- athlete w a hx of twisting the knee whilst weight bearing - occurs w/o contact and result from a sudden change of direction twisting the flexed knee - pt won’t be able to weight bear - pt says there was a ‘popping’ sound and immediate swelling (why so quick?) as well as significant pain - delayed presentation? pt describes leg as ‘giving way’

knee Flashcards by Anika Dossa

KNEE OA risk factors?

genetic factors - specific genes unknown
constitutional factors - eg? x4
local factors - prev joint injury, occupational or recreational stresses on the joint, reduced surrounding muscle strength or any joint laxity or misalignment

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KNEE OA clinical features?

pain - where is this typically felt? where can it radiate to? exacerbating & relieving factors?
often bilateral disease w associated joint stiffness - this can result in reduced function and even joint swelling.

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KNEE OA on examination?

reduced ROM
evidence of muscle wasting
crepitus in severe cases

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KNEE OA differential diagnoses?

main DDs for someone presenting w joint pain and stiffness are:

any meniscal or ligament injury
referred pain from another joint or back
crystal arthropathies - eg gout
patellofemoral arthritis

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KNEE OA imaging & investigations?

plain film x ray (lateral & AP views) you will be able to see diagnostic features on it - LOSS (what is this?)
skyline view can further assess for any ? involvement
additional investigations only required when alternative differentials suspected eg blood tests for infective cause or MRI in ligamentous injury

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KNEE OA classification?

by the Kellgren & Lawrence system - TMS has more detail

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KNEE OA initial management?

lifestyle modifications - eg??
adequate pain control to ensure ongoing mobility & QOL
PT to slow disease progression & improve joint mechanics
conservative management doesn’t work? surgical management is now warranted

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KNEE OA surgical management?

TKR - functions for at least 10 yrs & pts have significant reduction in knee pain
10% of pts only require partial (unicondylar) knee replacement - pts w disease localised to either the medial or lateral compartment so the affected compartment will be replaced and the healthy compartment left intact. PKR are more conservative so faster recovery time but maybe need a TKR at a later date

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KNEE OA what is patellofemoral oa?

patella rests in the trochlear groove on top of the femur - this is where the patella moves back & forth during knee flexion and extension. PF OA is OA affecting the articular cartilage along the trochlear groove & on the underside of the patella.

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KNEE OA - PF OA risk factors?

patella dysplasia - so the patella doesn’t properly fit into ? groove
previous patella fracture - leading to damage to the ? cartilage

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KNEE OA - PF OA clinical features?

anterior knee pain - worse w activities that put pressure on the patella eg??
associated w joint stiffness & swelling
diagnosis mainly made from Hx then confirmed w x rays (mainly skyline view)

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KNEE OA - PF OA management?

conservative - same as knee oa

- surgery: PF replacement -> if OA in other parts of the knee then TKR

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ACL TEAR typical hx?

athlete w a hx of twisting the knee whilst weight bearing
occurs w/o contact and result from a sudden change of direction twisting the flexed knee
pt won’t be able to weight bear
pt says there was a ‘popping’ sound and immediate swelling (why so quick?) as well as significant pain
delayed presentation? pt describes leg as ‘giving way’

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ACL TEAR specific clinical tests which can identify potential ACL damage?

lachman test - what is this?

- anterior draw test - what is this?

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ACL TEAR differential diagnoses?

prox tibial or distal femur fracture
meniscal tear
collateral ligament tear
quadriceps tendon tear
patellar ligament tear

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ACL TEAR imaging?

x ray of knee (AP & lateral) to exclude ?? x3

- MRI - gold standard & also picks up meniscal tears (50% ACL tears also include medial meniscus tears)

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ACL TEAR immediate management?

RICE - what is this?

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ACL TEAR conservative management?

rehab - which utilises strength training of the quadriceps to stabilise the knee. in an emergency setting inpatient admission is rarely required - pt can often partially weight bear & a cricket pad knee splint can be applied for comfort

ACL TEAR surgical management?

surgical reconstruction involves the use of a tendon or an artificial graft. this is performed following a period of ‘prehabilitation’ - pt w a PT for some months before surgery
acute surgical repair of ACL is possible in some cases dependent on the location of the tear within the ligament. if imaging on MRI is favourable pt can be further assessed under GA knee arthroscopy & acute repair involves resuturing the ends of the torn ligament together

ACL TEAR complications?

post traumatic OA - complication of ACL injury & surgery

MENISCAL TEARS menisci anatomy info

the menisci rest on the tibial plateau and have 2 main functions: - shock absorbers of the knee joint & - inc articulating SA
- the medial meniscus is less circular than the lateral and is attached to the medial collateral ligament, whilst the lateral isnt attached to the lateral collateral ligament

MENISCAL TEARS pathophysiology?

most common cause: trauma related injury & degenerative disease
trauma? young pt who has twisted their knee whilst it is flexed and weight bearing w the onset of sx soon after

MENISCAL TEARS types? pics on TMS

vertical
longitudinal (bucket handle)
transverse (parrot beak)
degenerative

MENISCAL TEARS clinical features?

pts report: a tearing sensation in knee, intense sudden onset pain, swelling over 6-12 hrs.
bucket handle tear? knee locked in ??

MENISCAL TEARS OE?

joint line tenderness, significant joint effusion, limited knee flexion

MENISCAL TEARS differentials (for an acutely swollen knee)?

frac, cruciate ligament tear, collateral ligament tear, osteochonditis dissecans

MENISCAL TEARS investigations?

- x ray to exclude frac | - MRI gold standard

MENISCAL TEARS management

- RICE - small tears (<1cm) will resolve over a few days - larger tears/sx?? arthroscopic surgery — tear in outer 1/3? repair w suture (due to ?) — tear in middle? repaired or trimmed — tear in inner 1/3? trimmed to reduce locking sx

MENISCAL TEARS comps?

- secondary OA | - knee arthroscopy - dvt, local structure damage eg saphenous nerve & vein, peroneal nerve & popliteal vessels

QUADS TENDOR TEAR causes?

- occurs on a weight bearing partially flexed knee ie landing a band jump - also by falls, direct impact to front of the knee & lacerations - due to tendon weakness eg tendinitis, chronic disease, steroids, fluoroquinalone abx, deconditioning

QUADS TENDOR TEAR sx?

- tearing/popping sensation - pain & swelling immediately after - stuck in flexion OE: localised swelling, tender palpable defect.

QUADS TENDOR TEAR investigations?

- normally clinical - x ray - patella is in the wrong place (displaced in what direction?) - USS to measure degree of rupture - mri is unsure

QUADS TENDOR TEAR management ?

- non surgical - immobilisation, PT | - surgery if complete tear. post op immobilisation in a brace before strength & flexibility exercise added in @ 6wks

PATELLA FRAC prevalence ?

- M>F | - 20-50 yrs

PATELLA FRAC clinical features?

- pts presents w: anterior knee pain following a mechanism of injury such as a hard blow to the patella (eg RTA) or strong quads contraction - pain is worse of movement and pt can’t straight leg raise (why?) - may not be able to weight bear

PATELLA FRAC OE?

- swollen & bruised knee | - visible & palpable patellar defect between bone fragments is common

PATELLA FRAC differentials?

other fracas, ligament tears, quad tendon tear

PATELLA FRAC x rays?

- plain film radiograph (what views? x3) | - comminuted frac? CT

PATELLA FRAC non-surgical management ?

- conservative - brace or cyclinder cast ensuring early weight bearing in extension w initial minimal displacement & articular step off, before inc flexion incrementally

PATELLA FRAC surgical management ?

* for significant displacement or compromise to the extensor mechanism * - ORIF w tension band wiring - why? - when can screw fixation be used instead?

PATELLA FRAC comps?

RROM, 2 OA

PATELLA DISLOCATION causes

- sudden blow | - sudden chnage in direction when leg is planted on the ground eg sports or dancing

PATELLA DISLOCATION Sx?

* **can pop back into place in many cases!! - popping sensation - severe knee pain - locked in flexion - sudden swelling - can’t weight bear

PATELLA DISLOCATION management ?

if it doesn’t pop back into place itself… - MUA - analgesia - x ray to check - removable splint post MUA - PT