Acute injuries of the knee Flashcards
List 5 possible pathologies of the knee
fracture tendon injury meniscal tear ligament injury acute on chronic degenerative joint disease
Important questions in the history for environment, activity and energy
sports - workplace - how fast - how heavy - sports tackle - jumping
Chronology questions in history
quick or slow onset
previous injury or event
Other questions in the history
hear or feel a pop or crack
swelling - early or late?
systemic symptoms
early swelling in a knee indicated what?
haemarthrosis
history of a meniscal injury
twisting movement on a loaded fixed knee "locked knee" painful squelch slow swelling - quicker in young painful to weight bear
history of an ACL tear
forward momentum, leg fixed +/- rotation
“pop”
quick swelling
often able to weight bear
History of collateral tears
lateralised pain
feel of crack, sharp pain
no or minimal effusion
bruising to 1 side
4 things to look for when examining the knee
scars, bruising, swelling, joint line irregularity
process of examining a joint
look, feel, move
5 things to feel for in joint examination
crepitus tissue lumps or defects heat effusion tenderness
5 techniques of movement in joint examination
active and passive range of movements straight leg raise dynamic testing ligament testing
3 imaging modalities used
x-ray, USS and MRI
List some things x-rays are good at picking up
fracture-loose bodies - lipohaemarthrosis - ligament avulsion - osteochondral defect - DJD
USS used for
tendon rupture - some meniscal tears - swelling - cysts
What is MRI not good for?
DJD or mobile pathology
List some indications for surgery
failure of conservative management
work, sport, problems with daily activities, prevent further joint injury and falls
Non surgical managements
physio - analgesia - swelling reduction - ROM
3 surgical treatments for meniscal tears
repair - partial meniscectomy - meniscal transplant
shape of the 2 menisci
medial is semi-circular and lateral is almost circular
Where are the tensile stresses which help to balance the radial component of loading force developed?
circumferentially orientated collage fibres
Where do periminiscal capillary plexus arise from?
branches of inferior medial and lateral geniculate arteries
What 2 vessels do the perimeniscal plexus go on to form?
circumferential and penetrating radial
who gets meniscal tears?
young - sporty - fresh tears up to 3 months - healthy meniscus
what zones do meniscal tears occur?
red/red or red/white
Repair techniques for meniscal injuries
open, all inside, inside-out or outside-in
Briefly explain the smith and nephew technique for the repair of meniscal tears
device passed through meniscus allowing “t” to be deployed. Knots tied outside joint and pushed snuggly against meniscus
2 treatments for ACL tear
full ACL rehab - ACL reconstruction
Reasons for ACL surgery
prevent further injury
back to work
back to sport
prevent OA
Treatment of osteochondral injuries
debridement reattachment of fragment ACI removal of loose bodies microfracture chondroplasty
