Disorrders Of The Knee Flashcards
Why are knee disorders important?
• Major weight-bearing joint • Required for walking – Critical for health & fitness • Reduces mobility – Predisposition to falls – Weight gain • Disability • Inability to Work • Psychosocial issues – Depression – Social isolation
What are moral shaft fractures?
• High energy injuries
– RTA (MVA)
– Falls from height
• Site
– Proximal
– Mid-Shaft
– Supracondylar
• Blood loss
– 1500 ml
– Hypovolaemic Shock
- Traction Splint
- Surgical fixation
What are tibial plateau fractures?
• High energy injury • Axial loading and angulation • Uni- / Bi-condylar • Articular cartilage damage • Instability • Accurate joint surface reduction • Fix articular segment to shaft • CT Scan • Post-traumatic OA “Exploded” out joint surafce damage unstable
What are patella fractures
• Direct or Indirect force • Is the Extensor Mechanism intact? – Straight Leg Raise • Displaced – Reduce & Fix • Undisplaced – Splint & Protect • Lever arm for Quadriceps • Post-traumatic OA
Beware Bipartite Patella
What is. Patella dislocation/subluxation
• Lateral direction • Twisting actions in small knee bend • Falls on bent knee • Predispositions are common – Ligamental laxity – Shallow groove – Long patellar tendon – Previous dislocations • Reduce & Immobilise • Giving way • Soft tissue reconstruction
What are meniscal injuries
• Twisting injury in high flexion • Localised pain • Swelling • Mechanical symptoms – Catching, Jamming, ‘Locking’ • MRI • Traumatic – Menisectomy / Meniscal repair • Degenerative – Leave alone & Rehabilitate?
Describe the knee joint stability
• Static
– Bones / Ligaments
• Dynamic
– Muscle & Tendons
• Knee Stability – Bones? – Menisci – 2 Collaterals – 2 Cruciates – Posterior Capsule – Quadriceps – Hamstrings
What are collateral ligament injuries
• Contact / Direct blow – Sport • Medial – Valgus strain • Lateral – Varus strain • Pain and/or Instability • Brace & Rehabilitation • Associated injuries – ‘Terrible triad’ • Surgical repair / reconstruction
What are cruciate ligament injuries
Anterior (ACL)
• Non contact - Landing or direction change
• Anterolateral Rotatory Instability
• Recurrent instability
– ‘Giving way’
– Twisting / turning / sudden stops
• Rehabilitation ± Surgical reconstruction
Posterior (PCL)
• Contact - Fall onto knee or hyperextension
• Brace & Rehabilitation
What is knee joint dislocaion
• Uncommon • High energy trauma • 3 out of 4 ligaments ruptured • Vascular injury – Popliteal artery tethers – Angiography / MRA • Reduce & Stabilise • Late Stiffness & Instability
Why can swelling of the knee occur
• Bony
– e.g. Osgood-Schlatters Disease
• Soft Tissue
– Localised or Generalised
– Mass?
• Fluid
– Inside or Outside of the joint
• Knee effusion – Never normal – Acute – Haemarthosis • < 6 hrs – Sub-acute – Reactive Synovitis • Next day / Variable
What are accute knee effusions
Haemarthrosis - Acl until proven otherwise
Lip-haemarthrosis - fracture until proven otherwise
See slide for images
What are bursae
- Fluid filled sacks protecting bony prominences
- Bursitis - Inflammation (and fibrosis) of a Bursa
• Chronic mechanical irritation
• Pre-patella Bursitis
– ‘Housemaids knee’
• Infra-patella Bursitis
– ‘Clergyman’s knee’
• Supra-patella Bursitis
– Knee joint effusion
• Semimembranosus Bursitis
– Popliteal (Baker’s) Cyst
What is knee arthritis
• Osteoarthritis
– ‘Wear & tear’
• Inflammatory Arthritis
– Sero-Positive (Rheumatoid) / Sero-Negative / Crystal (Gout)
• Joint surface / Chondral damage
– Diffuse
– Limited capacity for repair
- Synovitis (Swelling)
- Pain / Stiffness / Loss of function
• Deformity
– Varus / Valgus / Fixed flexion
• Uni- / Bi- / Tri-Compartmental
What is knee osteoarthritis
• Prevalence – 12% population, 35% >75yrs • Fluctuating symptoms – Provoked by activity, relieved by rest • Predispositions – Age / Sex / Weight / Post-trauma / Genetics • Treatment – Strengthening exercises / Analgesia / Weight loss / Activity modification – Surgery • 110 000 TKRs/yr in UK • 1 200 TKRs/yr in Leicester
