Knee

Question 1

What are the causes of knee pain in an adolescent?

Answer 1

1. associated with systemic sx
   septic arthritis
   cancer
   idiopathic/ juvenile arthritis
2. associated with an abnormal hip examination
   irritable hip
   perthe’s disease
   slipped capital femoral epiphysis
3. associated with trauma
   e. g. ACL/meniscal tear

4. associated with nil systemic sx and nil acute injury 
Anterior knee pain 
patellofemoral pain syndrome 
Osgood-Schlatter's disease 
Osteochondritis Dissecans

Question 2

What is severe’s disease?

Answer 2

Apophysitis of the calcaneus

Question 3

1. What is Osteochondritis Dissecans,
2. Where is it most common in the knee?
3. What causes it?
4. When should it be suspected?

Answer 3

1. Defect in the subchondral bone → avascular necrosis → subchondral bone cannot support the articular cartilage anymore → damage to the articular cartilage (more common in the medial condyle) → bony fragments
2. In the knee occurs most commonly in the medial condyle
3. Cause is idiopathic, thought to be secondary to repetitive overloading .
4. Should be suspected in a young person with an knee effusion it should be xray’d (ref. MSK for GP’s)

Question 4

What is chondromalacia?

Answer 4

It overlaps with patellofemoral pain –>
refers to softening and degeneration of the articular hyaline cartilage of the patella and is a frequent cause of anterior knee pain - patella rubs against the femur (Radiopedia)

Question 5

ACL rupture

Management:

Answer 5

1/ Conservative mx:
Do not all have to be repaired if patient doesn’t complain of being unstable or unable to do what they want to do

2/ Surgical Treatment:
Ideally should be able to straighten nee and waiting to heal for about 4-6/52 before surgery

(Ref: MSK for GP’s 2017)

Question 6

What is the most useful clinical test for mensical injury?

Answer 6

Thessaly Test (90% sensitivity and 95% specificity in detecting mensical injury)

RACGP 2012 - mensical tear