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Musculoskeletal > Common disorders of the knee > Flashcards

Common disorders of the knee Flashcards

1
Q

What are common disorders of the knee

A 
Menisacal tear 
Osteoarthritis 
ACL injury 
MCL 
Osteochondritis Dissecans
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2
Q

What causes an acute meniscal tear

A

Twisting esp in deep flexion

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3
Q

What causes degenerative meniscal tear

A

Osteoarthritis

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4
Q

What meniscus is more likely to tear and why

A

Medial meniscal tears more common because it’s a more fixed structure

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5
Q

Symptoms of Meniscal tear

A

Pain
Clicking
Locking
Intermittent swelling

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6
Q

Examination of Meniscal tear

A 
Look
-	effusion
Feel
-	Tender joint line at point of tear (esp medial tear)
Move
-	Mechanical block to movement
-	McMurrays test positive
-	Fail deep squat
-	Thassaly’s test positive
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7
Q

Investigations of Meniscal tear

A

Investigations

X-ray
-	Arthritis
-	Fracture
Mri
-	Most sensitive test
-	High False positive rate
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8
Q

Treatment of Meniscal tear Prognosis

A

Unlikely to heal as poor blood supply

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9
Q

Non-operative treatment of Meniscal tear

A

Rest
Nsaids
Physiotherapy

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10
Q

Operative treatment of Meniscal tear

A

Arthroscopy
¥ Repair
¥ resection

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11
Q

What typically causes ACL injury

A

Non-contact pivot injury

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12
Q

Presentation of ACL injury

A 
Heard a ‘pop’ or ‘crack’
Immediate swelling (70%)

haemarthrosis

Unable to continue playing

Can walk in straight line

Deep pain

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13
Q

Examination of ACL injury

A

Look
¥ Effusion (if recent injury)
Feel

Move
¥	Anterior draw
¥	Lachmann’s test
¥	Pivot shift
¥	Best done under anaesthetic
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14
Q

Investigations of ACL injury

A

X-ray
- Segond fracture
o Avulsion # of anterolateral ligament

Mri
- Acl
- Meniscii
o Lateral – simultaneous with acl tear (48%)
o Medial – secondary to shear from chronic instability

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15
Q

Non-operative of ACL injury

A
  • Focussed quadricep programme
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16
Q

operative of ACL injury

A
  • Acl reconstruction
    o +/- partial menisectomy +/- ligament repair or augmentation
    o Hamstring graft
17
Q

What is most common common ligament injury of the knee

A

MCL tear/rupture

18
Q

What causes MCL tear/rupture

A

Severe valgus stress

- Usually contact-related

19
Q

What is presentation of MCL rupture

A 
¥	Heard a ‘pop’ or ‘crack’
¥	Pain ++
¥	Medial side
¥	Unable to continue playing
¥	Bruising medial knee
¥	Localised swelling
20
Q

Examination

A 
¥	Look
¥	Medial swelling 
¥	bruising
¥	Feel 
¥	Tender medial joint line 
¥	Tender femoral insertion of mcl
¥	Move
¥	Painful in full extension
¥	Opening on valgus stress
21
Q

Imaging

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
22
Q

Non-operative treatment

A

¥ Majority
¥ Rest, nsaids
¥ Physiotherapy
¥ Brace for comfort

23
Q

operative treatment

A 
¥	Severe tears
¥	Failed non-operative management
¥	Repair or reconstruction
¥	Repair: avulsions
		 midsubstance tear with good tissue
¥	Reconstruction: damaged tissue
24
Q

What is Osteochondritis Dissecans

A

Pathological lesion affecting articular cartilage and subchondral bone

25
Q

How is Osteochondritis Dissecans categorised

A

Juvenile

adult

26
Q

Aetiology of Osteochondritis Dissecans

A

Hereditary
Traumatic
Vascular
- Adult form

27
Q

Presentation of Osteochondritis Dissecans

A

Activity-related Pain
- Poorly localised

Recurrent effusions

Mechanical symptoms

  • Locking
  • block to full movement
28
Q

Examination of Osteochondritis Dissecans

A

May be normal

Look
- effusion

Feel
- Localised tenderness

Move

  • stiffness
  • Block to movement
  • Wilson’s test
29
Q

Investigations of Osteochondritis Dissecans

A

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 fraglment
30
Q

Non-operative treatment Osteochondritis Dissecans

A

Restricted weight-bearing

Rom brace

31
Q

Operative treatment of Osteochondritis Dissecans

A

Arthroscopy

  • Subchondral drilling
  • Fixation of loose fragment

Open fixation

32
Q

Where is most common location of Osteochondritis Dissecans

A

Knee = most common

Posterolateral aspect of medial femoral condyle (70%)

Musculoskeletal (22 decks)

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