

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17
Q

How is the ACL ruptured?

A

Extreme internal rotation

usually during sport

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18
Q

Can the ACL be repaired?

A

No, only reconstructed

19
Q

By which three means can the ACL be reconstructed?

A

Autograft - from same patient - Achilles tendon, hamstrings

Allograft - from someone else / a cadaver - Achilles tendon

Synthetic graft (not common)

20
Q

Can people compensate for ruptured ACLs without surgery?

A

Yep

some do fine, some have to give up sport

21
Q

ACL runs from ___ to ___.

(medial , lateral)

A

lateral to medial

22
Q

The PCL runs from ___ to ___.

A

medial to lateral

23
Q

What is the only purpose of ACL reconstruction?

A

Regain rotatory stability

no impact on pain or OA risk

24
Q

What is a common consequence of ligament injury in the knee?

A

More rapid onset of OA

25
Q

How is the LCL ruptured?

A

Hyperextension and varus stress

26
Q

Does the LCL resolve in a way similar to the MCL?

A

No, doesn’t heal

may need urgent repair or reconstruction

27
Q

How may the PCL be ruptured?

A

Direct blow to the anterior tibia or hyperextension

e.g dashboard or motorbike collision

28
Q

Where may pain be felt following a PCL rupture?

A

Popliteal area

29
Q

In which situations would patients with a PCL rupture feel unsteady?

A

DESCENDING stairs (extension of knee)

Any situation requiring knee extension

30
Q

Which tests can be used to assess the condition of the ACL and PCL?

A

ACL - Lachman test

PCL - posterior drawer test

31
Q

What are some consequences of a severe knee dislocation?

A

Multi-ligament tear/rupture

Neurovascular compromise

32
Q

A rapid turn or direct blow to the ___ can cause it to dislocate.

A

patella

33
Q

Does the patella usually dislocate medially or laterally?

A

Laterally

34
Q

A significant proportion of patellar dislocation patients will have (one / recurrent) dislocations.

A

recurrent dislocations

35
Q

Which group of structures, responsible for extension of the leg, can be ruptured by a blow to the flexed knee?

A

Extensor mechanism

36
Q

Give a possible mechanism of injury for the following:

a) ACL rupture
b) PCL rupture
c) MCL tear
d) LCL tear
e) Meniscal tear

A

ACL rupture - internal rotation (a twisting injury)

PCL rupture - dashboard / hyperextension injury

MCL tear - valgus stress

LCL tear - varus stress

Meniscal tear - twisting injury, rising from a squat

37
Q

A pop indicates what sort of injury?

A

Ligament tear, likely ACL

38
Q

A crack indicates what sort of injury?

A

Fracture

39
Q

What is a haemarthrosis?

What accompanies it?

A

Blood and synovial fluid

Hideous pain

40
Q

In which sort of knee injuries would you see a haemarthrosis?

A

ACL rupture or fracture

41
Q

In which sort of knee injury would you see a generalised effusion?

A

Meniscal tears, cartilaginous injuries

42
Q

A Sunday league footballer has suffered a twisting injury on the pitch. He recalls a loud pop, swelling around his knee and horrendous, generalised knee pain. The pain settled after a few days. He now notes that his knee gives way if he rotates on it too quickly.

What knee injury has he suffered?

A

ACL rupture

43
Q

A weightlifter was squatting when she noticed sudden sharp medial knee pain and associated swelling. The pain returns periodically. She has noticed that her knee “catches” and occasionally locks up when she extends it.

What injury does this describe?

A

Meniscal tear

MSK Week 4 2017/18 (10 decks)

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