knee

Question 1

______is a fluid filled sack, lined by synovial membrane

Answer 1

bursa

Question 2

This type of film is best at showing patella alta/Baja.

Answer 2

lateral (30 degree flexion)

Question 3

This type of film is always done while the patient is bearing weight (if possible)

Answer 3

AP

Question 4

This type of film is looking specifically at the patella

Answer 4

sunrise

Question 5

This type of film is an AP view of a knee that is bent at 45 degrees

Answer 5

notch

Question 6

What should you do when you notice swelling around a joint?

Answer 6

determine if it is intra or extra articular

Question 7

Your 50 year old male patient comes in c/o a stiff swollen knee after twisting it while doing yard work. He has noticed a locking, catching sensation when he moves the knee. On exam, there’s ttp of the medial joint line, a mild effusion, and LROM. The McMurray test is positive.

Answer 7

Medial meniscus tear

Question 8

What imaging would you get to confirm a medial meniscus tear?

Answer 8

MRI!!! (Plain films will be normal)

Question 9

What is your threshold for surgical repair of a meniscus tear?

Answer 9

pretty low, especially if patient is young due to increased risk of OA.

Question 10

This ortho problem is most often caused by overuse, specifically jumping. The onset of this problem is very sudden, and it takes a long time to heal. PE will show point tenderness and painful knee extension.

Answer 10

patellar/quadriceps tendonitis

Question 11

You suspect either patellar or quadriceps tendonitis, but the patient swears the knee hurts “everywhere”. You decide to get a lateral xray. How would this help you determine if the problem is the patellar tendon or the quadriceps tendon?

Answer 11

1) Patella alta = patellar tendon

2) Patella Baja = quadriceps tendon

Question 12

How would you know if there had been a total rupture of either the patellar or quadriceps tendon?

Answer 12

No extension on exam

Question 13

This injury is commonly caused by the knee hitting the dashboard in an MVA.

Answer 13

PCL

Question 14

This injury will result in a positive posterior drawer sign

Answer 14

PCL

Question 15

This injury results in sudden pain and the sensation that the knee is “giving way”. It is commonly caused by rotation or hyperextension of the knee, and will elicit a positive Lachman test.

Answer 15

ACL

Question 16

These ligaments stabilize the knee against varus and valgus stress

Answer 16

collateral ligaments

Question 17

These ligaments keep the tibia in line with the femur

Answer 17

cruciate ligaments

Question 18

On a plain film, you see an avulsion fx on the lateral tibia, this is called the ________ sign and is associated with injury of the __________

Answer 18

Segond sign, ACL

Question 19

What is the threshold for surgical repair on the ACL? PCL?

Answer 19

reconstruct ACL if no contraindications! Treat PCL non-operatively if possible (brace)

Question 20

Your attending tells you that a patient has a valgus tear. What ligament does that indicate?

Answer 20

MCL

Question 21

A tear of the LCL could also be called ___________

Answer 21

varus tear

Question 22

What is the cardinal finding on PE for a collateral ligament injury?

Answer 22

joint line opening with either varus/valgus stress (and pain)

Question 23

This problem is caused by the softening or degeneration of the articular cartilage on the undersurface of the patella

Answer 23

chondromalacia patella

Question 24

This problem is caused by articular cartilage deterioration, typically most severe in the medial compartment of the knee

Answer 24

OA

Question 25

This problem is caused by irritation of a bursa, usually due to distance running or distance cycling. PE shows point ttp over the epicondyles

Answer 25

IT friction syndrome

Question 26

Your 67 yo female pt comes in c/o mild swelling in her left knee. She notices pops, clicks, catches, and grinding with flexion and extension. She can’t really point to a specific tender spot, but says her pain/discomfort is much worse after she has been sitting or standing for a prolonged period of time. What is the most likely problem?

Answer 26

chondromalacia patellae.

Question 27

How can you tell the difference b/t chondromalacia patellae and OA?

Answer 27

1) OA typically shows up on plain film as MEDIAL joint space narrowing
2) Chondro pat will usually be normal on xray, but MRI will show damage to the articular cartilage of the patella
3) OA = medial

Question 28

Your 56 year old obese patient tells you that his right knee seems to “buckle” on him, and that it is hard to rise from a seated position and to climb up and downstairs without pain. What do you suspect?

Answer 28

OA

Question 29

Your 71 year old OA patient has been using NSAIDS, heat/ice, PT, and a cane for 18 months with minimal relief. You tried 2 rounds of steroid injections which were also a disappointment. What is the next option? (PMH also significant for htn, cholesterol, thyroid dz which are all well managed)

Answer 29

1) Arthroplasty

2) Consider total knee if ineffective.

Question 30

How will you treat your distance runner who has developed IT friction syndrome?

Answer 30

1) rest
2) decrease distance
3) ortho shoes
4) improve stretching
5) steroid injections

Question 31

This dislocation is most likely to be lateral and results from a direct blow to the knee while it is flexed.

Answer 31

patella dislocation

Question 32

this dislocation can be treated conservatively

Answer 32

patella

Question 33

This dislocation is often caused by an MVA and is most likely to be anterior/posterior

Answer 33

knee

Question 34

this dislocation is an emergency (treat surgically)

Answer 34

knee

Question 35

what structures are at great risk during a knee dislocation? (2)

Answer 35

popliteal artery and peroneal nerve

Question 36

This dislocation often causes either an ACL or PCL injury

Answer 36

knee

Question 37

this dislocation causes a tear in the retinacular tissue

Answer 37

patella