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MI1 > Acute Knee Injuries > Flashcards

Acute Knee Injuries Flashcards

1
Q

Where does most of the weight bearing in the knee happen?

A

Medial meniscus/compartment

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2
Q

How is the medial femoral condyle different to the lateral?

A

Narrower and longer

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3
Q

Where do the cruciate ligaments sit?

A

In the intercondylar notch

  • ACL: Lat/post - med/ant
  • PCL: Med/post - lat/ant
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4
Q

What is the anatomy of the meniscus?

A
  • Bi-concave
  • C-shaped discs of fibrocartilage
  • Viscoelastic material
  • 75% water
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5
Q

How does the blood supply differ within the meniscus?

A

Outer 1/3 vascular, better chance of healing

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6
Q

What are the functions of the meniscus?

A
  • Load sharing/transmission (Increase joint’s weight bearing area)
  • Improve joint lubrication
  • Shock absorption
  • Articular cartilage nutrition
  • Stabilise the joint, act as secondary restraints
  • Maintain joint congruence by guiding femoral condyles
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7
Q

What are some of the different types of meniscus tears?

A
  • Longitudinal
  • Degenerative
  • Flap
  • Radial
  • Bucket handle
  • Horizontal cleavage
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8
Q

What type of imaging is used to view the meniscus?

A

MRI

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9
Q

What are the common mechanisms of injury for acute meniscus injuries?

A
  • Impact blow, deep flexion, rotation insult
  • Part of other injuries, e.g. ACL
  • Rate of swelling into joint slow from torn meniscus
  • May or may not have clicking, locking & giving way
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10
Q

What are the common mechanisms of injury for chronic meniscus injuries?

A
  • Slow onset, no particular event but may be aggravated by an event
  • Frequently occupation specific, e.g. long time in flexion
  • Chronic knee effusion, small amounts of swelling, slow onset (puffy around joint line)
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11
Q

How does the movement of the femoral condyles and menisci differ in flexion between medial and lateral?

A
  • Medial: Minimal translation of condyle, very stable (increased risk of injury)
  • Lateral: Condyle slips off the back of the tibial plateau, meniscus requires lots of mobility to allow this
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12
Q

What are the support, protect, maintain principles for treating meniscus?

A
  • Treat symptomatically, especially joint effusion
  • Limit aggravating flexion in full WB
  • If locked knee, requires urgent arthroscopy
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13
Q

What are the ‘regain’ treatments for meniscus?

A
  • ROM: Treat/maintain muscle & capsular flexibility, maintain extension, gradually increase flexion ROM
  • Strength: As required
  • Control: Protect pint by teaching dynamic motor control/stability
  • Function: Functional re-training, monitor outcomes 4-6 weeks, surgical options if not resolving
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14
Q

When do ACL injuries commonly occur?

A
  • In sports involving pivoting & sudden deceleration (e.g. planting foot & twisting, usually non-contact)
  • Higher incidence in females (2x) competing at similar level
  • Isolation or in combination with MCL, medial meniscus or articular cartilage lesions
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15
Q

Why is there a higher incidence of ACL injuries in females?

A
  • Anatomical: Wider pelvis & Q angle, narrow intercondylar notch, narrow ACL
  • Hormonal: Increased general joint laxity
  • Neuromuscular: Less quads/hamstring strength, different muscle recruitment pattern, landing techniques
  • Shoe: surface interface (more common on hard surfaces)
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16
Q

What are the contact and non-contact mechanisms of ACL injuries?

A 
Contact:
- Valgus stress to outer aspect of joint
- Posterior force while foot is fixed
Non-contact:
- Landing from a jump in rotated position
- Pivoting
- Sudden deceleration
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17
Q

What happens in the muscles/joint during a non-contact ACL injury?

A

Major quadriceps contraction force pulling the tibia anteriorly

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18
Q

What are some of the other injuries that can be associated with ACL injuries?

A
  • Osteochondral lesion
  • Bony oedema
  • Meniscal injury
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19
Q

How is ACL avulsion treatment different to ACL tears?

A
  • Tears: Let it settle down before repairing

- Avulsion: Repair as quickly as possible

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20
Q

What is a Segond fracture?

A
  • Avulsion fracture of lateral tibial plateau

- Sign of ACL injury

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21
Q

What is the aim of surgical treatment for ACL injuries?

A
  • Replace torn ACL with graft that reproduces normal kinetic function of the ligament
  • Most commonly performed arthroscopically
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22
Q

What are some of the grafts used for ACL surgery?

A
  • Bone-patellar tendon-bone
  • Hamstring (semitendinosus +/- gracilis)
  • Allografts (cadaver tissues): less frequent
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23
Q

What is a BPTB graft associated with?

A

Higher incidence of knee pain & pain on kneeling

24
Q

What are one of the limitations of hamstring grafts?

A

End of range flexion weakness

25
Q

What is a LARS graft?

A
  • Ligament augmentation & reconstruction system
  • Artificial ligament made from polyester
  • Associated with faster recover
26
Q

When can ACLR patients expect to return to some level of activity?

A

100% by 2 years, but significantly dropping off by 5 years

27
Q

What amount of ACL laxity post repair is associated with poor outcomes?

A

Laxity > 10mm

28
Q

What are the support, protect, maintain principles for treating ACLR?

A
  • Treat symptomatically, especially joint effusion

- No open chain extension

29
Q

What are the ‘regain’ treatments for ACLR?

A
  • ROM: Esp. regain full extension early
  • Control: Protect joint by teaching dynamic motor control/stability (cocontraction)
  • Strength: As required (with cocontraction)
  • Function: Re-training
30
Q

What are the characteristics of a PCL injury?

A
  • Less common, not as debilitating
  • Hyperextension, dashboard or fall onto flexed knee
  • Combines with P-L corner
  • Not commonly reconstructed
31
Q

How can the positioning of the tibia change with a PCL injury?

A
  • Sags back, so posterior aspect doesn’t align with posterior aspect of condyles
  • Noticeable in crook lying
  • Can be mistaken as ACL injury (large anterior drawer)
32
Q

What are the support, protect, maintain principles for treating PCL?

A
  • Treat symptomatically, especially joint effusion

- May not require surgery

33
Q

What are the ‘regain’ treatments for PCL?

A
  • ROM
  • Control: Protect joint by teaching dynamic motor control/stability (cocontraction)
  • Strength: As required (with cocontraction)
  • Function: Re-training
34
Q

What is the mechanism of MCL injuries?

A
  • Valgus force in partial flexion (to outside of knee)

- E.g. downhill skiing, contact sports

35
Q

Why is the MCL tested at 0 and 30 degrees?

A
  • Has connections with meniscus & deep layers of joint capsule (tested at 0 degrees)
  • If laxity at 0 degrees, indicates more issues
36
Q

Why does the MCL heal so well?

A

High levels of fibroblasts

37
Q

What is a complication of MCL injuries?

A

Pellegrini-Steida lesion: Curvilinear calcification at site of previous MCL injury

38
Q

What are the support, protect, maintain principles for treating MCL?

A
  • Brace to minimise valgus
  • Can mobilise fl/ex after 1/52 - limited ROM brace
  • Usually good healer (4-6 weeks)
39
Q

What are the ‘regain’ treatments for MCL?

A
  • ROM: Heel slides, to bike, to function
  • Control: Depends on lig healing; dynamic stability training, proprioception as required
  • Strength: As required
  • Function: Re-training
40
Q

What is the mechanism of an LCL injury?

A

Varus force, rarely isolated (think P-L corner)

41
Q

How is the treatment for LCL different from MCL?

A
  • Make sure P-L corner is intact
  • If not, spend more time on education, control, stability & outcome modification - likely to be loose for a long time
42
Q

What commonly occurs in a patella dislocation?

A
  • Takes of condyle fragments
  • Results in osteochondral lesion
  • Commonly becomes recurrent
43
Q

What are the support, protect, maintain principles for treating patella dislocation?

A
  • Brace in extension straight away, but with active isometric quads
  • Can mobilise fl/ex when ligament test is satisfactory - limited ROM
44
Q

What are the ‘regain’ treatments for patella dislocation?

A

Same as MCL & LCL, but focus on VMO control

45
Q

Where does the patellofemoral joint obtain stability from?

A
  • Medial & lateral retinaculum

- Large extensor mechanism tendons (quads & patellar)

46
Q

What do the ACL & PCL prevent?

A

ACL: Prevents forward movement of the tibia & rotation of the tibia under the femur

PCL: Prevents femur from sliding forward off tibial plateau (e.g. running down stairs)

47
Q

What is the mechanism of a patellar tendon rupture?

A

Sudden, severe eccentric quads contraction, e.g. stumbling, powerful take-off

48
Q

What are the clinical signs of patellar tendon rupture?

A
  • Sudden onset of pain, tearing sensation, undoable to stand
  • Loss of fullness at anterior knee
  • Patella retracted proximally
  • Ext not possible from straight leg position
49
Q

What is the treatment for a patellar & quads tendon ruptures?

A
  • Surgical repair

- 6-9 months rehabilitation

50
Q

What is the mechanism of a quads tendon rupture?

A
  • Less common than patellar

- Non-contact, landing from jump/changing direction suddenly, falls

51
Q

What are the clinical signs of quads tendon rupture?

A
  • Unable to contract extensors

- Defect above patella

52
Q

What is the mechanism of burial hematoma?

A

Fall onto knee

53
Q

What does the posterolateral corner/complex consist of?

A
  • Arcuate complex
  • Biceps femoris tendon
  • Popliteus tendon – helps to unlock knee
  • Posterior capsule of tib fem joint
  • LCL
  • Lateral head of gastroc
54
Q

Why is injury to the P/L corner so complex?

A
  • Creates a lot of instability

- Anatomy is very layered & complex so most surgeons don’t want to operate on it

55
Q

What is the function of the coronary ligaments of the knee?

A
  • Hold the menisci down against the tibial plateau

- Esp medial meniscus - very stably bound

56
Q

What ligaments bind the menisci to each other?

A
  • Ligament of Wrisberg (posterior meniscofemoral)

- Ligament of Humphrey (anterior meniscofemoral)

MI1 (18 decks)

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