Adult Knee Problems

Question 1

what does the knee consist of?

Answer 1

medial and lateral tibiofemoral articulations and the patellofemoral joint

Question 2

what are the bone surfaces covered with in the knee joint?

Answer 2

articular (hyaline) cartilage

Question 3

what does the tibiofemoral joint contain?

Answer 3

fibrocartilage menisci

Question 4

what does the extensor mechanism consist of?

Answer 4

tibial tuberosity
patellar tendon
patellar
quadriceps tendon
quadriceps muscle

Question 5

what action causes rupture of the extensor mechanism?

Answer 5

fall on a flexed knee with quadriceps contraction

Question 6

what is damaged in an extensor mechanism rupture?

Answer 6

quadriceps ligament

patellar tendon

Question 7

what age is the quadriceps ligament more likely to be damaged?

Answer 7

> 40

Question 8

what age is the patellar tendon more likely to be damaged?

Answer 8

<40

Question 9

predisposing factors for tendon rupture

Answer 9

tendonitis
quinolone antibiotics
chronic steroids
DM
RA
chronic renal failure

Question 10

presentation of extensor mechanism rupture

Answer 10

unable to straighten leg (SLR)

palpable gap

Question 11

diagnosis of extensor mechanism rupture

Answer 11

XR high patellar is patellar tendon

XR low patellar is quadriceps tendon

Question 12

management of extensor mechanism rupture

Answer 12

surgical repair

Question 13

what is patellofemoral dysfunction?

Answer 13

excessive grinding of the patella on the femur

Question 14

presentation of patellofemoral dysfunction

Answer 14

anterior knee pain worse going downhill
grinding or clicking sensation at front of knee
prolonged sitting leads to pseudo-locking where knee stiffens in flexed position

Question 15

management of patellofemoral dysfunction

Answer 15

physio to rebalance quads
tapping
surgery is last resort to release tight lateral retinaculum

Question 16

what causes a patellar dislocation?

Answer 16

sudden blow or twist of knee

Question 17

most common direction of the patella in dislocation

Answer 17

lateral

can reduce when knee is straightened

Question 18

what increases the risk of patella dislocation?

Answer 18

hypermobility
under-developed lateral femoral condyles
increased Q angle
weak vastus medialis

Question 19

diagnosis of patellar dislocation

Answer 19

XR can show small opacification where patella strikes the lateral femoral condyle

Question 20

presentation of patellar dislocation

Answer 20

most have reduced themselves

lipohemarthrosis

Question 21

management of patellar dislocation

Answer 21

risks reoccurrence

physiotherapy to strengthen quads

Question 22

what causes a meniscal tear?

Answer 22

twisting force on a loaded knee

Question 23

common causes meniscal tears

Answer 23

sports

getting up from squat

Question 24

which side tears are more common?

Answer 24

medial

Question 25

types of tears

Answer 25

1. longitudinal > bucket handle 2. radial > parrot beak/oblique 3. horizontal > flap tear

Question 26

what can a bucket handle mensical tear cause?

Answer 26

it can displace and prevent extension

Question 27

presentation of a meniscal tear

Answer 27

localised pain in joint line effusion day after catching/locking sensation

Question 28

what happens if difficulty straightening the knee persists?

Answer 28

fixed flexion deformity (FFD)

Question 29

diagnosis of meniscal tear

Answer 29

Steinmann's test | MRI

Question 30

what happens in Steinmann's test with a lateral meniscal tear?

Answer 30

pain in internal rotation and extension at 90 degrees

Question 31

management of meniscal tears

Answer 31

``` only outer 1/3rd has blood supply so need to do arthroscopic meniscectomy steroids injections (NEVER into tendon) ```

Question 32

what causes an ACL rupture?

Answer 32

high rotational force

Question 33

presentation of ACL rupture

Answer 33

``` pop that is felt or heard deep pain in knee hemarthrosis rotatory instability feeling the knee could give way ```

Question 34

diagnosis of ACL rupture

Answer 34

Lachman's test (tibia can be pulled forward on femur when knee is flexed)

Question 35

management of ACL rupture

Answer 35

reconstruction and intensive rehab

Question 36

what causes MCL rupture?

Answer 36

valgus stress

Question 37

presentation of MCL rupture

Answer 37

laxity pain when stretched tenderness over origin and insertion

Question 38

management of MCL rupture

Answer 38

tend to heal well so early motion and physio | if chronic instability then reconstruction

Question 39

what causes LCL rupture?

Answer 39

varus stress

Question 40

is LCL rupture common?

Answer 40

no

Question 41

management of LCL rupture

Answer 41

doesn't heal well so urgent reconstruction

Question 42

what causes a PCL rupture?

Answer 42

direct blow on anterior tibia with flexed knee OR | hyperextension

Question 43

what are the risks in PCL rupture?

Answer 43

peroneal nerve injury | popliteal artery incident

Question 44

what does peroneal nerve injury present with?

Answer 44

foot drop

Question 45

presentation of PCL rupture

Answer 45

instability descending stairs pain bruising

Question 46

management of PCL rupture

Answer 46

tendon graft surgery

Question 47

who is most likely to dislocate their knee

Answer 47

teenage girls

Question 48

complications of knee dislocation

Answer 48

popliteal artery peroneal nerve compartment syndrome CHECK CIRCULATION OF FOOT

Question 49

management of knee dislocation

Answer 49

urgent surgical repair