Conditions of the Knee Flashcards
Acute cause of meniscal tears
Twisting in deep flexion
Degenerative cause of meniscal tears
Osteoarthritis
Why are medial meniscal tears more common?
Attached to medial collateral ligament, fixed structure
Presentation of meniscal tear
Pain
Clicking
Locking
Intermittent swelling
Examination findings in meniscal tear
Effusion Tender joint line at point of tear Mechanical block to movement McMurrays test positive Fail to deep squat Thessaly's test positive
Investigation for meniscal tear
Xray
MRI
Treatment for meniscal tear
Rest
NSAIDs
Physio - Quad and hamstring strengthening
Operative - arthroscopy - repair and resection
Positive tests for meniscal tear
McMurray’s
Thessaly’s
Describe osteoarthritis
Degenerative change of synovial joint - loss of cartilage and secondary bony changes
Pain and stiffness of affected joint
The anterior cruciate ligament runs between which structures?
Tibial eminences
What is the blood supply of the anterior cruciate ligament?
Middle geniculate artery
What is the nerve supply of the anterior cruciate ligament?
Posterior articular nerve - branch of tibial
Function of the ACL
Restraint to anterior translation of tibia relative to femur
Secondary restraint to tibial rotation and varus/valgus stress
How is the ACL most commonly injured?
Non contact pivotal injury
Females
Weak quadriceps
Presentation of ACL tear
Popping/cracking
Immediate swelling
Cannot continue playing
Deep pain
Findings on examination of ACL
Effusion
Anterior Draw
Lachmann’s test
Pivot shift - do under anaesthetic
Investigations for ACL tear
X-ray
MRI
Look at menisci
Non-operative treatment for ACL tear
Focused Quadriceps programme
Operative treatment for ACL tear
ACL reconstruction
+ partial menisectomy
+/- ligament repair or augmentation
+ hamstring graft
Which movement does the MCL assist?
Full knee extension
What is the most common ligamen injury of the knee?
Medial Collateral ligament
How is the MCL injured?
Severe valgus stress
Contact related
Associated injuries with MCL tear
ACL
Medial meniscus
Presentation of MCL tear
Cracking, popping Pain Unable to continue playing Bruising medial side of knee Localised swelling
Examination of MCL tear
Medial swelling and bruising
Tender medial joint, tender femoral insertion
Painful in full extension, opening on valgus stress
Investigation of MCL tear
X-ray
MRI
Treatment of MCL tear
Rest
NSAIDs
Physio
Brace
Repair or reconstruction
What is osteochondritis dissecans?
Pathological lesion affecting articular cartilage and subchondral bone
Juvenile form or Adult
Causes of osteochondritis dissecans
Hereditary
Trauma
Vascular
What is the adult-only cause of osteochondritis dissecans?
Vascular
Most common location of osteochondritis dissecans
Posterolateral aspect of medial femoral condyle
Presentation of osteochondritis dissecans
Activity-related pain
Recurrent effusions
Locking and block to full movement
Examination findings for osteochondritis dissecans
Effusion
Tenderness
Block to movement
Wilsons test positive - internal rotation
Investigation for osteochondritis dissecans
Xray
MRI
Non-operative treatment for osteochondritis dissecans
Restrict weight-bearing
ROM brace
Operative treatment for osteochondritis dissecans
Arthroscopy - subchondral drilling
Fixation of loose fragment
Open fixation
