Disorders Of The Knee

Question 1

What is septic arthritis?

Answer 1

Invasion of joint space by microorganism

Question 2

What microorganism most commonly causes septic arthritis?
What its gram stain?

Answer 2

Staphylococcus aureus
Gram positive cocci

Question 3

Risk factors of septic arthritis

Answer 3

Extremes of age
RA
Diabetes mellitus
Immunosuppression
IV drug use

Question 4

What can cause septic arthritis?

Answer 4

Recent surgery - prosthetic joints
Knee effusion secondary to bacterial infection
Articular cartilage damage

Question 5

Symptoms of septic arthritis and what to examine for

Answer 5

• fever
• pain
• reduced ROM

Examine for:
- erythema
- swelling
- warmth
- tenderness
- ROM

Question 6

What needs to be done if septic arthritis is suspected?

Answer 6

• Aspiration of joint - use ultrasound to help
• Send aspirate for urgent microscope, culture + sensitivities

Question 7

Risk factors for knee osteoarthritis

Answer 7

Age
Sex female > male
Weight
Post traumatic
Genetics

Question 8

Treatment of osteoarthritis

Answer 8

Weight loss
Strengthening exercises
Surgery
NSAIDs

Question 9

How is sclerosis seen on an x ray?

Answer 9

Increased whiteness as bone is more dense

Question 10

What is Osgood-Schlatter’s disease?

Answer 10

Inflammation of the apophysis of patella ligament into tibial tuberosity

Question 11

Treatment of Osgood-Schlatter’s disease

Answer 11

Resolves with rest + ice

Question 12

What bursae is inflamed in housemaid’s knee?

Answer 12

Pre-patellar bursitis
Leaning forward on knee

Question 13

What bursa is inflated in clergyman’s knee?

Answer 13

Intra-patellar bursitis
Kneeling

Question 14

What bursa is inflamed in Baker’s/popliteal cyst?

Answer 14

Semimembranosus bursa

Question 15

What is another name for semimembranosus bursitis?

Answer 15

Baker’s/popliteal cyst

Question 16

What is another name for pre-patellar bursitis?

Answer 16

Housemaid’s knee

Question 17

What is another name for infra-patellar bursitis?

Answer 17

Clergyman’s knee

Question 18

What is fluid inside a joint called?

Answer 18

Effusion

Question 19

`What is fluid outside a joint called?

Answer 19

Soft tissue haematoma

Question 20

When is a knee effusion normal?

Answer 20

Never normal

Question 21

What are the types of knee effusion and what is suspected until proven otherwise?

Answer 21

Haemarthrosis - blood in joint
- ACL injury until proven otherwise

Lipo-haemarthrosis- fat and blood in joint
- fracture until proven otherwise

Question 22

What is haemarthrosis in the knee thought to be caused by until proven otherwise?

Answer 22

ACL injury

Question 23

What is lipo-haemarthrosis in the knee thought to be caused by until proven otherwise?

Answer 23

Fracture

Question 24

Causes of knee swelling

Answer 24

VITAMIN C+D
Vascular - haemarthosis
Inflammatory - bursitis
Trauma - meniscal tear&raquo_space; effusion
Autoimmune - RA
Metabolic - gout
Iatrogenic - infected prosthetic joint
Neoplasia - rare
Cancer - rare
Degernative - OA

Question 25

How many ligaments are ruptured in a knee joint dislocation?

Answer 25

3/4

Question 26

Cause of knee joint dislocation

Answer 26

High energy trauma

Question 27

Mechanism of collateral ligament injury

Answer 27

Contact/direct blow *e.g. sport*

Question 28

What type of strain is there if the medial collateral ligament is injured?

Answer 28

Valgus strain }{

Question 29

What type of strain is there if the lateral collateral ligament is injured?

Answer 29

Varus strain {}

Question 30

What is the unhappy triad?

Answer 30

ACL Medial collateral ligament Medial meniscus

Question 31

Treatment of collateral ligament injury

Answer 31

Brace + rehabilitation Surgical repair + reconstruction

Question 32

What crucial ligament is more common to injury?

Answer 32

ACL

Question 33

Mechanism of ACL injury

Answer 33

Non contact - landing or direction change

Question 34

Mechanism of PCL injury

Answer 34

Contact - falls + hyperextension

Question 35

What tests can be used to examine the cruciate ligaments

Answer 35

Lachman’s test Anterior and posterior drawer test

Question 36

What do normal menisci look like on an MRI?

Answer 36

Black triangle

Question 37

Mechanism of meniscal injures

Answer 37

Twisting injury

Question 38

Symptoms of meniscal injuries

Answer 38

Catching Jamming Locking - unable to straighten knee Localised pain Swelling

Question 39

Treatment of traumatic meniscal injury

Answer 39

Meniscal repair Menisectomy

Question 40

Treatment of degenerative meniscal injury

Answer 40

Leave alone Rehabilitate

Question 41

What helps to prevent patella dislocation?

Answer 41

Vastus medialis obliquus

Question 42

Function of VMO

Answer 42

Stabilise patella in trochlea groove Control tracking in flexion + extension Prevents patella dislocation

Question 43

Mechanism of patella dislocation

Answer 43

Twisting action in slight flexion Trauma Direct blow to knee

Question 44

Predisposition of patella dislocation

Answer 44

Previous dislocation Long patellar ligament Shallow trochanter grove Ligament laxity Weakness of Vastus medialis obliquus

Question 45

Treatment of patella dislocation

Answer 45

Reduce + immobilise Soft tissue reconstruction

Question 46

How to check for a patella fracture

Answer 46

Ask patient to raise a straight leg Inability to is indicative of a patella fracture

Question 47

Inability to raise straight leg is indicative to what?

Answer 47

Patella fracture

Question 48

What risk if there after a patella fracture?

Answer 48

Post traumatic OA

Question 49

Treatment of displaced patella fracture

Answer 49

Reduce + fix

Question 50

Treatment of undisplaced patella fracture

Answer 50

Splint + protect

Question 51

Sites of femoral shaft fractures

Answer 51

Proximal Mid shaft Supracondylar

Question 52

Risk after femoral shaft fracture

Answer 52

Hypovolaemic shock

Question 53

Mechanism of femoral shaft fracture

Answer 53

High energy injury - RTA + falls from height Significant force needed

Question 54

Treatment of femoral shaft fracture

Answer 54

Traction splint - stabilises bone Surgical fixture

Question 55

Mechanism of distal femoral fracture

Answer 55

Young - high energy sport Older - fall from standing

Question 56

What is at risk of damage in a distal femoral fracture?

Answer 56

Popliteal artery