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Orthopedics > CM Knee > Flashcards

CM Knee Flashcards

1
Q

Bones of the knee

A

Femru
Tibia
Fibula
Patella

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2
Q

Knee Joints

A 
Largest joint in the body
Primarily function as a hinge
VERY complex
1. The knee joint proper=Tibiofemoral joint
2. Patellofemoral joint
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3
Q

Knee ligaments

A

MCL, LCL, ACL, PCL

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4
Q

The knee ligaments provide what kind of stability

A

Static

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5
Q

The Quad/Hamstrings provide what kind of stability

A

Dynamic

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6
Q

These are the cushions between the bones of the knee (sit on top of the tibia)

A

Menisci (Medial and Lateral)

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7
Q

The articular surfaces of the knee are covered with

A

Cartilage

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8
Q

The strongest and largest bone in the body

A

Femur

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9
Q

Femur

A

Holds ~2L of blood

Enlarged femoral condyles-articulate on enlarged tibial condyles (distal femur, prox tibia)

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10
Q

Tibia

A

Medial
Medial and lateral condyles (AKA tibial plateaus) serve as receptacles for femoral condyles
Tibial tuberosity (attachment for the patellar ligament/tendon
Tibia bears most of the weight

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11
Q

Fibula

A 
Lateral
NOT part of the knee joint
Doesn't articulate w/femur or patella
Biceps femoris and LCL attachments
Used a lot for bone grafting
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12
Q

Patella

A 
Triangular shaped bone
Sesamoid bone (In quadraceps femoris)
Articulates w/femur
Embedded in Quad and Patelllar tendons
Acts as a pulley, improving angle of pull (q angle)
Can cause/be a part of OA
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13
Q

Bony Landmarks of the Knee

A 
Superior and Inferior patellar poles
Tibial tuberosity
Gerdy's tubercle
Medial and lateral femoral condyles
Prox anterior medial tibial surface
Head of fibula
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14
Q

Bursae

A

Synovial Cavity: supplies knee w/synovial fluid; lies under patella between surfaces of tibia and femur; “Capsule of the knee”; synovial fluid can leak out w/an open fx and disruption of the capsule

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15
Q

Infrapatellar Fat Pad

A

Just post to patellar tendon
Insertion point for folds of tissue called plica
Plica tear/injury can cause knee to lock up

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16
Q

Knee Bursae

A

Front: Suprapatellar, prepatellar, deep infrapatellar, pretibial (should flow between front and back of knee)
Lateral: Gastrocnemius, fibular, fibulopopliteal, subpopliteal
Medial: Medial gastroc, anserine bursa, semimembranosa

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17
Q

Knee Bursae Functions

A

Shock absorbers
Decrease friction
>10 bursae in the knee
Overdeveloped or enlarged bursa indicates knee injury in that location

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18
Q

Knee Muscle Functions

A

Flexors
Extensors
ADductors
ABductors

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19
Q

What nerves innervates the knee extensors

A

Femoral Nerve

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20
Q

Knee extensor muscles

A

Rectus femoris
Vastus intermedius
Vastus lateralis
Vastus medialis

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21
Q

What nerve innervates the knee flexors

A

Sciatic Nerve: Tibial nerve and Common peroneal nerve

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22
Q

Tibial nerve innervates:

A

Semitendinosus, semimembranosus, biceps femoris (long head)

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23
Q

Common Peroneal nerve innervates:

A

Biceps femoris (short head)

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24
Q

Blood supply to the knee extensors

A

LCFA: Lateral circumflex femoral artery (ascending, transverse, descending)
Supplies the femoral head

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25
Q

Blood supply to the knee joint

A

Medial genicular arteries penetrate the joint

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26
Q

The “BIG” artery in the knee

A

“The Big Red One”

Popliteal artery: many different blood supply routes to knee, little risk of avascular necrosis

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27
Q

Being in a plane parallel to the sagittal suture

A

Sagittal plane

28
Q

Divides the body into dorsal and ventral (back and front)

A

Coronal or Frontal plane

29
Q

Divides the body into cranial and caudal (head and tail)

A

Transverse or Axial plane

30
Q

Bending heel towards buttucks to 0 degrees of flexion

A

Flexion

31
Q

Straightening to about 140 degrees

A

Extension

32
Q

Rotation away from midline

A

External rotation (knee must be flexed >20-30 degrees for this to be possible)

33
Q

Rotation towards midline

A

Internal rotation (knee must be flexed >20-30 degrees for this to be possible)

34
Q

MCL Injuries

A

MCL resists valgus stress to knee
Injury occurs as a result of valgus stress to the knee (medial force)
Place knee off table and load to find instability
Xrays may with chronic MCL sprains show calcifications (from repeat injuries)
MRI is rarely needed but helpful if injury to ACL is suspected w/MCL
US can show if ligament is torn or not

35
Q

LCL Injuries

A

LCL resists varus stress
Injury occurs as a result of varus forces
Test w/30 degrees of flexion to negate ACL and PCL resistance of varus stress
Conservative tx if mild (rest, ice, brace)
Complete disruptions may need allograft reconstruction

36
Q

MCL and LCL Tx

A

Rest, ice, immobilize if mild case
Non-operative care is the mainstay
Scar heals in 6wks-1yr (ligaments don’t heal but form scar tissue, 60-80% tensile strength of ligament)
Combined ACL/MCL injuries will require MRI and possible repair—refer to ortho

37
Q

ACL Injuries

A

Occur most often in football and basketball injuries in young pts, downhill ski accidents in older pts
Occur as a result of shearing forces on the ACL while the quad muscles are contracting especially when the knee is at 0-30 degrees
Main forces that cause this injury:
1. Hyperextension
2. Marked internal rotation of tibia on femur

38
Q

Cruciate

A

Cross

39
Q

ACL Injury Evaluation

A

Hemarthrosis present in 70% of ACL injuries
Lachman & Anterial Drawer Tests: attempt, but write “unable to perform Lachman and AD tests due to swelling and pain”
MRI gives definite info as to the severity of the injury

40
Q

ACL Tx

A

Depends on the pt and severity of injury
Partial tears generally tx conservatively: rest initially, bracing, PT for quad and hamstring strengthening
Complete tears commonly tx w/surgery to replace the ACL with either autograft (middle 1/3 patellar tendon) or allograft reconstruction

41
Q

Types of Meniscal Tears

A

Bucket Handle
Horizontal
Longitudinal
Radial

42
Q

A Bucket Handle Meniscal tear is frequently associated with what kind of tear?

A

ACL tear

43
Q

Bucket Handle meniscal tear

A
  • More common medially
  • Condyles catch the tear, very painful
  • Can lock the knee (can’t fully extend) -torn piece gets caught under the condyle and impedes motion; important to note if it clicks AND hurts
  • Presentation: intermitently lock, cannot get full extension, can come and go
  • Often missed on MRI
  • Double PCL sign (lies just post to PCL)
  • Tx: closed reduction (temporarily reduces tear), arthroscopic resection, not much success w/repair
44
Q

Double PCL sign

A

Bucket Handle Meniscal tear

45
Q

What should you not do to a Baker’s Cyst

A

Aspirate! Popliteal artery is in that area

46
Q

Herniation of synovial membrane thru joint capsule (exclusive to knee)

A

Baker’s Cyst

47
Q

Baker’s Cyst

A
  • Normal fluid flow thru a normal communication of a bursa
  • Mimics DVT when they ruputre
  • Tx: Conservative tx first (knee joint steroid injection, PT for compression/wrapping, US); Surgery-high incidence of recurrance
48
Q

Baker’s Cyst in Children

A
  • Common in kids
  • M>F
  • Medial>Lateral
  • DDx: lipomas, xanthomas, vascular tumors, fibrosarcomas
  • Use US if Dx is in doubt
  • Surgery is RARELY indicated; most resolve in 10-20 months
49
Q

Baker’s Cyst in Adults

A
  • Freq assoc w/meniscal tears and chondral injury (one way valve of fluid flow)
  • If pt doensn’t have pain, no need to tx
  • Giant cysts can be found in RA
  • Rupture of cyst can be quite painful
  • Can view on US
  • Rupture can resemble DVT as fluid flows into calf
50
Q

Bursitis

A
  • Inflammed synovial fluid: prepatellar, infrapatellar, pes anserine
  • Usually insidious onset and caused by repetitive motion occupations, gets worse over time
  • If acute onset, think about trauma and infection (rarely, drug allergy)
  • Make sure it’s not septic bursitis: Usually secondary to trauma or cellulitis (50-70%); less commonly contiguous septic arthritis or bacteremia (10%); Hot, tender to the touch
51
Q

Bursitis Tx:

A
  • If concerned for infection, consider I&D and cultures
  • CBC, ESR, Chemistries
  • Conservative Tx (not for septic bursitis): compression, ice therapy, activity modification, sometimes steroid injection
52
Q

Patellar Fx

A
  • Direct trauma (ex dashboard injury)
  • Get 2 view xray
  • Some may require CT or MRI but usually unnecessary
  • Non operative care if not open, not displaced more than 3mm, not transverse, extension preserved
53
Q

Patellar Fx Tx

A
  • Operate if extensor mechanism compromised
  • Displaced fx or transverse (avulsion) fx
  • OCD: osteochondroitin dissecans - loss of blood supply to bone under joint surface; usually adolescents/young adults; usually secondary to unrecognized trauma which disrupts or blocks tiny bone arteries; think about this if normal healing doesn’t occur
54
Q

Patellar Dislocation/Subluxation

A

**Different from “knee dislocation”
-Freq in adolescents
-Males=Females
+/- Assoc w/osteochondral fxs

55
Q

Patellar Dislocation Risk Factors

A
  • Patella alta: abnormally high patella
  • Laxity of ligaments: esp in kids
  • Increased q angle: more stress on patella and quad/patella tendons (Measure q angle by measuring from ASIS to middle of patella to tibial tuberosity)
  • Femoral anteversion or genu valgum
56
Q

Patellar Dislocation Tx

A
  • Sedation + Combo of Lido and Marcaine
  • Reduction
  • Post reduction films
  • Immobilize
  • CT and MRI follow up if OCD or bone bruise causing gait disturbance
57
Q

High Fibula Fx

A
  • Prox fx of fibula can be seen w/trauma
  • Check for distal neurologic deficits
  • Can be seen in severe ankle external rotation injuries (press on fibular head w/ankle injuries)
  • Maisonneuve Fx ??
  • REMEMBER: Check joint above and below w/any injury
58
Q

OA of the Knee

A
  • DJD of the knee
  • Usually >40yo, VERY common
  • Greater risk w/hx of previous trauma
  • Considered a wear and tear process
  • Can involve one, two or all three knee compartments (medial, lateral, patellofemoral)
59
Q

Sxs of Knee OA

A
  • Usually present w/worsening pain, stiffness, muscle atrophy, decreased ROM over time
  • Sxs worse upon arising, but will often improve w/movement and activity
  • As OA and DJD worsen, conservative tx measures will begin to fail
60
Q

Knee Films

A 
Standing bilateral (shows pressure on knees)
AP
PA
Lat 
Sunrise
61
Q

Evaluate Xrays for

A

Joint space narrowing
Osteophytes (icicles on knee)
Subchondral sclerosis
subchondral cysts

62
Q

Knee OA Tx

A
  • Conservative when able (NSAIDs/APAP for pain, Steroid injections q3-6mo; vicosupplementation)
  • Bracing
  • Exercise and weight loss
  • Surgery
63
Q

What are the most common organisms of knee joint infections

A

MRSA
MSSA
Gram Negative Bacilli
(These are causing more amputations)

64
Q

Knee joint infections

A
  • Important to get a good hx
  • Details like age, surgical hx, location help refine tx
  • Empiric therapy after collection of blood and joint for culture
65
Q

Knee joint infections: Special situations

A
  • Diabetic pediatric: Salmonella
  • Arthroplasty: S pyogenes, Group A B or G strep
  • Tick bourne disease: Lymes
  • *Sexually active: N. gonorrhoeae
  • RA: TB, Fungal 2 TNF inhibitor
  • Endemic TB area: TB
66
Q

Knee joint infection Tx

A
  • Abx: often for weeks to months
  • Cultures: repeat to check for clearance
  • Biopsy bone: certain situations
67
Q

Steroid injections

A

Study conclusion: Steroids are useful adjuncts in the management of pts w/arthritic joints; this study shows no increased incidence of infection in pts given steroid injections prior to arthroplasty

Orthopedics (5 decks)

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