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RB Y2 MSK 04 - Adult Orthopaedics > Knee > Flashcards

Knee Flashcards

1
Q

where is the thickest hyaline cartilage in the body found

A

retropatellar surface

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2
Q

chondrocytes

A

chondrocytes live in ECM in lacuna

they secrete and maintain the ECM

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3
Q

what properties do collagen fibres and proteoglycans have

A

collagen fibres have tensile strength

proteoglycans are highly hydrophilic -act like balloons to give compressive stength

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4
Q

cartilage healing

A

only healing of full thickness injuries is possible - fibrocartilage forms

this is less wear resistant and has greater friction

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5
Q

cartilage regeneration surgical methods

A

drilling/microfracture - holes drilled to induce bleeding promoting fibrocartilage formation from stem cells differentiating into chondrocytes

osteochondral autograft or allograft

mosaicplasty

MACI

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6
Q

mosaicplasty

A
  • Harvest small grafts from non-weight bearing regions of knee and transplant onto affected area
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7
Q

MACI

A

membrane induced autologous chondocyte implantation - harvest healthy chondrocytes

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8
Q

osteochondritis dissecans

A

subchondral bone becomes avascular, and may progress to fragments of bone breaking away to form loose bodies

pothole on surface of bone predisposes to OA

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9
Q

where/who does OD commonly affect

A

knee - lateral side of femoral head

adolescence

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10
Q

treatment of OD

A

may heal spontaneously

lesions which are at risk of breaking off are fixed and loss fragments removed

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11
Q

what predisposes one to early OA of the knee

A

previous meniscal tears, ligament injuries, malalginment

inflammatory arthritis

patellofemoral dysfunction and instability predipose to patellofemoral OA

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12
Q

what OA does genu varus and valgus predipose one to

A

varus - medial

valgus - lateral

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13
Q

who would receive an osteotomy to treat OA

A

younger patients with isolated medial compartment OA - particularly in varus knee - shift the load to the lateral compartment

heavy manual workers

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14
Q

results of osteotomy

A

unpredictable

benefit lasts around 7-10 years

can affect results of later TKR

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15
Q

when is knee replacement considered (OA)

A

patient with substantial pain and disability where conservative management is no longer effective

partial or total

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16
Q

results of knee replacement

A

dissapointing results for OA

younger patients have poorer outcomes

PKR poorer results than TKR (80% satisfaction, 20% ongoing pain)

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17
Q

when is unicompartmental knee replacement considered

A

potential treatment for patients with isolated OA

particularly younger patients

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18
Q

risks of KR surgery

A

infection, thrombosis

often unexplained knee pain after TKR

likely failure and revision surgery in younger patients

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19
Q

if the knee examination is difficult due to pain, but is thought to be significant what will be performed

A

MRI

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20
Q

when do meniscal tears classically occur

A

twisting force on loaded knee or when getting up from squatting

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21
Q

who do meniscal tears usually occur in

A

sporting injuries in younger patients

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22
Q

meniscal injury

A

twsting force/getting up from squatting

pain localises to medial/lateral joint line

effusion develops (inc synovial fluid)

pain and mechanical symptoms - catching/locking

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23
Q

what clinical examination will be performed in acute meniscal tear

A

steinmann’s test - pain on tibial rotation localising to affected compartment

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24
Q

what is found in the knee joint in meniscal tear

A

effusion - increased synovial fluid

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25
Q

what will confirm clinical suspicion of a meniscal tear

A

MRI

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26
Q

true knee locking

A
  • mechanical block to full extension caused by torn meniscus flipping over and becoming stuck in joint line
  • may require partial meniscectomy to unlock knee and prevent further damage
  • can perform heel height test if suspected
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27
Q

what is true knee locking a clinical sign of

A

meniscal tear

  • can occur without locking however
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28
Q

pseudlocking

A

can occur in patients with OA etc that describe their knee can temporarily become stuck when straightening the joint

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29
Q

are lateral or medial meniscal tears more common

A

medial as it is fixed (lateral is mobile)

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30
Q

types of meniscal tear

A
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31
Q

what is a large longitudinal meniscal tear called and what can it cause

A

bucket handle tear

  • knee locking
32
Q

degenerative meniscal tears

A

can occur as meniscus weakens with age - first stage in many knee OA

33
Q

how are degenerative meniscal tears clinically distinguished from acute tears

A

Steinmann’s test negative

early signs and symptoms of OA likely

34
Q

treatment of degenerative meniscal tears

A

will not improve from arthoscopic meniscectomy

steroid injection will help symptoms

35
Q

meniscal repair

A

only the outer third has arterial blood supply - limited healing potential

red zone has highest chance of healing

Whilst meniscal tears don’t usually heal, the pain and inflammation may settle with time, particularly with degenerate tears.

36
Q

when should arthroscopic meniscectomy be considered

A

in acute peripheral tears in young patients

37
Q

grades of knee ligament injury

A

1- tear some fibres but macroscopic structure intact (sprain)

2 - some fascicles disrupted (partial tear)

3 - complete tear

38
Q

MCL resists

A

valgus stress

39
Q

LCL resists

A

varus stress

40
Q

ACL resists

A

anterior subluxation of tibia and internal rotation of the tibia

41
Q

PCL resists

A

posterior subluxation of the tibia and hyperextension at knee

42
Q

posterolateral corner

A

PCL and LCL with popliteus etc resist external rotation of the tibia in flexion

43
Q

MCL tear

A

valgus stress injury eg rugby tackle from side

usually heals well - patient may have laxity and pain of valgus stress

44
Q

unhappy triad

A

MCL, ACL and medial meniscus

45
Q

MCL treatment

A

acute - hinged knee brace

chronic - MCL tightening or reconstruction with tendon graft

usually heal well - some laxity and pain on valgus stress experienced

46
Q

ACL tear

A

usually occur with a higher rotational force (internal rotational force on tibia)

pop is felt or heard

haemarthrosis (effusion due to bleeding in joint from ACL vascular supply) occurs

chronically, excessive internal rotation (instability)

47
Q

ACL rupture - on examination

A

excessive anterior translation of tibia on ant drawer test and Lachmann test

48
Q

ACL rule of thirds

A

third function well and compensate

third avoid instability by avoiding certain activities

third dont compensate and have frequent instability/cant go back to sport

49
Q

repair

of ACL

A

primary repair is not effective

reconstruction available with tendon graft (from patellar, gracilis or semitendinosus)

only given to patients who need to get back to sport (eg professional) or those whose knees give way with sedentary activity

intensive rehabilitation required

50
Q

who gets what treatment in ACL

A

older patients are more likely to compensate.avoid certain activities

younger patients more likely to get surgery

51
Q

LCL tear

A

varus stress injury (+/- PCL)

LCL doesnt heal and causes varus and rotatory instability (excessive external rotation)

high incidence of common peroneal nerve palsy and other vascular injuries

often part of multiple knee ligament injury

52
Q

LCL tear treatment

A

complete rupture needs early repair

late repair involves reconstruction

53
Q

PCL tear

A

a direct blow to anterior tibia on flexed knee (dashboard/motorbike) or hyperextension

PCL instability may cause hyperextension, and feeling of unstable when going down stairs

54
Q

knee dislocation

A

complete knee dislocation results in rupture of all 4 ligaments and has a high incidence of neurovascular injury

55
Q

what neurovascular structures are commonly affected in knee dislocation

A

popliteal artery

common peroneal nerve (end branch of sciatic nerve)

compartment syndrome

56
Q

treatment of knee dislocation

A

emergency reduction

may require external fixation for temporary stabilisation

usually multi ligament reconstruction is required

57
Q

what is a particular risk of knee dislocation

A

intimal tears can thrombose - regular foot checks are mandatory

any concerns with vascular status require vascular surgery assessment

reperfusion may result in compartment syndrome

58
Q

patellar dislocation

A

can occur with direct blow or sudden twist of knee

virtually always dislocates laterally

59
Q

predisposition for patellar dislocation

A

inc incidence in females, teens, hypermobility, valgus knee and torsional abnormalities

risk dec with age and physio

recurrent dislocation - 10%

60
Q

what is seen on x ray with patellar dislocation

A

lipohaemarthorsis

fat sits on top of blood

61
Q

what is performed is there is frequent patellar dislocation

A

tibial tubercule transfer or medial patellofemoral ligament reconstruction

62
Q

what is the extensor mechanism of knee

A

tibial tuberosity, patella, patellar tendon, quadriceps, quadriceps tendon

63
Q

what tendon of extensor mechanisms tends to rupture

A

patellar <40

quadriceps > 40

64
Q

how does extensor mechanisms rupture come about

A

falling onto flexed knee with quads contraction

65
Q

predisposing factors for extensor mechanism rupture

A

history of tendonitis

chronic steroid abuse

diabetes

RA

chronic renal failure

quinolone antibiotics (ciprofloxacin)

66
Q

how do quinolone antibiotics inc risk of EMR

A

can cause tendonitis

67
Q

what should be avoided in tendonitis with possible EMR

A

steroid injections

68
Q

examination of patient with EMR

A

unable to straight leg raise

paplable gap in extensor mechanism

X ray

in obese patients US can be used to view the gap in extensor mechanism

69
Q

treatment of EMR

A

surgical tendon to tendon repair or reattachment of tendon to patella

70
Q

what often occurs in patellofemoral dysfunction

A

chondromalacia patella (softening of hyaline cartilage of patella)

71
Q

why are teens more likely to get patellofemoral dysfunction

A

inc ligamentous laxity

72
Q

why are females more likely to get patellofemoral dysfunction

A

wider hips and subsequent more lateral pull of quadriceps

73
Q

patellofemoral dysfunction presentation

A

anterior knee pain,worse down hill

grinding or clicking sensation

pseudolocking

74
Q

patellofemoral dysfunction treatment

A

most cases self limiting and patients grow out of them

physiotherapy

75
Q

pre patellar bursitis

A
  • eg housemaids knee, carpet layers knee
  • most likely due to repetitive knee trauma
  • presents as severe anterior knee pain, warmth and swelling of the patella
  • local pain on patellar presssure and pain with knee flexion
76
Q

treatment of non septic bursitis

A

NSAIDs with the option of local steroid injection

77
Q

treatment of septic arthritis

A

ABx cover and drainage

RB Y2 MSK 04 - Adult Orthopaedics (7 decks)

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