disorders of the knee

Question 1

femoral shaft traumas

Answer 1

• high velocity trauma
• proximal fragment is abducted due to glutus medius and minimus
• distal segement is adducted due to adductor muscles
• blood loss can develop into a hypovolemic shock

TREATMENT

• surgery

Question 2

distal femoral fractures

Answer 2

• sport injury or fall
• popliteal artery can be damaged

Question 3

tibal plataeu fractures

Answer 3

• high energy injuries
• normally affect the lateral tibial condyle
• can be associated with ACL fractures

Question 4

patellar fractures

Answer 4

• caused by direct injury
• cant raise leg in air

TREATMENT

• surgery

Question 5

patella dislocation

Answer 5

• completely displaced out of normal position
• most common is lateral dislocation due to line of pull between the quadricepts tendon and the patella ligament
• trauma
• strengthen vastus medialis muscle

TREATMENT

• extend the knee and manually reducing the patella and need physiotherapy

Question 6

meniscal injury

Answer 6

• very common
• intermittent (not continous) pain
• localised pain
• swelling is delayed
• tenderness and pain

TREATMENT

• acute = surgically
• chronic = conservative managment

Question 7

collateral ligament injury

Answer 7

• sporting injury in direct contact sport
• immediate pain and swelling of knee
• valgus = MCL at risk of damage
• varus = LCL at risk

Question 8

valgus and varus angulation

Answer 8

• valous = various = wide

Question 9

unhappy triad

Answer 9

• ACL
• medial meniscus
• medial collateral ligament

all injured

Question 10

ACL and PCL injury

Answer 10

• ACL = due to a sudden change in direction (quick deceleration or hypoextension)
• or large force to the back of the knee
• immediate swelling
• PCL = player falls on knee and tibia hits ground first

Question 11

dislocation of the knee

Answer 11

• 3/4 ligaments must be ruptured (ACL, PCL, MCL, LCL)
• risk of damaging popliteal artery

Question 12

swelling around knee

Answer 12

due to:

• bone
• soft tissue
• fluid

Question 13

knee effusion

Answer 13

• accumulation of fluid inside the knee joint
• can be blood, recative synovitis (increased synovial fluid)

divisions

1. heamarthrosis = ACL rupture
2. lipo- haemartrosis = blood and fat in joint and fat can be seen on x ray and appears darker
   3.

Question 14

pre patella bursitis

Answer 14

• knee pain and swelling and cant walk
• housmaids knee - tend to lean forwards
  *

Question 15

infrapatella bursitis

Answer 15

clergymans knee

Question 16

suprapatella bursitis

Answer 16

due to:

• osteoarthritis
• rheumatoid arthritis
• infection

Question 17

OSD (osgood - schlatters disease)

Answer 17

• inflammed patella ligament
• intense knee pain during movement
• relieved with rest

Question 18

osetoarthritis of knee

Answer 18

• stiffness and swelling
• deformity of knee joint = valgus
• loss of articular cartilage

Question 19

septic arthritis in the knee

Answer 19

• invasion of joint space via micro-organisms
• common = staph.areus, staph.epidermis, strep.pneumoniae, nisseria ghonnorhoea
• fever, pain, reduced motion

risk factors:

diabetes, immunosupression, prosthetics (biofilm from staph. epidermis can invade)

• neutrophils stimulate cytokeins = hydrolysis of collagen and proteoglycans

Question 20

where to feel for the femoral pulse

Answer 20

halfway between the ASIS and the pubic symphysis