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Musculoskeletal > Knee > Flashcards

Knee Flashcards

1
Q

What could cause a haemarthrosis in the knee?

A

ACL

Fracture

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2
Q

What is likely to cause an effusion?

A

Meniscal or chondral injury

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3
Q

If there is pain in the joint line, what might this be?

A

meniscal/chondral

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4
Q

How can you check for effusion/haemarthosis?

A

Wipe test

Patellar ballottement

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5
Q

Gap in extensor mechanism?

A

Quad or PT rupture

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6
Q

Pain in the joint lines?

A

Meniscus

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7
Q

Pain on the bony prominences?

A

Fracture

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8
Q

What does straight leg raising assess?

A

The integrity of the extensor mechanism

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9
Q

Meniscal provocation test?

A

McMurrays

-Pain or palpable click suggests meniscal tear

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10
Q

Movements to check knee?

A

Straight leg raise (extensor mechanism)
Extension (springy block to full extension indicated locked knee-displaced bucket handle tear)
Flexion

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11
Q

Ligament Tests

A

May be difficult in acute setting

Look for abnormal laxity compared to contralateral knee and for end point

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12
Q

When checking for MCL and LCL injuries, why do you flex the knee to 30º?

A

To relax the posterior capsule

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13
Q

Which ligament tear does the Lachman test look for?

A

Anterior cruciate ligament

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14
Q

Tests for anterior cruciate ligament?

A

FIRST, check no posterior sag (PCL, would give false positive)
Lachman test at 30º
Anterior drawer test at 30º

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15
Q

Tests for posterior cruciate ligament?

A

Posterior sag at 90º

Posterior drawer test at 90º

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16
Q

If you have a suspected tibial plateau fracture, what investigation should you carry out?

A

CT

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17
Q

Investigation for fracture/bony avulsion?

A

X-ray

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18
Q

What are 50% of ACL tears associated with?

How would you investigate?

A

50% of ACL tears are associated with meniscal tears

Investigate with MRI

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19
Q

What could happen if a bucket handle tear isn’t repaired?

A

Could develop a fixed flexion deformity

20
Q

The 3 grades of ligament tear?

A

Grade 1: some fibres tear but macroscopic structure still in tact
Grade 2: partial tear with some fascicles disrupted
Grade 3: complete tear

21
Q

Surgery for MCL tear?

A
  • usually heals well even if complete tear unless combined with ACL or PCL rupture
  • brace, early motion, physio
  • Pain can take several months to settle
  • If combined ACL & MCL rupture may consider early ACL reconstruction + MCL repair

-Rarely requires surgery – advancement or reconstruction with tendon graft

22
Q

Which ligament is the main stabiliser against internal rotation of the tibia?

A

ACL

23
Q

ACL rupture

A

ACL is main stabiliser against IR of tibia
Usually sports injury – football, rugby, skiing
ACL repair doesn’t work  reconstruction only
Autograft – Patellar tendon or hamstrings
Allograft – Achilles
(synthetic graft)
ACL can stick to PCL to give some stability
Physio can stabilise ACL deficient knees

24
Q

Which nerve is commonly damaged following an LCL injury?

A

Common peroneal nerve palsy

25
Q

How quickly should you aim to repair LCL tears?

A

You should aim to repair them quickly (i.e. within 2-3 weeks)
If you repair them later, you are probably going to have to do a reconstructio

26
Q

An injury to which ligament to lead to a feeling of instability when going down the stairs?

A

PCL

27
Q

Wn injury to which ligament could present with popliteal knee pain and bruising?

A

PCL

28
Q

Is a PCL injury usually isolated?

A

No, usually occurs with other injury

29
Q

Complications of high energy knee dislocation?

A
  • Popliteal artery injury
  • Common peroneal nerve injury
  • Compartment syndrome
30
Q

How might you dislocate your patellar?

A

Rapid turn or direct blow

31
Q

Extensor mechanism rupture?

A
  • Falling onto flexed knee with quads contraction
  • Previous tendonitis
  • Steroids
  • Chronic renal failure (CIPROFLOXACIN)
32
Q

Which test can people with extensor mechanism rupture not do?

A

The can’t do a straight leg raise and there is a palpable gap
-Needs surgical repair

33
Q

If you fall onto your knee with quad contraction what might happen?

A

You might rupture your extensor mechanism

34
Q

How might an osteochondral injury heal?

A

It may heal with fibrocartilage

  • If not, you can do surgery (drilling, microfracture, culture, osteochondral plugs)
  • Surgery only for smaller lesions and NOT OA
35
Q

What does the PCL prevent?

A

PCL prevents hyperextension and anterior translation of femur

36
Q

What is the principle role of the ACL?

A

To prevent internal rotation of the tibia

37
Q

What is the function of the LCL?

A

The LCL prevents external rotation of the tibia, it also prevents against varus force

38
Q

Effusion, joint line tenderness, pain on tibial rotation, localising to the affected compartment?

A

Meniscal tear

39
Q

Meniscal tear

A

Effusion, joint line tenderness, pain on tibial rotation localising to the affected compartment (Steinman’s test)

40
Q

Why are medial meniscal tears more common than lateral meniscal tears?

A

The medial meniscus is more fixed and less mobile than the lateral meniscus and the force from pivoting movements is centred on the medial compartment

41
Q

Which part of the meniscus has a blood supply?

A

The outer 1/3rd of the meniscus has a blood supply
therefore, the meniscus has limited healing potential
Healing potential also decreases with age (over about 25-30, healing rates are poor) and with increased time from injury

42
Q

Which type of meniscal tear should be considered for surgery?

A

Longitudinal in the outer 1/3rd of the meniscus in a younger patient
Repair involves suturing the meniscus to its bed
(25% of repairs still fail though and require arthroscopic menisectomy)

43
Q

Principle complaint of ACL?

A

Rotatory instability with giving way on turning

44
Q

What does the PCL do?

A

PCL prevents hyperextension and anterior translation of the femur

45
Q

Approximately what percentage of patients suffer from unexplained pain following a TKR?

A

15%

46
Q

Which is harder, a TKR or revision of knee replacement surgery?

A

Revision surgery is a bigger undertaking than the original TKR

Musculoskeletal (44 decks)

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