ACL, PCL and meniscal tear Flashcards
1
Q
Clinical features of ACL tear
A
- Twisting knee while weight bearing
- Without contact
- Unable to weight bear
- Rapid joint swelling
- Significant pain
- Laxity in Lachman/Anterior drawer test
2
Q
What causes rapid joint swelling in ACL tear?
A
- Highly vascular ligament
- –> haemoarthrosis
- Clinically apparent within 15-30mins
3
Q
Lachman test
A
More sensitive than ADT
4
Q
Differentials for ACL tear presentation
A
- Tibial plateau #
- Distal femoral #
- Meniscal tear
- Collateral ligament injury
- Quadriceps tendon injury
5
Q
Imaging for ACL tear
A
- AP and lateral X-rays
- MRI scan of knee - GOLD STANDARD - confirm and pick up any meniscal tears additonally
half of ACL tears have meniscal tear too
6
Q
Fracture that suggests ACL tear
A
- Segond fracture
- Bony avulsion of lateral proximal tibia
7
Q
Immediate management ACL tear
A
- RICE - rest, ice, compression, elevation
- Can apply cricket pad knee splint for comfort
8
Q
two options for ACL management
A
- Dependent on current levels of activity and suitability for surgery
- Conservative vs surgical reconstruction
9
Q
Conservative management ACL
A
- Rehabilitation
- Strength training quadriceps to stabilise knee
- Use cricket pad knee splint for comfort - rarely need admissio
10
Q
Surgical management ACL
A
- Surgical reconstruction - following a period of pre-rehabilitation, physio prior to surgery, autograft or allograft
- Acute surgical repair - depends on location of tear in ligament - GA knee arthroscopy, resuture ends together
Auto - from self, allo - from someone else
11
Q
Why is timing of swelling important in knee injuries?
A
- Haemoarthrosis vs post traumatic effusion
- Rapid = haemoarthrosis often associated with ruptured cruciate or # bone within joint capsule
- Slower = reactive synovitis - meniscal or chondral pathology
12
Q
PCL injury mechanism
A
- High energy trauma
- Eg direct blow to proximal tibia during RTA
- OR can be low energy when hyperflexed knee and plantarflexed foot
13
Q
Clinical features PCL tear
A
- Immediate posterior knee pain
- Instability of joint - +ve posterior drawer test
14
Q
Imaging PCL
A
- MRI - gold standard
15
Q
Management PCL tear
A
- Conservative
- Knee brace and physio
- If continues to be symptomatic and recurrent instability may require surgery with insertion of graft
If associated with other injuries then specialist knee surgery needed