Acetabular labral tear; ACL injury; Bicep tears; Meniscal tears Flashcards
Describe where the acetabulam & acetabulam labrum is and their function [2]
The acetabular labrum is a cartilaginous ring which encompasses the acetabulum, deepening the socket and subsequently increasing the stability of the hip joint.
Describe what happens in an acetabular labral tear [1]
results from damage to the cartilage that makes the acetabular labrum, most commonly occurring on the anterior aspect
What are the cardinal features of acetabular labral tears? [3]
The cardinal clinical features of acetabular labral tears are hip pain, locking and instability:
- Pain is felt in the groin/hip region: specifically in the anterior hip or groin region.
- Clicking, locking, catching and giving way of the hip
The two main diagnostic investigations for acetabular labral tears are [2]?
MR-arthrogram
* An MRI scan combined with injecting contrast direct into the hip joint.
Diagnostic laparoscopy
* The gold standard definitive investigation.
Describe the treatment for acetabular labral tears [3]
Physiotherapy:
Medical management:
- NSAIDs
- Intra-articular steroid and local anaesthetic injections
Surgery:
- Hip arthroscopy is the surgical management of choice for acetabular labral tears: debridement or repair
Describe the role of the ACL in the knee
Key stabilising structure within the knee joint:
- preventing excessive anterior translation and rotational movement of the tibia relative to the femur
Draw the ligaments of the knee [5]
What caueses an ACL injury? [1]
ACL injuries typically occur due to a sudden change in direction, deceleration, or landing from a jump with an extended, twisted, or hyperextended knee
The majority of ACL injuries occur without contact and result from a sudden change of direction twisting the flexed knee.
Desribe the clinical presentation of an ACL injury [3]
Acute onset of pain
- severe and local to knee joint
- hear a pop at time of injury
Swelling
Instability:
- knee ‘gives way’
50% of ACL tears will also have a [] tear, with the [] the more commonly affected
50% of ACL tears will also have a meniscal tear, with the medial meniscus the more commonly affected
Describe which clinical tests you can perform to test an ACL injury [2]
Anterior drawer test:
- Increased anterior translation, along with a soft or absent endpoint, suggests an ACL injury
Lachman test:
- patient is positioned supine with the knee flexed to 20-30 degrees
- The examiner stabilizes the femur with one hand and grasps the proximal tibia with the other hand
- The tibia is then pulled anteriorly while stabilizing the femur
- Increased anterior translation and a soft or absent endpoint compared to the contralateral side indicate an ACL injury.
NB: The Lachman test is considered more sensitive and specific than the anterior drawer test for detecting ACL injuries
[] is the gold standard for diagnosing ACL injuries
Magnetic resonance imaging (MRI) is the gold standard for diagnosing ACL injuries
How would you differentiate ACL to meniscal injury:
- based off the history [1]
- based off the symptoms [1]
- clinical test [1]
meniscal tears are typically associated with a twisting injury or direct impact to the knee while it’s flexed and weight-bearing.
Meniscal injuries classically have a ‘locking’ of the knee joint
A positive McMurray’s test - characterised by pain or a palpable click during flexion and rotation of the knee - is suggestive of a meniscal tear.
https://litfl.com/mcmurray-test/ for video
How do you differentiate ACL injury to patellar dislocation? [1]
patients with patellar dislocation typically report a visible deformity or ‘shifting’ of the kneecap which is not seen in ACL injuries.
Surgical management for ACL injury? [1]
ACL reconstruction: Autograft (using the patient’s own tissue) or allograft (using donor tissue) is used to replace the torn ACL.
ACL repair: In select cases, such as proximal avulsion tears with preserved tissue quality, primary ACL repair may be performed.