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MSK > Knee > Flashcards

Knee Flashcards

1
Q

Name the two ‘joints’ that make up the knee joint.

A
  • Medial and lateral compartments of the tibiofemoral joint
  • Patellofemoral joint
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2
Q

What is the role of the menisci in the tibiofemoral joint

A
  • Ensures congruence of the concave femoral condoles & flattish tibial plateau
  • Act as shock absorbers
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3
Q

What is the main role of the ACL & how is it tested

A

Main role: Resists internal rotation of tibia,
But also: Prevents anterior translation of tibia
Clinical test: Lachman’s/ Anterior drawer test

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4
Q

What is the main roles of PCL & how is it tested

A

Main roles: Prevents hyperextension & posterior translation of tibia
Clinical Test: Posterior drawer test

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5
Q

What is the main roles of MCL

A

Resists valgus force

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6
Q

What is the main roles of LCL

A

Resists varus force & external rotation of tibia

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7
Q

Clinical history & presentation of an ACL tear

A
  • High force twisting injury with audible ‘pop’
  • Sudden onset rotatory instability
  • Positive anterior drawer/ lachman’s test
  • Haemarthrosis effusion within an hour
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8
Q

Clinical history & presentation of a PCL tear

A
  • Direct blow to anterior tibia
  • Hyper extension &/ instability descending stairs
  • Positive posterior drawer test
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9
Q

Clinical history & management of an MCL tear

A
  • Valgus stress
  • Medial joint line tenderness
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10
Q

Clinical history & management of an LCL tear

A
  • Varus stress
  • Lateral joint line tenderness
  • Associated ACL/PCL tear
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11
Q

Clinical history of a menisceal tear

A
  • Twisting injury on loaded knee OR
  • getting up from squatting
  • ‘giving way’/ ‘catching’/ ‘locking’
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12
Q

Clinical presentation of a lateral menisceal tear

A
  • pain on internal rotation
  • pain on lateral joint line
  • effusion within a day
  • ‘catching’/ ‘locking’ when straightening knee
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13
Q

Clinical presentation of a medial menisceal tear

A
  • pain on external rotation
  • pain on medial joint line
  • effusion within a day
  • ‘catching’/ ‘locking’ when straightening knee
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14
Q

If you were to take a joint aspiration after a ligament tear what would you expect to find?

A

Haemarthrosis (especially with ACL tears)

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15
Q

What nerve is commonly injury with an LCL tear

A

Common peroneal nerve injury

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16
Q

What clinical test can be used to check for a menisceal tear

A

Steinman’s/ McMurrays test

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17
Q

Summarise the clinical tests used for ACL, PCL, MCl & LCL tears

A

ACL - anterior drawer test/ lachmans test
PCL - posterior drawer test
MCL - valgus stress test
LCL - varus stress test

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18
Q

How would you test for a displaced bucket handle menisceal tear

A

Heel height test
Positive - heel height discrepancy, indicating fixed flexion deformity

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19
Q

How would you test for a bucket handle menisceal tear

A

Heel height test
Positive - heel height discrepancy

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20
Q

Why might a patient feel as though their knee might give way with a menisceal tear

A

Loose menisceal fragment is caught in the knee when walking

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21
Q

Why might a patient feel as though their knee might give way with a menisceal tear

A

Loose menisceal fragment is caught in the knee when walking

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22
Q

Valgus stress injuries usually cause an MCL tear. If they occur at a high enough force, they can also tear another ligament and risk fracture of a bone. Name this ligament & bone.

A

ACL & tibial plateau fracture

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23
Q

What does a lipohaemarthrosis indicate

A
  • Fracture with intra-articular extension OR
  • significant intra-articulator soft tissue injury (ligament or menisci)
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24
Q

Degenerate menisceal tears occur with age and are often the first stage of what condition

A

Osteoarthritis

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25
Q

Why do meniscal tears have a limited healing potential

A

Menisci only have an arterial blood supply around their outer third

26
Q

What two factors further decrease the healing potential of meniscal tears

A
  • age >25yrs
  • increased time from injury
27
Q

Meniscal tear investigations

A

MRI

28
Q

Meniscal tear management

A

Young patient & bucket handle meniscal tear OR
Younger patient & acute traumatic peripheral meniscal tear
=> possibility for meniscal repair
————————————————————————————
Failed meniscal repair & recurrent pain/locking/effusion OR
Meniscal repair unsuitable & recurrent pain/locking/effusion
=> arthroscopic meniscectomy
————————————————————————————
If degenerative changes on X-ray or MRI
=> avoid surgical intervention
=> analgesia & possible corticosteroid injections

29
Q

ACL/PCL/MCL/LCL Investigations

A

Usually clinical diagnosis but MRI can be helpful for confirmation or to rule out other conditions.

30
Q

Summarise ACL/PCL/MCL/LCL treatment

A
  • Acute MCL tear - hinged knee brace
  • Chronic MCL tear - MCL tightening
    ————————————————————————————
  • Acute LCL tear - Repair
  • Late diagnosis - Reconstruction with tendon graft
    ————————————————————————————
  • Acute ACL/PCL tear - Rest & physio
  • Chronic ACL/PCL instability - Reconstruction & rehab
31
Q

Name some factors that make someone a good candidate for ACL reconstruction

A
  • failure to respond to physio
  • professional sportsperson
  • those whose knees give way on sedentary activities
32
Q

What does an ACL reconstruction involve

A

Tendon graft being passed through tibial and femoral tunnels and secured at usual ACL location. Followed by intensive rehab with up to a year before getting back to high impact sports.

33
Q

Complete knee dislocation aetiology

A
  • serious high energy injuries OR
  • low energy injuries in elderly
34
Q

Complete knee dislocation investigations

A
  • Urgent & then regular neurovascular status checks
  • Imaging - NV status concern (CT angio), no concern (MRI)
35
Q

Complete knee dislocation management

A

IMMEDIATE
- Urgent neurovascular status check
- Emergency reduction under sedation & external fixator PRN
- Recheck neurovascular status
————————————————————————————
IF VASCULAR ISSUE
- Vascular stenting or bypass
- Observe closely for compartment syndrome
————————————————————————————
DEFINITIVE
- Multi-ligamentous repair

36
Q

Which nerve & which artery is commonly affected in a complete knee dislocation

A
  • Popliteal artery
  • Common peroneal nerve
37
Q

What makes up the extensor mechanism of the knee

A

Tibial tubersoity, patellar tendon, patella
Quadriceps tendon, quadriceps muscles

38
Q

Extensor mechanism rupture clinical history

A

Rapid contractile force e.g. after heavy lifting, falling or severe tendon degeneration

39
Q

Extensor mechanism rupture risk factors

A
  • Runners or jumpers
  • Previous tendonitis, Steroids, Quinolones
  • CKD, Diabetes, RA
40
Q

Extensor mechanism rupture can be caused by rupture of the patellar or quadriceps tendon. Which is more likely in younger patients and which is more likely in older patients?

A

Younger patients (<40) - Patellar tendon
Older patients (>40) - Quadriceps tendon

41
Q

Extensor mechanism rupture clinical presentation

A
  • Sudden onset knee pain and weakness
  • Unable to straight leg raise (or reduced power - partial tear)
  • Palpable gap in extensor mechanism
42
Q

Extensor mechanism rupture investigations

A
  • X-Ray - Effusion & patellar displacement (high -PT, low -QT)
  • USS/MRI - Partial/ complete tendon tear
43
Q

Extensor mechanism (complete/ substantial partial) rupture management

A

Urgent surgical repair and post-op physio

44
Q

Can steroid injections be used in extensor mechanism tendonitis? Why?

A

No - high risk of rupture

45
Q

What is patellofemoral dysfunction and how would it present?

A

What? - Any disorder of patellofemoral articulation causing anterior knee pain, often worse when going downhill.

Other symptoms - grinding or clicking sensation & pseudolocking/ stiffness after prolonged sitting

46
Q

Patellofemoral dysfunction management

A

Physiotherapy to rebalance quadriceps muscles
(especially the vastus medialis obliqus)

47
Q

Softening of the patella hyaline cartilage can occur in patellofemoral dysfunction. What is the name for it?

A

Chondromalacia patellae

48
Q

Patellar dislocations can occur with a direct blow or sudden twist of the knee. Which way does the patellar tend to dislocate to? Which ligament is teared?

A

Laterally
Medial patellofemoral ligament tear

49
Q

As the medial facet of the patella strikes the lateral femoral condyle during patella dislocation, what may occur?

A

Osteochondral fracture

50
Q

Describe the X-ray appearance of a patellar dislocation

A
  • Medial patellofemoral tear
  • Lipohaemarthrosis
  • Small opacification (if osteochondral fracture)
51
Q

Patella dislocation management

A

Usually spontaneously reduces.
Follow up physiotherapy

52
Q

Recurrent patella dislocation/ instability management

A

Patellofemoral ligament reconstruction + tendon autograft
OR Tibial tubercle transfer

53
Q

Patella dislocation investigations

A
  • Positive patella apprehension test
  • X-ray
54
Q

Patella dislocation risk factors

A
  • Ligamentous laxity/hypermobility
  • Increased Q-angle - genu valgum, femoral neck anteversion
  • High riding patella
  • Hypoplastic lateral femoral condyle
  • Lateral quads insertions or weak vastus medialis
55
Q

What is a major source of pain after a meniscal/ ligament injury & how is it treated

A

Bone marrow oedema
Self limiting, typically settles after 3 months

56
Q

Loose bodies can occur due to trauma, OCD and joints degeneration and present as a mobile lump or sharp occasional pain & locking. How would you determine whether it is truly a ‘loose’ body or not?

A

MRI or serial XRay’s

57
Q

A fabella is commonly misdiagnosed as a loose body on X-Ray. What is it?

A

An accessory ossicle usually in the lateral head of the gastrocnemius

58
Q

acute haemarthrosis… what next?

A

acute haemarthrosis warrants an MRI to confirm Dx and look for associated injuries

59
Q

acutely locked knee… what next?

A

acutely locked knee warrants prompt MRI and management to prevent fixed flexion and potentially repair a meniscus

60
Q

Football injury, twist, pop, haemarthrosis, generalised pain, pain settles after a few days, rotatory instability. What is the most likely diagnosis?

A

ACL rupture

61
Q

Getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain & catching +/- locking. What is the most likely diagnosis?

A

Meniscal tear

MSK (20 decks)

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