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Orthopaedics (Surgery) > Knee > Flashcards

Knee Flashcards

1
Q

what is the main role of the anterior cruciate ligament

A

limits anterior translation of the tibia (relative to the femur)

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2
Q

what is the most common mechanism of ACL tears

A

athletes who twist their knee whilst in a flexed position and whilst weight bearing

majority occur without contact

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3
Q

clinical features of an ACL tear

A

rapid joint swelling (due to ligament being highly vascularised, hence damage leads to haemoarthrosis)

significant pain

instability

unable to weight bear

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4
Q

what are the specific clinical tests to identify an ACL tear

A

Lachman Test

Anterior draw test

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5
Q

describe Lachmans Test

A

placing the knee in 30 degrees flexion, with one hand stabilising the femur pull the tibia forward to assess the amount of anterior movement of the tibia compared to the femur

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6
Q

investigations into ACL tears

A

plain film radiograph to exclude fracture

gold standard is an MRI scan of the knee

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7
Q

management of an ACL tear

A

as with any acutely swollen knee, the immediate management of a suspected ACL tear is RICE (rest, ice, compression, elevation)

Conservative; rehab and knee splint

surgical; reconstruction of the ACL, or acute surgical repair of the ACL by suturing the two torn ends of the ligament back together

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8
Q

classification system used in knee OA

A

Kellgren and Lawrence system

Grade 0-4 dependent on severity of characteristic OA changes

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9
Q

management of knee OA

A

conservative; weight loss, smoking cessation, exercise, analgesia, physio

surgical; total or partial knee replacement

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10
Q

what is patellofemoral OA

A

osteoarthritis of the articular cartilage along the trochlear groove of the femur and the underside of the patella

common symptom is pain when walking up the stairs (anterior knee)

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11
Q

a medial collateral ligament tear occurs after trauma to what part of the knee

A

lateral side

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12
Q

what is the most commonly injured ligament of the knee

A

medial collateral ligament

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13
Q

how are MCL injuries graded

A

grade I-III

grade III being severe injury with a complete tear of the MCL

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14
Q

characteristic feature of an MCL tear

A

patient reports hearing a ‘pop’ sound followed by immediate medial joint line pain

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15
Q

investigations into an MCL tear

A

X-ray to exclude fracture

gold standard being an MRI

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16
Q

management of MCL tear

A

dependent on the grade of injury

grade I - RICE, analgesia, physio

grade II - analgesia, knee brace, physio

grade III - analgesia, knee brace, crutches, any associated distal avulsion fracture then surgery is required

17
Q

what determines if an MCL tear requires surgery

A

distal avulsion on MRI

18
Q

what nerve can be damaged in MCL tears

A

saphenous nerve

19
Q

describe the anatomy of the meniscus of the knee

A

lateral and medial meniscus - sits on the tibial plateau and acts as shock absorber of the knee joint

the medial meniscus is less circular than the lateral meniscus and is also attached to the MCL whereas the lateral meniscus is not attached to the LCL

20
Q

different types of meniscal tear and which one is most common

A

longitudinal (Bucket handle) tear - most common

vertical

transverse

degeneration

21
Q

clinical features of a meniscus tear

A

‘tearing’ sensation in the knee

intense sudden onset pain

locked in flexion and unable to extend

joint effusion

22
Q

investigation into Meniscal tears

A

x ray to exclude fracture

MRI is gold standard

23
Q

management of meniscal tears

A

conservative; RICE and analgesia (usually small tears)

surgical; arthroscopic surgery to repair meniscus (larger tears or those remaining symptomatic)

24
Q

mechanism of injury of a patellar fracture

A

usually either a hard blow to the patella or a strong contraction of the quadriceps muscle

25
Q

what is a bipartite patella

A

congenital condition whereby there is failure of patella fusion, leaving two separate bone fragments of the patella joined only by cartilaginous tissue

26
Q

management of a patella fracture

A

conservative; place in cast and ensure early weight bearing (minimally displaced or non-displaced fractures providing extensor mechanism is still intact)

surgical; reduction, fixation and restoration of extensor mechanism, ORIF with tension band wiring is the most common method (significant displacement or extensor mechanism is compromised)

27
Q

why are tibial shaft fractures more susceptible to open fractures and compartment syndrome

A

lack of soft tissue envelope around the bone, particularly anteromedial

presence of fascial compartments in the lower leg

28
Q

clinical features of compartment syndrome

A

pain out of proportion to the injury

pain worse on passive stretch of the affected compartments

29
Q

management of tibial shaft fracture

A

resus and stabilisation

realignment under analgesia, following this apply an above knee backslab and elevate limb and closely monitor for signs of compartment syndrome

surgical management; IM nailing, ORIF with locking plates (acute compartment syndrome, limb ischaemia or open fracture)

30
Q

common mechanism of a tibial plateau fracture

A

high energy trauma such as a fall from height, with impaction of the femoral condyle onto the tibial plateau

31
Q

what does fat inside the joint (lipohaemarthrosis) indicate

A

indicates an intra-articular fracture present e.g. tibial plateau, patella or distal femur

32
Q

management of a tibial plateau fracture

A

conservative; knee brace, analgesia and physio (uncomplicated fractures)

surgical; ORIF to restore joint surface, followed by a knee brace (complicated fractures, open fractures or compartment syndrome)

33
Q

what is the iliotibial band

A

branch of longitudinal fibres that form the shared aponeurosis of the tensor fasciae latae muscle and the gluteus maximus muscle

it extends from the iliac tubercle to the anterolateral tubercle of the tibia

34
Q

what is iliotibial band syndrome

A

inflammation of the iliotibial band

35
Q

risk factors for iliotibial band syndrome

A

regular exercise involving repetitive flexion and extension of the knee

commonly in runners, weightlifters or cyclists

36
Q

clinical features of iliotibial band syndrome

A

lateral knee pain exacerbated by exercise

37
Q

specific tests for iliotibial band syndrome

A

nobles test

renne test

38
Q

investigations into iliotibial band syndrome

A

clinical diagnosis

X ray or MRI can be used to exclude other pathologies if history and examination aren’t conclusive

39
Q

management of iliotibial band syndrome

A

conservative; modify activity, analgesia, physio, local steroid injections

surgical; involves release of iliotibial band from its attachment at the patella (in functionally limited patients or those who remain symptomatic)

Orthopaedics (Surgery) (10 decks)

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