3- soft tissue knee injuries

Question 1

what are some examples of soft tissue knee injuries?

Answer 1

1. meniscal tears
2. medial collateral ligament tears
3. lateral collateral ligament tears
4. ACL tear
5. PCL tear
6. knee dislocation
7. patellar dislocation
8. extensor mechanism rupture (patellar or quadriceps tendon)
9. osteochondritis dissecans

Question 2

what is typical presentation of traumatic meniscal tear?

Answer 2

young sporty person (more likely medial meniscal than lateral meniscal tear)
- they have pain & tenderness localised to joint line, +ve steinman’s test

history = sudden sharp pain after getting up squatting, often twisting injury

Question 3

what extra symptom of meniscal tear suggests bucket handle meniscal tear?

Answer 3

acutely locked knee = found from heel height testing clin exam

• it’s a relative emergency as locked knee means bit of meniscus cartilage floating about locking knee

Question 4

what are 4 types of traumatic meniscal tear?

Answer 4

1. longitudinal (will heal is peripheral)
2. radial (won’t heal as menisci mostly avascular especially middle)
3. bucket handle tear (big cut out looking like bucket handle)
4. parrot beak tear

Question 5

what often happens after degenerative meniscal tear?

Answer 5

it’s pretty common, often one of 1st signs of OA as meniscal shock absorbers worn down which puts pressure on bone and other bits - in old people

Question 6

is there pain in degenerative meniscal tear?

Answer 6

sometimes yes, sometimes no
- it usually comes from secondary effects like bone marrow oedema or synovitis (due to OA)
- pain often settles with time and can use NSAIDs

Question 7

what instability does MCL, ACL and PCL rupture lead to?

Answer 7

MCL = valgus instability
ACL = rotatory instability
PCL = recurrent hyperextension or instability of descending stairs

Question 7

what are grades of ligament injuries?

Answer 7

grade 1 = sprain
grade 2 = partial tear
grade 3 = complete rupture

Question 8

what is MCL injury management?

Answer 8

brace them, early movement, physio ( to strengthen muscle)
= good blood supply to medial collateral ligaments so no surgery needed, pain can last a while though

Question 9

what is common presentation of ACL injury?

Answer 9

football injury, twist, pop, haemarthrosis, generalised pain, pain settles after few days, rotator instability

*haemarthrosis = bleed into joint, swollen up (causes pain)

Question 10

what is management of ACL?

Answer 10

rehab for 3 months to a year, some people never fully get back to sport, pain for a long time, inevitable arthritis within 10yrs

• sometimes surgery to reconstruct ligaments

Question 11

what is management of LCL injury?

Answer 11

uncommon - LCL doesn’t have good blood supply so needs surgery

Question 12

why is knee dislocation so serious?

Answer 12

lots of complications - popliteal artery injury, nerve injury, compartment syndrome

= surgical emergency to fix blood supply

Question 13

how to treat patellar dislocation?

Answer 13

physio (it’s common, from rapid turn or direct blow)

Question 14

what is patellofemoral pain syndrome? treatment?

Answer 14

= common, general term to describe pain in front of knee

• idiopathic
• may be due to muscle imbalance, tightness of lateral tissues, bony malalignment (valgus or internal rotation), flat foot

treatment = physio

Question 15

what is extensor mechanism rupture? how is it diagnosed?

Answer 15

= patellar tendon or quadriceps tendon injury

= found from straight leg raise (can’t do it) - sometimes can palpate gap too

Question 16

what are risk factors for extensor mechanism rupture?

Answer 16

previous tendinitis, steroids, chronic renal failure, ciprofloxacin
(then caused by fall on flexed knee with quad contraction)

Question 17

what is osteochondritis dissecans?

Answer 17

= cracks in articular cartilage

= atraumatic defect

= vague condition, vague symptoms or asymptomatic →poorly localised pain, some have effusion, don’t know what causes

Question 18

what is the major source of meniscal tear or ligament injury?

Answer 18

when bones impact on each other causing micro scapular fracture of trabeculae then bleeding & inflammation because of it
- can take long time (3 months to year) to settles

Question 19

what can lock knee?

Answer 19

loose cartilage body, synovium can nourish loose body so it can grow and cause painful locking

Question 20

what is done for treatment of knee osteoarthritis?

Answer 20

start conservative →painkillers, weight loss, exercise (maintains muscle strength & nourishes cartilage). can give steroid injection in flare ups (not too many, 3 a year)

could then consider surgery = for end stage arthritis with severe constant pain, sleep disturbance, limiting function, frequent flare ups (knee replacement won’t help stiffness or movement much)

Question 21

what structure is most likely injured if lateral blow to knee?

Answer 21

medial collateral ligaments

Question 22

what ligament of ankle is most injured if inversion of ankle?

Answer 22

anterior talofibular ligament (part of lateral complex)