Common conditions of the knee Flashcards
what is Varus and what is valgus
Varus = (). Valgus = )(
what is the function of the Meninscii?
shock absorption, lubrication, buffer between the joint, limits flexion and extension, increase stability
Meniscal tear cause
twisting in deep flexion, OA, the medial meniscus tears most often as it is a more fixed structure.
presentation meniscal tear
Pain, clicking, locking, intermittent swelling, feel a “pop”
on examination meniscal tear
effusion, tender joint line, mechanical block to movement - hard to straighten or bend knee, McMurray’s test positive, fail to deep squat.
name a test for a meniscal tear
mcmurrays test OR apleys test.
Ix men tear
XRAY, MRI, arthroscopy.
non operative tx men tear
ice, NSAID’s, do not weight bear, avoid sports, physio, knee immobiliser
operative tx meniscal tear
Meniscal repair, Meniscectomy.
OA
degenerative change of synovial joints, progressive loss of articular cartilage, secondary bony changes, worsening pain and stiffness of the effected joint limiting everyday life.
key anatomy and function of the ACL
Runs from between tibial eminences to lateral wall of intercondylar notch of femur Blood Supply: middle geniculate artery Innervation: posterior articular nerve - Branch of tibial nerve Primary restraint to anterior translation of the tibia relative to femur Secondary restraint to tibial rotation and varus/valgus stress
what causes an ACL tear
external rotation of the tibia on the femur, hyperextension and inversion of the knee, most commonly sporting injury
presentation of acl injury
heard a pop/crack, immediate swelling (haemarthrosis), unable to keep playing, deep pain
symptoms of acl injury
pain, swelling are early symptoms. Late - arthritis and joint instability.
on examination of acl
Anterior draw test, Lachmann’s test, pivot shift test, effusion seen.
A positive Lachman test or pivot test is strong evidence of an existing anterior cruciate ligament (ACL) tear, and a negative Lachman test is fairly good evidence against that injury.
Ix acl
MRI
Tx for acl
PRICEM – protected weight bearing, rest, ice, compression, elevation, medication’s (analgesia, NSAID’s) and if these don’t work then consider surgery
ACL reconstruction using a graft (using the patellar tendon).
hit on the side of the leg most commonly causes what kind of injury?
MCL tear, valgus stress
what are the functions of the deep and superficial MCL?
Superficial = primary restraint to valgus stress Deep = contributes in full knee extension, attaches to medial meniscus, continuous with joint capsule
how deoes a MCL tear present?
pop/crack heard, pain on the medial side, bruising of the knee medially, localised swelling. PAIN, SWELLING, JOINT INSTABILITY, JOINT STIFFNESS
what is found on examination? mcl tear
medial swelling and bruising, tender medial joint line, tender femoral inversion of the MCL, painful on full extension, opening on valgus stress. look for: Scars, deformity, palpate for tenderness of joint effusion, assess movement of the joint, ant draw test, lachmans, pivot shift, mcmurrays, valgus stress test, apleys test ect.
In an MCL injury - what nerve is commmonly damaged and what does this cause?
common peroneal n. causing foot drop.
on Ix mcl
MRI, xray shows calcificationat the femoral insetion,
Non operative tx mcl
rest, NSAID’s, physio, brace
operative tx mcl
repair or reconstruction
what is Osteochondritis Dissecans and its causes?
Pathological lesion affecting articular cartilage and subchondral bone, 2 forms - Juvenile, 10-15 years while growth plates still open, Adult. Hereditary, trauma, vascular (adult). Posterolateral aspect of medial femoral condyle (70%).
how does it present? OD
activity related pain, recurrent effusions, locking, block of full movement.
what is found on examination? OD
effusion, tenderness, stiffness
What test is done? OD
Wilsons test - Patient seated with knees flexed 90° hanging over the edge of the examination table, Examiner instructs patient to internally rotate the tibia and extend leg, Examiner then asks the patient to repeat the motion with the tibia externally rotated, During both motions the examiner is palpating the popliteal fossa looking for signs of crepitus or nonuniform motion. Positive - Pain, apprehension or joint “locking”: Meniscal lesion, osteochondritis dissecans
Ix OD
MRI, XRAY shows calcificationat the femoral insetion,
Tx OD
restrict weight bearing, brace, arthroscopy, open fixation
