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MSK Pathology > Knee > Flashcards

Knee Flashcards

1
Q

What in the knee has the thickest hyaline cartilage in the body?

A

retropatellar surface

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2
Q

Which joint contains the menisci?

A

tibiofemoral joint

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3
Q

What is the main role of the ACL?

A

prevents abnormal internal rotation of tibia

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4
Q

What is the PCL for?

A

prevents hyperextension and anterior translation of femur

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5
Q

How is the ACL assessed?

A

assessing anterior translation of tibia

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6
Q

How is PCL assessed?

A

assessing posterior translation of tibia

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7
Q

What does the MCL do?

A

resists valgus force

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8
Q

What does the LCL do?

A

resists varus force

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9
Q

What may predispose early OA of the knee?

A

previous meniscal tears

ligament injurines and malalignment

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10
Q

What side of OA does genu varum lead to?

A

medial OA

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11
Q

What side of OA does genu valgum lead to?

A

lateral OA

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12
Q

What should you consider in a patient with substantial knee pain and disability where conservative management is no longer effective?

A

knee replacement

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13
Q

Is there more of a chance of dislocation in knee or hip replacements?

A

hip

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14
Q

In which, knee or hip replacements is there a higher chance of unexplained pain?

A

knee

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15
Q

Which type of injuries classically occur with twisting force on loaded knee?

A

meniscal injuries

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16
Q

Describe presentation of meniscal injury.

A

localized pain
effusion develops by following day
catching sensation or locking - difficulty straightening knee

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17
Q

When do ACL ruptures tend to occur?

A

with higher rotational force, turning upper body laterally on planted foot
Normally during high impact sports

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18
Q

Describe what symptoms occur in an ACL injury.

A

pop is usually heard/felt
patient develops haemarthrosis and swelling within an hour
deep pain

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19
Q

What may patients complain of in ACL later?

A

rotatory instability

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20
Q

What happens to the tibia in ACL rupture?

A

excessive internal rotation

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21
Q

What may cause a valgus stress injury?

A

rugby tackle from side

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22
Q

What will a valgus stress injury usually tear?

A

MCL, but if higher force, may also damage ACL

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23
Q

A direct blow to the anterior tibia with the knee flexed eg in a motorcycle crash may rupture what?

A

PCL

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24
Q

What will a varus stress injury rupture?

A

LCL/PCL

25
Q

What percentage of ACL ruptures also have a meniscal tear?

A

25%

26
Q

What may clinical examination of a meniscal tear reveal?

A

effusion
joint line tenderness
pain on tibial rotation

27
Q

A locked knee with a displaced bucket handle meniscal tear will have what degree block to full extension

A

15’

28
Q

What type of meniscal tear is more common and why?

A

medial because medial meniscus is more fixed so force from pivoting movements is centred here

29
Q

What may large longitudinal tears result in?

A

bucket handle tear

30
Q

What happens in a bucket handle tear?

A

large meniscal fragment can flip out of its normal position and displace anteriorly and knee locks

31
Q

Why does the knee lock in a bucket handle tear?

A

due to mechanical obstruction from trapped meniscal fragment

32
Q

When do degenerate meniscal tears tend to occur?

A

as meniscus weakens with age

33
Q

Why does the meniscus have limited healing potential?

A

only has arterial blood supply in outer third

34
Q

What type of meniscal tears should be considered for meniscal repair?

A

fresh, longitudinal tears, involving outer 1/3 of meniscus in younger patient

35
Q

What should be performed in patients with meniscal tear in whom pain or mechanical symptoms do not improve in around 3 months?

A

arthroscopic partial menisectomy

36
Q

What is the principal complaint in an ACL injury?

A

rotatory instability, giving way on turning

37
Q

What does clinical examination reveal in ACL?

A

knee swelling with excessive anterior translation of tiba on anterior drawer test and Lachman

38
Q

Who are good candidates for ACL reconstruction and what does it involve?

A

those who want to go back to sports

involves tendon graft and intense rehabilitation

39
Q

Do MCL tears tend to heal well?

A

Yes

40
Q

How are acute MCL tears usually treated?

A

hinged knee brace

41
Q

How can chronic MCL instability be treated?

A

MCL tightening or reconstruction with tendon graft

42
Q

What is a complete knee dislocation?

A

rupture of all four of the knee ligaments

43
Q

What may reperfusion in complete knee dislocation result in?

A

compartment syndrome, especially after prolonged ischaemia

44
Q

When does an extensor mechanism rupture e.g. of patellar tendon or quadriceps tendon tend to occur?

A

with rapid contractile force eg after lifting heavy weight

45
Q

What should the assessment of ANY acute knee injury include?

A

straight leg raise test to determine if extensor mechanism is intact

46
Q

Which out of patellar tendon ruptures and quadriceps tendon ruptures occur in under 40s?

A

patellar tendon ruptures

47
Q

Who may be likely to get an extensor mechanism rupture?

A

body builders

48
Q

What antibiotics can cause tendonitis and risk tendon ruptures?

A

quinolones e.g. ciprofloxacin

49
Q

Should steroid injections for tendonitis of the extensor mechanism of the knee be given?

A

no - high risk of tendon rupture

50
Q

What may X rays reveal regarding the patella in extensor mechanism ruptures?

A

high patella in patella tendon rupture or low lying in quads rupture

51
Q

What may determine the extent of the extensor mechanism injury in obese patient?

A

ultrasound

52
Q

What does patellofemoral dysfunction describe?

A

disorders of patellofemoral articulation resulting in anterior knee pain

53
Q

In whom is patellofemoral dysfunction more common?

A

females, particularly in teens

54
Q

What do patients complain of in patellofemoral dysfunction?

A

anterior knee pain, worse going downhill, grinding/clicking sensation at front of knee
stiffness after prolonged sitting causing “pseudolocking” - stiffens in flexed position

55
Q

When do you see true locking?

A

bucket handle tear

56
Q

Which way does the patella almost always dislocate?

A

laterally

57
Q

What is seen on X ray in patellar dislocation?

A

lipo haemarthrosis

58
Q

Does risk of patellar instability increase or decrease with age?

A

decrease

MSK Pathology (17 decks)

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