Acute injuries of the knee

Question 1

List 5 possible pathologies of the knee

Answer 1

fracture 
tendon injury 
meniscal tear 
ligament injury 
acute on chronic degenerative joint disease

Question 2

Important questions in the history for environment, activity and energy

Answer 2

sports - workplace - how fast - how heavy - sports tackle - jumping

Question 3

Chronology questions in history

Answer 3

quick or slow onset

previous injury or event

Question 4

Other questions in the history

Answer 4

hear or feel a pop or crack
swelling - early or late?
systemic symptoms

Question 5

early swelling in a knee indicated what?

Answer 5

haemarthrosis

Question 6

history of a meniscal injury

Answer 6

twisting movement on a loaded fixed knee 
"locked knee"
painful squelch 
slow swelling - quicker in young 
painful to weight bear

Question 7

history of an ACL tear

Answer 7

forward momentum, leg fixed +/- rotation
“pop”
quick swelling
often able to weight bear

Question 8

History of collateral tears

Answer 8

lateralised pain
feel of crack, sharp pain
no or minimal effusion
bruising to 1 side

Question 9

4 things to look for when examining the knee

Answer 9

scars, bruising, swelling, joint line irregularity

Question 10

process of examining a joint

Answer 10

look, feel, move

Question 11

5 things to feel for in joint examination

Answer 11

crepitus 
tissue lumps or defects 
heat
effusion 
tenderness

Question 12

5 techniques of movement in joint examination

Answer 12

active and passive 
range of movements 
straight leg raise 
dynamic testing 
ligament testing

Question 13

3 imaging modalities used

Answer 13

x-ray, USS and MRI

Question 14

List some things x-rays are good at picking up

Answer 14

fracture-loose bodies - lipohaemarthrosis - ligament avulsion - osteochondral defect - DJD

Question 15

USS used for

Answer 15

tendon rupture - some meniscal tears - swelling - cysts

Question 16

What is MRI not good for?

Answer 16

DJD or mobile pathology

Question 17

List some indications for surgery

Answer 17

failure of conservative management

work, sport, problems with daily activities, prevent further joint injury and falls

Question 18

Non surgical managements

Answer 18

physio - analgesia - swelling reduction - ROM

Question 19

3 surgical treatments for meniscal tears

Answer 19

repair - partial meniscectomy - meniscal transplant

Question 20

shape of the 2 menisci

Answer 20

medial is semi-circular and lateral is almost circular

Question 21

Where are the tensile stresses which help to balance the radial component of loading force developed?

Answer 21

circumferentially orientated collage fibres

Question 22

Where do periminiscal capillary plexus arise from?

Answer 22

branches of inferior medial and lateral geniculate arteries

Question 23

What 2 vessels do the perimeniscal plexus go on to form?

Answer 23

circumferential and penetrating radial

Question 24

who gets meniscal tears?

Answer 24

young - sporty - fresh tears up to 3 months - healthy meniscus

Question 25

what zones do meniscal tears occur?

Answer 25

red/red or red/white

Question 26

Repair techniques for meniscal injuries

Answer 26

open, all inside, inside-out or outside-in

Question 27

Briefly explain the smith and nephew technique for the repair of meniscal tears

Answer 27

device passed through meniscus allowing "t" to be deployed. Knots tied outside joint and pushed snuggly against meniscus

Question 28

2 treatments for ACL tear

Answer 28

full ACL rehab - ACL reconstruction

Question 29

Reasons for ACL surgery

Answer 29

prevent further injury back to work back to sport prevent OA

Question 30

Treatment of osteochondral injuries

Answer 30

``` debridement reattachment of fragment ACI removal of loose bodies microfracture chondroplasty ```