Common conditions of the knee Flashcards

1
Q

Key ligaments within the knee?

A

Cruciate ligaments:

  • ACL
  • PCL

Collateral ligaments:

  • MCL
  • LCL
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2
Q

What are the menisci of the knee?

A

> Specialised C-shaped cartilage:

  • Triangular in cross-section
  • Medial = attached to deep MCL
  • Lateral

> Function:

  • AID force transmission
  • Increase stability
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3
Q

What can cause a meniscal tear?

A

> Acute = Twisting especially in deep flexion

> Degenerative = Osteoarthritis

> Medical meniscal tears more common

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4
Q

What is the significant difference between an acute and a degenerative MCL tear?

A

Degenerative is not repairable where as acute is

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5
Q

How does someone present with a meniscal tear?

A

> Pain
Clicking
Locking
Intermittent swelling

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6
Q

Meniscal tear examination?

A

1) Look - effusion

2) Feel:
- Tender joint line at point of tear (esp medial tear)

3) Move:
- Mechanical block to movement
- McMurrays test positive
- Fail deep squat
- Thassaly’s test positive

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7
Q

Meniscal tear investigations?

A

X-ray

  • Arthritis
  • Fracture

MRI

  • Most sensitive test
  • High False positive rate
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8
Q

Meniscal tear management?

A

Unlikely to heal due to poor blood supply

Non-operative

  • Rest
  • Nsaids
  • Physiotherapy
  • Hamstring and Quadriceps strengthening

Operative
- Arthroscopy = Repair or
resection

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9
Q

What is osteoarthritis?

A

Degenerative change of synovial joints

Progressive loss of articular cartilage

Secondary bony changes

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10
Q

Characteristic presentation of osteoarthritis?

A

Characterised by worsening pain and stiffness of the affected joint that gets worse with activity and better with rest

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11
Q

Blood supply to the ACL?

A

Middle geniculate artery

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12
Q

innervation of the ACL?

A

Posterior articular nerve a branch of the tibial nerve

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13
Q

What is the function of the ACL?

A

Primary restraint to anterior translation of the tibia relative to femur

Secondary restraint to tibial rotation and varus/valgus stress

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14
Q

How is the ACL usually torn?

A

Non-contact pivot injury

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15
Q

Presentation of an ACL tear?

A

Heard a ‘pop’ or ‘crack’

Immediate swelling (70%)

haemarthrosis

Unable to continue playing

Can walk in straight line but hurts to turn

Deep pain

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16
Q

Examination ACL tear?

A

1) Look = Effusion (if recent injury)
2) Feel

3) Move
- Anterior draw
- Lachmann’s test
- Pivot shift = Best done under anaesthetic

17
Q

Investigations for an ACL tear?

A

X-ray

  • Segond fracture
  • Avulsion # of anterolateral ligament

MRI
- ACL
- Meniscii
> Lateral – simultaneous with acl tear (48%)
> Medial – secondary to shear from chronic instability
- MCL

18
Q

ACL treatment?

A

Non-operative = Focussed quadricep programme

Operative= ACL reconstruction:
> +/- partial menisectomy +/- ligament repair or augmentation
> Hamstring graft

19
Q

What is the most common ligament injury of the knee?

A

The MCL (Medial collateral ligament?

20
Q

How does MCL tear usually occur?

A

Sever valgus stress, usually from contact

21
Q

Associated injuries with MCL tear?

A
  • ACL tear

- Meniscal tear

22
Q

Presentation of a MCL tear?

A
>  Heard a ‘pop’ or ‘crack’
>  Pain ++ on Medial side
>  Unable to continue playing
>  Bruising medial knee
>  Localised swelling
23
Q

Examination of MCL tear?

A

Look

  • Medial swelling
  • Bruising

Feel

  • Tender medial joint line
  • Tender femoral insertion of mcl

Move

  • Painful in full extension
  • Opening on valgus stress
24
Q

Investigations for MCL tear?

A

X-ray

  • May be normal
  • Calcification at femoral insertion (Pellegrini-stieda), Chronic injury

MRI

  • Modality of choice
  • Assess location and severity of injury
  • Identify other pathologies (ACL, menisci)
25
Management of MCL tear?
Non-operative - Majority - Rest and NSAIDs - Physiotherapy - Brace for comfort Operative - Severe tears - Failed non-operative management - Repair or reconstruction - Repair: avulsions = midsubstance tear with good tissue - Reconstruction: damaged tissue
26
What is Osteochondritis dissecans?
Pathological lesion affecting articular cartilage and subchondral bone 2 forms: 1) Juvenile = 10-15 years while growth plates still open 2) Adult
27
Causes of osteochondritis dissecans?
Cause - Hereditary - Traumatic - Vascular = Adult form
28
Most common location of osteochondritis dissecans?
Knee = most common | Posterolateral aspect of medial femoral condyle (70%)
29
Presentation of osteochondritis dissecans?
- Activity-related Pain., Poorly localised - Recurrent effusions - Mechanical symptoms > Locking > Block to full movement
30
Examination of osteochondritis dissecans?
- May be normal Look - effusion Feel - Localised tenderness Move - stiffness - Block to movement - Wilson’s test
31
Investigations for osteochondritis dissecans
X-ray - Add in tunnel view (flexed 30-50 deg) MRI - Lesion size - Status of cartilage and subchondral bone - Signal intensity, Oedema suggests instability of fragment
32
Management of osteochondritis dissecans?
Non-operative - Restricted weight-bearing - Rom brace Operative - Arthroscopy - Subchondral drilling - Fixation of loose fragment - Open fixation