Acute Knee Injury Flashcards
What are common injuries to the knee?
- Fracture
- Acute/chronic degenerative joint disease
- Meniscal injury
- Ligament injury
- Tendon injury
What needs to be covered in a knee injury history? [EAESCHS]
- Environment: sport or recreation, workplace
- Activity: sports tackle, jumping
- Energy: how fast and how heavy
- Systemic symptoms
- Chronology: quick or slow onset, previous injury/event
- Hear/feel pop
- Swelling: early means haemarthrosis (bleeding into the joint)
What often causes a meniscal injury?
- Twisting movement on a loaded fixed knee]
- Painful squelch
- Slow swelling
- Painful to weight bear
- “locked knee”
What causes an ACL tear?
- Forward momentum, leg fixed +/- rotation
- “Pop”
- Quick swelling
- Often able to weight bear
What often causes collateral tears?
- Lateralised pain
- Feel of ‘crack’, sharp pain
- No or minimal effusion
- Bruising to one side
What do we do on examination for knee injuries?
- Look, feel and move
- Look for:
- scars, bruising, swelling
- joint line irregularity
What do we feel for on knee examination?
- Feel for effusion
- Crepitus
- Heat
- Tenderness
- Tissue lump or defects
What movements do we test for knee injury?
- Passive and active
- Straight leg raise
- Their range of movement
- Ligament testing
- Dynamic testing
What knee injuries are visible on xray?
- Fracture
- Loose bodies
- Ligament avulsion
- Osteochondral defect
- Degenerative joint disease
- Lipohaemarthrosis
What knee injuries are visible on ultrasound?
- Tendon rupture
- Some meniscal tears
- Swelling
- Cysts
What are MRI used for in knee injuries?
- For clinical confirmation
- Variable sensitivity & specificity
- Not good for DJD or mobile pathology
What is the role of surgery in knee trauma?
- Joint preservation
- Life-long care of the joint
What are the indications for surgery in knee trauma?
- Failure of conservative Rx
- Demands of work
- Demands of sport
- Problems with daily activities
- Prevention of future joint injury
- Fall prevention
What are some non-surgical options for knee trauma?
- Restoration of function
- Physio
- Analgesics
- Swelling reduction
- Range of motion/normal movement
What is the meniscus?
Piece of cartilage that provides a cushion between your femur and tibia.
What are some surgical options for meniscus damage?
- Mensical repair
- Partial mensicetomy
- Meniscal tranplantation
Name the parts of the menisus.
Where are the ligaments attached to meniscus?
Ligaments around the edge
Why are the orientation of fibres arranged in that way?
Allows it to take load from all directions
How is the vascular supply to the knee relevant in trauma?
- Section with good blood supply [the edge] will live when repaired
- Section with poor blood supply [the centre] will die on repair
Who is eligable for meniscal repair?
- Young
- Sporty
- Fresh tears (3 months)
- Healthy meniscus
- Where there is good vascularity
What are the main techniques of meniscal repair?
- open technique
- Outside-in
- Inside-out
- All inside
What is the anterior cruciate ligament (ACL)?
Cruciate ligaments control forward and backward movement of the knee. ACL runs diagonally in the middle of the knee.
What are some of the treatment options for ACL injury?
- Full ACL rehab
- ACL reconstruction
- Acute or delayed
- Done to prevent further injury, such as osteoarthritis
- May be done to get patient back to work or to sport
What are reasons for surgical intervention for ACL?
- Prevent further injury
- Back to work
- Back to sport
- Prevention of osteoarthritis
Why do osteochondral injuries occur in adults?
Often happens due to direct trauma: chip off some cartilage and bone.
What are the steps to osteochondral repair?
- Debridement
- Reattachment of fragment
- Removal of loose bodies
- Microfracture chondroplasty
