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MSK > Acute Knee Injuries > Flashcards

Acute Knee Injuries Flashcards

1
Q

What may cause an acute knee injury?

A 
Fracture 
Acute on degenerate joint dx 
Meniscal injury 
Ligament injury 
Tendon injury
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2
Q

What are important things to ask in your history for an acute knee injury?

A

Environment - sport/work/recreation
Activity - sports tackle/jumping for e.g.
Energy - how fast, how heavy?
Systemic symptoms (rigors, fever - thinking infection?)
Chronology - quick/slow onset, prev injuries or events?
Hear/feel a pop/crack
Swelling - how fast the swelling came on

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3
Q

What would really fast swelling indicate?

A

Haemarthrosis (bleeding into the joint)

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4
Q

Examination of acute knee injury

A

Look: scars, bruising, swellings, joint lines

Feel: effusion, crepitus, heat (inflammation), tenderness, tissue/lump defects

Move: passive/active, straight leg raise, range of movement, ligament testing and dynamic testing

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5
Q

Why might it be difficult to examine a patient who you suspect as had a ligament injury but who is very muscly?

A

Muscles can compensate and stabilise the joint

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6
Q

What form of imaging must you always do in acute knee?

A

XRays

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7
Q

What can Xrays help you to identify?

A 
Fractures 
Loose bodies 
Ligament avulsions 
Osteochondral defects
Degenerative joint disease
Lipohaemarthrosis (intra-articular fracture leads to bone/fat leakage from the bone marrow)
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8
Q

What other investigations can you use?

A

USS and MRI

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9
Q

When would you do an USS?

A

Not very often

Can be used to see tendon ruptures, some meniscal tears, swellings and cysts

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10
Q

When would you use an MRI?

A

For clinical conformation it is the test of choice

Can be used to see ligaments and menisci
Not good for DJD or mobile pathology

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11
Q

What would be a typical history of a meniscal injury?

A

Twisting movement on a loaded fixed knee

Squelch and pain
Gradual swelling
Painful to weight bear
Locked knee

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12
Q

Which of the menisci is most likely to tear and why?

A

Medial menisci - as it is relatively immobile

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13
Q

What is a typical history of a ACL tear?

A

Forward momentum on a fixed leg +/- rotation

Pop, immediate swelling
Often able to weight bear
Pain

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14
Q

What is the best test for diagnosing ACL tear?

A

MRI

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15
Q

How common is ACL tear?

A

1 in 3 people in high level sport will get this

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16
Q

What is a typical history for a collateral tear?

A

Force to the side of the knee

No/minimal effusion
Bruise on one side
Feel of crack
Lateralised, sharp pain

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17
Q

What is involved in the first aid care of an acute knee injury?

A

RICE, analgesia

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18
Q

What other non-pharmacological management may follow RICE & analgesia?

A

Physiotherapy

19
Q

What is the goals of surgical treatment?

A

Joint preservation and to introduce as little to the joint as possible (which may fail)
Life-long care of joint

20
Q

What are indications for surgical treatment?

A

Failure of conservative Rx
Demands of work/sport
Interferes with activities of daily living
Prevention of further injuries or prevention of falls

21
Q

What are the three surgical methods of treating meniscal tears?

A

Meniscal repair
Partial Menisectomy
Meniscal transplant

22
Q

What are the indications for meniscal repair?

A

Young, sporty
Fresh tears (up to 3 months)
Health meniscus
Red/red or red/white zone

23
Q

Why does the tear need to be in the red/red zone or the red/white zone to qualify for meniscal repair?

A

These are the areas with higher vascularity and better chances of healing after repair

24
Q

Why might arthroscopic meniscal repair be preferred over open meniscal repair?

A

You can reach more central tears (greater accessibility)

25
Q

What are the various techniques for meniscal repair?

A 
Open 
Outside-in 
Outside-out 
All inside 
Smith and Nephew
26
Q

Describe the smith and nephew technique for meniscal repair

A

Device passed through portal and meniscus to a depth that enables the T to be deployed, then knot tied outside the joint

Knot pusher slides knots snuggly against meniscus

27
Q

What is the success rate of meniscal repair?

A

90% when its done on the right joint (i.e. injuries that will heal)

1 in 5 will fail/need re-arthroscopy and probable partial meniscectomy

VAST majority of these tears are in the white zone

28
Q

What would occur if you removed the whole menisci?

A

Predisposes to bad OA

29
Q

What is involved in management of ACL tears?

A

1st line: ACL rehab

2nd line: ACL reconstruction

30
Q

What is involved in ACL reconstruction?

A

Use tendon/fascia to fashion new ligament (allograft), feed this up through tibia and femur
OR can try to stitch ACL back together

31
Q

What is involved in post-op care after ACL reconstruction?

A

Crutches, knee braces and physical therapy

32
Q

What are indications for ACL reconstruction?

A

Prevention of further injury/OA

Back to work/sport

33
Q

What is an osteochondral injury?

A

Injury to the cartilage and bone underneath

34
Q

How can you surgically manage an osteochondral injury?

A

Debridement
Reattachment of loose bodies
Microfracture chondroplasty
Artificial cartilage implantation

35
Q

What is involved in microfracture chondroplasty?

A

Puncture little holes into the bone and this causes bleeding –> clot formation and fibrous repair (not as good as cartilage)

36
Q

What is involved in artificial cartilage implantation?

A

Grow cartilage in the lab and stitch it with a layer of periosteum covering to cover the defect - this will also stimulate chondrocytes to manufacture articular cartilage

37
Q

What is the appearance of the medial meniscus?

A

Semicircular

38
Q

What is the appearance of the lateral meniscus?

A

Circular

39
Q

What are the menisci composed of?

A

Fibro and chondroblasts in matrix of type I collagen

40
Q

How are the fibres of the menisci arranged?

A

Circumferential hoop fibres, superficially randomly orientated fibres, radially orientated tie fibres

41
Q

What are the function of the menisci?

A

Spread the force over the articular cartilage and allow the joint to be more slack allowing for an increase in movement

42
Q

Where does the perimeniscal capillary plexus originate from?

A

Branches of the inferior medial and lateral geniculate arteries

43
Q

What vessels does the perimeniscal plexus form?

A

Circumferential vessels and penetrating radial vessels

MSK (27 decks)

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