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Musculoskeletal > Knee > Flashcards

Knee Flashcards

1
Q

What radiographic changes are seen with osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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2
Q

Where is knee OA most commonly seen?

A

Posterior patella

Medial compartment ➔ varus deformity

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3
Q

List the signs of osteoarthritis of the knee

A 
Joint swelling
Wasting of quadriceps and/or calfs
Deformity: most commonly varus deformity
Fixed flexion of knee: posterior patellar involvement
Joint line tenderness
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4
Q

Name 3 causes of secondary osteoarthritis

A 
Post-traumatic: fracture, meniscus tear, ligament tear
Post-operative
Malposition
Mechanical instability
Osteochondritis dissecans
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5
Q

Name 5 predisposing factors for osteoarthritis

A 
Increased BMI
Genetics
Increasing age
Occupation
Trauma
Inflammatory arthritis
Hyperparathyroidism
Haemochromatosis
Wilson's disease
Acromegaly
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6
Q

Outline the management options for knee osteoarthritis

A

Lifestyle: weight loss, knee support
Physiotherapy

NSAIDs
Steroid injection

Arthroscopy
Osteotomy
Knee replacement: total or unicondylar
-plus 6-8 weeks post-op rehab

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7
Q

What clinical features support surgical intervention for osteoarthritis?

A

Night pain
Increasing impact on QoL
Increasing deformity

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8
Q

What is the benefit of knee replacement?

A

Improves knee pain*

Returns some function: usually limited to 90 degrees of flexion

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9
Q

What is the average lifespan of a total knee replacement?

A

10-15 years

Younger patients tend to wear it out faster ➔ recommended for unicondylar replacement if only one compartment affected

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10
Q

Describe the Outerbridge classification of cartilage damage

A
  1. normal cartilage
    I. soft cartilage with swelling
    II. partial-thickness defect with fissures that do not reach subchondral bone
    III. fissuring to level of subchondral bone
    IV. exposed subchondral bone
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11
Q

Name 3 causes of anterior knee pain +/- swelling

A 
Patellofemoral pain syndrome
Recurrent patella subluxation
Patella tendinopathy
Iliotibial tract syndrome
Medial shelf syndrome
Hoffa's fat pad syndrome
Osgood-Schlatter disease
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12
Q

Define patellofemoral pain syndrome

A

Pain and crepitus around the patella. Often aggravated by climbing stairs and running.

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13
Q

How is patellofemoral pain syndrome treated?

A

NSAIDs and paracetamol
Physiotherapy: quadriceps strengthening*
-80% success rate

Injection, PFJ replacement or TFR

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14
Q

How should an acute traumatic knee be managed?

A

History
X-ray to rule out fracture/dislocation
Splint and repeat exam at 3 weeks
MRI

Physiotherapy
Knee arthroscopy/reconstruction

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15
Q

What are the symptoms of bone bruise?

A 
Pain or tenderness
Swelling
Change in skin colour
Joint inflammation
Joint stiffness
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16
Q

Describe the types of bone bruise

A

Subperiosteal: after traumatic injury
Interosseous: repeated pressure
Subchondral: compression or rotation

17
Q

Name 2 risk factors for bone bruising

A

High-impact sport
Physically demanding job
Not wearing protective equipment during sport/job
Osteoarthritis

18
Q

What is the prognosis of bone bruising?

A

Tends to self-resolve within months, unlikely to progress

19
Q

Name 3 complications of total knee replacement

A

Infection
Bleeding
Pain/tenderness around scar
DVT/PE

20
Q

List the signs seen with injury to a collateral ligament

A

Effusion +/- tenderness over affected ligaments

Associated common perineal nerve injury

21
Q

Describe the management of injury to a collateral ligament

A

Rest + firm support
Surgery
-rarely needed for isolated MCL
-required for LCL if joint instability present

22
Q

What is the typically cause of an ACL tear?

A

Twisting injury to the knee with foot planted on ground

23
Q

Describe the clinical features of an ACL tear

A

Sudden onset of swelling: haemarthrosis
Unable to continue at time of tear
Knee giving way, instability esp when twisting

Swelling or popping suggests 70% likelihood of ACL tear

24
Q

Name 3 tests used to assess an ACL tear

A

Lachman test*: flexion at 30 degrees
Anterior draw test: flexion at 90 degrees
Pivot shift test: done under anaesthetic

25
Q

What treatment options exist for ACL tear?

A

3 weeks rest
Physiotherapy
ACL reconstruction: young or knee instability

26
Q

How are ACL injuries classified?

A

Grade I: fibres stretched, but no tear. Little tenderness and swelling. Joint does not feel unstable or give out.

Grade II: fibres partially torn. Little tenderness and moderate swelling. Joint may feel unstable or give out.

Grade III: ACL ruptured. Tenderness. Ligament cannot control knee movements.

27
Q

What is the commonest cause of meniscal tears?

A

Medial: Twisting or hyperflexion injury
Lateral: Adduction + internal rotation

28
Q

Describe the clinical features of meniscal tears

A

Knee locking: fragments lodge between femur and tibia
Tender joint line
Unable to continue
Delayed swelling of knee

29
Q

What investigation is ideal for meniscal tears?

A

MRI: tear location, morphology, length, depth, stability

30
Q

What management options are available for meniscal tears?

A

Conservative

Arthroscopic repair/excision: locked knee, cysts, or persistent symptoms

31
Q

Name 3 types of bursitis affecting the knee

A

Pre-patellar bursitis: housemaid’s knee
Infra-patellar bursitis: clergyman’s knee
Semi-membraneous bursitis: popliteal cyst

32
Q

Define osteochondritis dissecans of the knee

A

Defect in subchondral region with partial or complete separation of the bone fragment.

Caused by repetitive overloading.

33
Q

Describe the clinical features of osteochondritis dissecans

A 
Poorly localised pain, exacerbated by exercise
Intermittent effusion
Occasional locking
Crepitation
Tender affected femoral condyle
34
Q

What is the treatment of osteochondritis dissecans?

A

Conservative if stable lesion

Arthroscopic stabilisation excision

35
Q

Which patient group is most commonly affected by osteochondritis dissecans?

A

Males (2:1) aged 13-21

36
Q

Define Osgood-Schlatter disease

A

A common self-limiting cause of pain below the knee in adolescents. Caused by inflammation where the patellar tendon inserts into the tibia.

Pain on active extension of the knee against resistance.

37
Q

Describe one congenital knee problem

A

Discoid lateral meniscus (incomplete or complete).

Excess covering of tibia leads to the knee being more prone to mechanical symptoms (locking, catching, giving way) and tears.

Treatment: knee arthroscopy

Musculoskeletal (17 decks)

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