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Ortho > Chapter 39- Injured Knee And Patella > Flashcards

Chapter 39- Injured Knee And Patella Flashcards

1
Q

What is the differential for painful knee and no other findings on examination

A
  • referred from hip/ spine

- painful patellar syndrome (will have tenderness on underside of patella)

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2
Q

Differentials for pain on the anterior knee?

A

Patella: acute: fracture; chronic: chondromalacia

Extensor mechanism: acute: rupture
Chronic: tendonitis

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3
Q

Differentials for blood cause swelling of the knee joint

A

Swelling is immediate (hours)

  • haemarthrosis: confined to synovial space - 70 percent are due to ACL rupture
  • meniscal tear or collateral ligament injury
  • Intra articular fracture
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4
Q

Differentials for synovial fluid causing swelling of the knee

A

Occurs in days rather than hours

  • meniscal pathology
  • joint instability (ligament injury)
  • articular pathology
  • synovitis
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5
Q

Differentials ‘giving way’ of the knee joint?

A
  • ligamentous laxity (ACL)
  • loose body
  • meniscal tear
  • articular pathology
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6
Q

What does locking of the knee refer to?

A

Inability to extend the joint

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7
Q

What is the cause of locking of the knee?

A

Meniscal tear

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8
Q

What is anatomical valgus position of the legs

A

5 degrees in males and 7 degrees in females

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9
Q

Symptoms of the ACL Injury (at initial injury)

A
  • acute episode, usually rotational stress, during sporting activities
  • may have heard or felt a pop or snap sensation
  • immediate swelling
  • could not continue activities
  • pain: variable and sometimes may be mild
  • acute symptoms settle in +- 2 weeks
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10
Q

Symptoms of ACL tear (untreated or chronic)

A
  • present with giving way on rotational activities especially
  • intermittent swelling with episodes of giving way
  • no locking experienced unless a meniscus is torn as well
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11
Q

Findings on examination of an ACL tear

A

Effusion
Muscle wasting if chronic
Lachman test positive
Pivot shift positive

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12
Q

What is a possible X-ray finding of ACL tear

A

Avulsion of bony attachment of ACL or ITB

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13
Q

Treatment of ACL Tear in high level athlete

A

ACL reconstruction: refer to specialist

Rehabilitation: thigh muscle, hamstring in particular, rehab for propriception retraining

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14
Q

Treatment of ACL Low demand individual

A
  • rehab thigh muscles, especially hamstrings
  • brace
  • reconstruction of ACL is giving way and swelling is the problem
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15
Q

Typical history for collateral ligament tear ( acute)

A
  • varus or valgus stress injury
  • pain on medial or lat side
  • localized swelling
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16
Q

If persistant pain or instability is associated with the collateral ligament tear what are the likely associated conditions?

A
  • persistant pain: meniscal tear, articular cartilage damage or bone bruise
  • instability: associated PCL or ACL injury
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17
Q

Treatment of collateral ligament tear?

A
  • supportive: Robert jones or knee immobilizer
  • rehab: quads and hams
    Gradual return to activity as discomfort and swelling subsides
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18
Q

How may a chronic PCL tear present (history)

A
  • may present with anterior knee pain months after injury or medial compartment OA years later
  • posterior pain: associated postero-lateral capsule tear, meniscal tear or bone bruise
  • classic instability rare
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19
Q

Examination findings for PCL

A
  • Minimal if any swelling in isolated history

- Posterior subluxation of the tibia on the femur (post sag sign, tibial step off sign)

20
Q

Describe the PCL brace

A

Extension with thick foam pad behind calf muscle

21
Q

Treatment of PCL tear in high demand individuals

A

Refer for repair/ reconstruction

22
Q

Treatment of PCL tears in low demand individuals

A

Brace in extension with PCL brace for 2-3 weeks

Rehab focused on quads mainly

23
Q

In a knee dislocation, which other structures should be examined for injury?

A
  • common perineal nerve and popliteal artery
24
Q

Treatment of knee dislocation

A
  • all knee dislocations must be reduced as soon as possible and an angiogram performed if possible
  • vascular injury present: vascular repair, repair accessible tear of the posterior capsule, stabilize the knee with exoskeleton, address remaining instability at a later stage
  • no vascular injury: primary if status of tissue permit (i.e. If minimal swelling). If swollen, allow to settle and then address disrupted ligaments. Stabilize with POP cast or exoskeleton
25
Q

What is the mechanism of injury in a meniscal tear

A

Tears occur with rotation of the knee in a flexed position

26
Q

Symptoms of meniscal tear

A
  • pain: posterio-medial/ postero- lateral corners
  • locked knee
  • intermittent swelling
  • flexion deformity
  • giving way with low energy activity
  • experience clunk or feel something move in the knee
27
Q

Examination findings for meniscal tear

A
  • tender- medial or lateral joint line
  • swelling - effusion
  • flex deformity
  • muscle wasting if >2 weeks
  • mcmurray and steinman positive
28
Q

Treatment of meniscal tear

A
  • endoscopic repair or partial menisectomy
  • Rehab: quads and hams
  • crepe or tubigrip support
29
Q

What types of loose bodies are found in the knee and where do they originate from

A
  • Chondral or osteochondral

- originate from injury to articular cartilage or osteochondritis dissecans fragment

30
Q

Symptoms of Loose bodies in the knee

A
  • patients can locate it if mobile
  • giving way
  • locking sporadically
31
Q

Treatment of loose bodies in the knee

A

Remove

Replace intra articular defect if osteochondritis dissecans

32
Q

Causes of extensor mechanism rupture in the knee

A
  • quadriceps tendon: rupture in the elderly
  • patellar fracture
  • patellar tendon rupture in athletes
33
Q

Describe quadriceps lag

A

Patient can passively extend the knee but cannot maintain active extension

34
Q

Cause and treatment of popliteus tendon rupture

A
  • sharp external rotation of the tibia on the femur may rupture or avulse the popliteus tendon, also seen with LCL injury
  • treatment is symptomatic and supportive
35
Q

What injury is gastrocnemius rupture associated with?

A

Seen in association with severe lateral ligament disruption

36
Q

What is the cause of iliotibial band tendinitis? what is the treatment?

A
  • Caused by the ITB passing over the lateral femoral epicondyle during repetitive flexed knee activity
  • Treatment is LA and steroid, divide ITB under LA
37
Q

Treatment of pes anserinus bursitis or tendinitis

A

Local anaesthetic and steroid- modify activity

38
Q

Name and describe the types of patellar fractures

A
  • Linear: Due to explosion contraction of the quads, such as jumping down from a height
  • Stellate or comminuted fracture: caused by direct blow
39
Q

Clinical presentation of patellar fracture

A
  • History of a fall/ jump from a height, or direct trauma
  • Swollen knee with bruising
  • Palapable gap in patella with separation of the fragments
  • Unable to elevate leg with knee fully extended
  • Movement limited by pain in the acute stage, usually in full flexion in chronic injury with an extensor lag
40
Q

What are the parameters to define a displaced/undisplaced patellar fracture

A

Undisplaced: <2mm separation or step
Displaced: >2 mm separation or step

41
Q

Treatment of undisplaced patellar fractures

A

-POP cylinder or extension knee brace for 4-6 weeks then active flexion and extension exercises

42
Q

Treatment of displaced patellar fractures

A
  • Mid-patella: open reduction and internal fixation (tension band wiring) and POP cast in extension for 6 weeks
  • Proximal or distal pole: Excise small fragment and repair tendon and POP cast for 6 weeks
  • Longitudinal: interfragmentary screw fixation

If irreducible/ irreparable or cartilage too badly damaged –patellectomy

43
Q

Name a patellar stabilizer that is commonly torn, causing lateral dislocation of the patellar

A

-Medial Patello-femoral ligament

44
Q

Causes of patellar dislocation

A
  • Congenital
  • Acquired: direct blow forcing it out of position, indirect force: Strong quadriceps contraction with low leg in external rotation (jumping)
45
Q

Examination findings of patellar dislocation

A

-Acute: knee held flexed and medial femoral condyle is prominent
Look for
-Overall leg alignment (usually valgus and anteversion of femoral neck with squinting patellae)
-Quadriceps mechanism alignment (Q angle)
-Ligamentous laxity
-Size and position of the patellar

46
Q

What is the skyline view used to view in a patellar dislocation

A

-Identify bony avulsion from medial side or an osteochondral injury to the crest of the patella

47
Q

Treatment of patellar dislocation

A

Acute:

  • Analgesia and and extension to reduce the dislocation
  • If significant force: arthroscopy to look for chondral or osteochondral injury
  • Repair of retinacular tear in young, active individuals
  • immobilise with POP cast in 10-15 degrees flexion
  • Rehab of quads

Chronic or recurrent:

  • Refer to specialist
  • Reconstruction of the medial patello-femoral ligament is recommended
  • Rehab of quads

Ortho (41 decks)

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