Common conditions of the knee

Question 1

what is Varus and what is valgus

Answer 1

Varus = (). Valgus = )(

Question 2

what is the function of the Meninscii?

Answer 2

shock absorption, lubrication, buffer between the joint, limits flexion and extension, increase stability

Question 3

Meniscal tear cause

Answer 3

twisting in deep flexion, OA, the medial meniscus tears most often as it is a more fixed structure.

Question 4

presentation meniscal tear

Answer 4

Pain, clicking, locking, intermittent swelling, feel a “pop”

Question 5

on examination meniscal tear

Answer 5

effusion, tender joint line, mechanical block to movement - hard to straighten or bend knee, McMurray’s test positive, fail to deep squat.

Question 6

name a test for a meniscal tear

Answer 6

mcmurrays test OR apleys test.

Question 7

Ix men tear

Answer 7

XRAY, MRI, arthroscopy.

Question 8

non operative tx men tear

Answer 8

ice, NSAID’s, do not weight bear, avoid sports, physio, knee immobiliser

Question 9

operative tx meniscal tear

Answer 9

Meniscal repair, Meniscectomy.

Question 10

OA

Answer 10

degenerative change of synovial joints, progressive loss of articular cartilage, secondary bony changes, worsening pain and stiffness of the effected joint limiting everyday life.

Question 11

key anatomy and function of the ACL

Answer 11

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

Question 12

what causes an ACL tear

Answer 12

external rotation of the tibia on the femur, hyperextension and inversion of the knee, most commonly sporting injury

Question 13

presentation of acl injury

Answer 13

heard a pop/crack, immediate swelling (haemarthrosis), unable to keep playing, deep pain

Question 14

symptoms of acl injury

Answer 14

pain, swelling are early symptoms. Late - arthritis and joint instability.

Question 15

on examination of acl

Answer 15

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.

Question 16

Ix acl

Answer 16

MRI

Question 17

Tx for acl

Answer 17

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).

Question 18

hit on the side of the leg most commonly causes what kind of injury?

Answer 18

MCL tear, valgus stress

Question 19

what are the functions of the deep and superficial MCL?

Answer 19

Superficial = primary restraint to valgus stress Deep = contributes in full knee extension, attaches to medial meniscus, continuous with joint capsule

Question 20

how deoes a MCL tear present?

Answer 20

pop/crack heard, pain on the medial side, bruising of the knee medially, localised swelling. PAIN, SWELLING, JOINT INSTABILITY, JOINT STIFFNESS

Question 21

what is found on examination? mcl tear

Answer 21

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.

Question 22

In an MCL injury - what nerve is commmonly damaged and what does this cause?

Answer 22

common peroneal n. causing foot drop.

Question 23

on Ix mcl

Answer 23

MRI, xray shows calcificationat the femoral insetion,

Question 24

Non operative tx mcl

Answer 24

rest, NSAID’s, physio, brace

Question 25

operative tx mcl

Answer 25

repair or reconstruction

Question 26

what is Osteochondritis Dissecans and its causes?

Answer 26

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%).

Question 27

how does it present? OD

Answer 27

activity related pain, recurrent effusions, locking, block of full movement.

Question 28

what is found on examination? OD

Answer 28

effusion, tenderness, stiffness

Question 29

What test is done? OD

Answer 29

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

Question 30

Ix OD

Answer 30

MRI, XRAY shows calcificationat the femoral insetion,

Question 31

Tx OD

Answer 31

restrict weight bearing, brace, arthroscopy, open fixation