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Gwen - MSK > Acute Injuries of the Knee > Flashcards

Acute Injuries of the Knee Flashcards

1
Q

What is the unhappy triad of the knee?

A
  • commonly seen following a lateral blow to the knee and consists of damage to the:
    • anterior cruciate ligament
    • medial collateral ligament
    • meniscus (classically the medial meniscus but recent evidence shows that the lateral meniscus is more commonly injured)
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2
Q

Who is most at risk of ACL tears?

A
  • 15-45yrs
  • Active individuals - 70% occur in sporting activities
  • Females>Males
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3
Q

What are the functions of the ACL?

A

Prevents

  • Posterior displacement of the femur
  • Hyperextension of the knee joint.
  • Minimises tibial rotation
  • Resists valgus/varus stress
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4
Q

Where does the ACL arise from and attach to?

A

Arises from anterior intercondylar area of the tibia, and attaches to the posteromedial aspect of the intercondylar notch of the femur

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5
Q

How do ACL tears occur?

A

As a result of an acute non-contact deceleration injury, forceful hyperextension, or excessive rotational forces about the knee.

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6
Q

Tearing what ligament can also result in an ACL tear?

A

MCL

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7
Q

Is the ACL intracapsular or extracapsular?

A

Intracapsular

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8
Q

What are the symptoms of an ACL tear?

A
  • Mechanism of injury - twisting motion
  • Popping sound
  • Swelling - rapidly (haemoarthrosis)
  • Inability to return to play
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9
Q

What are the clinical signs of ACL tear?

A
  • Instability
  • Effusion
  • Haemarthrosis? - immediate swelling?
  • Anterior Draw sign - positive
  • Lachman’s test - positive
  • Decreased ROM - esp. flexion
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10
Q

How would you investigate a suspected ACL tear?

A

Clinical diagnosis!!

Imaging

  • MRI Scan (INITIAL TEST) - For clinical confirmation
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11
Q

How would you manage someone with a ruptured ACL?

A
  • RICE
  • Analgesia
  • Protected weight-bearing - with crutches +/- knee immobiliser
  • Physiotherapy
  • Surgical reconstruction - autograft - iin the young/increased knee instability
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12
Q

What groups of individuals are more likley to suffer collateral ligament ruptures?

A
  • Adults
  • 20-35 yrs
  • Most common in American footbal, skiing, rugby
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13
Q

Where are the attachment points for the MCL?

A
  • Medial epicondyle of the femur
  • Medial condyle of the tibia
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14
Q

Which collateral ligament attaches to its respective meniscus?

A

Medial collateral ligament

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15
Q

What is the function of the MCL?

A
  • Resist valgus
  • Resist external rotation forces
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16
Q

What are the attachement points for the LCL?

A
  • Lateral epicondyle of femur
  • Lateral surface of the head of the fibula
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17
Q

Does the LCL attach to the lateral meniscus?

A

No

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18
Q

What tendon passes deep to the LCL?

A

Tendon of popliteus

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19
Q

What causes LCL injuries?

A

Very rare in isolation

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20
Q

What is the mechanism of injury in a MCL tear?

A
  • Valgus stress - blows to lateral aspect of the knee while foot is fixed
  • External rotation load placed on the knee
  • Overuse - Breast stroke whip kick, gymnastics
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21
Q

What are the symptoms of a collateral tear?

A
  • Sudden sharp pain - medial or lateral side
  • Feeling a crack
  • Mechanism of injury - varus/valgus stress
22
Q

What are the signs of a collateral ligament tear?

A
  • Effusion - haemarthrosis if immediate
  • Tenderness - over affected ligament
  • Bruising? - over one side of the knee
  • Positive medial/collateral assessment
    • Laxity on valgus stress - MCL damage
    • Laxity on varus stress - LCL damage
23
Q

How would you investigate someone with a suspected collateral ligament tear?

A
  • MRI scan - clinical confirmation
  • X-ray - fracture/loose body, avulsion
  • US - tendon rupture, meniscal tears
24
Q

How would you manage someone with a collateral ligament tear?

A
  • RICE
  • Analgesia
  • Protected weight-bearing - with crutches +/- knee immobiliser
  • Physiotherapy
  • Surgical Reconstruction - rarely needed in MCL; LCL often more severe and can involve cruciates, therefore more likely to need surgery
25
Q

What can injury to the lateral collateral cause?

A

Injury of the common peroneal nerve

26
Q

What are menisci made of?

A
  • Fibrocartilage - Fibro and chondroblasts in matrix of type 1 collagen
  • Collagen fibres arranged in radial and circumferential orientation
27
Q

Function of the menisci

A
  • Improve articular congruency and increase stability of the knee
  • Controlling complex rolling and gliding action of the joint
  • Distributing load during movement
28
Q

What side are menisci tears more common on?

A

Medical - the medial meniscus is much less mobile than the lateral.

29
Q

What is an important thing to remember about the vascular supply of the menisci?

A

Vascular supply to menisci diminishes as you move more towards the centre of the meniscus - important when considering how to manage tear in relation to where it is

30
Q

What can cause meniscal tears?

A
  • Twist to the flexed knee
  • Older - daily activites due to degenerative changes and ageing
31
Q

What are the signs of a meniscal tear?

A
  • Locked knee - due to displaced segment becoming lodged between femoral and tibial condyles
  • Tender joint line
  • McMurray’s Test positive/apley’s grinding test
  • Swelling - may or may not be any swelling
  • Pain on internal/external rotation

Thessaly’s test?

32
Q

How would you investigate a suspected meniscal tear?

A
  • MRI Scan - location, morphology, length, depth, stability
  • X-ray - avulsion
33
Q

How would you manage someone with a meniscal tear?

A
  • RICE
  • NSAIDs/Paracetamol
  • Conservative - small tears heal spontaneuously
  • Surgery - early arthroscopic repair in most circumstances, especially sports related tears
34
Q

What is the typical traumatic knee injury triad?

A

ACL + MCL + medial meniscus following valgus stress with rotation of the knee.

35
Q

What is osgood schlatter’s disease?

A

Tibial tubersoity apophysitis

Repeated traciton causes inflammation and chronic avulsion of the secondary ossification centres of the tibial tuberosity, leading to inflammation, hence its known association with physical overuse

36
Q

What sex does osgood schlatters affect more commonly?

A

Males

37
Q

What age range does osgood schlatters commonly affect?

A

10-15 years old

38
Q

What are features of osgood schlatters?

A
  • Pain below knee - worse on strenuous activity and quad contraction
  • Swollen, tender area below knee
39
Q

What investigations might you do in a child with suspected osgood schlatters?

A
  • X-ray
  • MRI
40
Q

What might you see on X-ray in someone with osgood schlatters?

A

Tibial tuberosity enlargement +/- fragmentation

41
Q

What might you see on MRI in a child with osgood schlatters disease?

A

Tendonitis

42
Q

How would you manage a child with osgood schlatters disease?

A
  • Modificaiton of daily activities
  • Ice packs
  • Oral NSAIDs
  • Physiotherapy
  • Consider surgery - drilling of the tibial tubercle, partial resection of the tibial tubercle, excision of the separated ossicle, and combination of these procedures
43
Q

What is patellofemoral pain syndrome?

A

Patellofemoral pain syndrome is defined as knee pain resulting from mechanical and biochemical changes to the patellofemoral joint.

44
Q

What is patellofemoral pain syndrome associated with?

A
  • Lower limb malaligment
  • Muscle imbalance
  • Patella tracking abnormalities
45
Q

What are features of patellofemoral pain syndrome?

A
  • Patella aching - after prolonged sitting/cimbing stairs
  • Positive clark test - pain on compression with tensed quadriceps
  • Decreased/increased patella mobility
  • J test positive
46
Q

How would you diagnose Patellofemoral pain syndrome?

A

Clinical diagnosis

47
Q

How would you manage someone with patellofemoral pain syndrome?

A
  • Relative rest
  • NSAIDs
  • Physio - quad and hip strengthening exercises
  • Surgery - rarely needed
48
Q

What normally causes PCL injuries?

A

Dashboard injuries

49
Q

What is osteochondiritis dessicans?

A

Typically affects males aged 15-20.

Is a tear of the cartialge at the end of the bone - appears as a loose body in the joint.

Most likely cause is trauma, whether by single impact or repeated micro trauma.

50
Q

Signs of osteo chondritis dessicans

A
  • Tenderness localised to one femoral condyle
  • Positive wilson’s test
51
Q

What is oscgood schlatters?

A

Pain and swelling over the tibial tuberosity. Can be bilateral.

Exacerbated by exercise.

Reslves when physis joins.

Gwen - MSK (28 decks)

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