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E - MSK > Knee > Flashcards

Knee Flashcards

1
Q

What kind of joint is the knee

A

Synovial hinge - flexion - extension

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2
Q

What is the normal range of movement of the knee

A

5-130

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3
Q

What ligaments strengthen the joint capsule

A 
Lateral collateral ligament 
Medial collateral ligament 
Patellar ligament 
Oblique popliteal ligament 
Arcuate popliteal ligament
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4
Q

Which bursa articular with the joint cavity

A

Suprapatellar - largest, proximal to joint
Popliteal bursa - posterior, bakers cyst
Anserine (semimembranosus)
Gastrocnemius

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5
Q

What are the deep fibres of the medial collateral ligament firmly attached to

A

medial meniscus

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6
Q

What passes deep to the lateral collateral ligament

A

Tendon of popliteus

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7
Q

Difference between the anterior and posterior cruciate ligaments

A

Anterior - weaker, poor blood supply
- prevents posterior rolling of femur on tibia and hyperextension of knee

Posterior - stronger
- limits anterior rolling of femur on tibia and hyperextension of knee

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8
Q

What is the mechanical axis of the knee

A

Hip centre to ankle centre should pass through knee centre

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9
Q

What is the anatomical axis of the knee

A

Knee-angle (tibiofemoral angle) is 6 degrees valgus relative to mechanical axis - as the centre o the femoral shaft is 6 degrees valgus off the mechanical axis but the centre of tibia is parallel to mechanical axis

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10
Q

how is the knee angle in relation to the mechanical axis

A

3 degrees varus (3o off from being perpendicular to MA)

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11
Q

What are the static and dynamic soft tissue constraints of the knee

A

Static - collaterals, cruciates, capsule, ITB, meniscii

Dynamic - quadriceps, hamstrings (BF, ST, SM), gastrocnemius, popliteus

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12
Q

Extensors of knee - innervation, origin and insertion

A

Femoral nerve

Rectus femoris - AIIS + sup. ace. rim –> ischial tub.
Vastus med. - intertroch. line + med. linea aspera –> tib. tub.
Vastus lat. - GT + lat. linea aspera –> tib. tub.
Vastus intermedialus - prox. fem. shaft –> tib. tub.

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13
Q

Flexors of knee - innervation, origin and insertion

A

Sciatic - gastrocnemius S1

Biceps femoris - ischial tub + linea aspera –> fibula head / lat tibia
Semimembranosus - ischial tub. –> pes anserinus
Semitendinosus - ischial tub. –> medial condyle of tibia
Gastrocnemius - med & lat fem. condyles –> Os Calcis via achilles tendon

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14
Q

What are the meniscii and what are their function

A

Crescentric plates of fibrocartilage
Are avascular centrally

  • load transmission
  • stability
  • proprioception
  • shock absorption
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15
Q

difference between the medial and lateral meniscus

A

Medial

  • C-shaped
  • adheres to deep surface of MCL
  • less mobile as firmly attached to tibia

Lateral

  • circular and smaller
  • more freely mobile
  • popliteus tendon separates it from LCL
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16
Q

Mechanism of meniscal injury

A

Twisting movement on a loaded fixed knee

17
Q

Clinical features of meniscal injury

A 
Painful squelch
Joint-line tenderness
Slow swelling - quicker in young
Painful weight-bearing
Locked knee
18
Q

How does the menisci allow slack and increased movement of the joint

A

The radial component of the loading force is balanced by tensile stresses developed in the circumferentially orientated collagen fibres

19
Q

What are the different zones in the meniscii

A

Radial zone
Red / White Zone - good blood supply so heals well
White Zone - not good blood supply so doesn’t heal as well

20
Q

Blood supply of the meniscus

A

Branches from the inferior medial and lateral geniculate arteries form the perimeniscal capillary plexus

This plexus forms the circumferential vessels and penetrating radial vessels

21
Q

Repair techniques for meniscal tears

A

Meniscal repair
Partial meniscectomy
Meniscal transplantation

22
Q

What is the typical injury triad of knees

A

ACL tear + medial collateral ligament + medial meniscus

23
Q

Mechanism of medial collateral ligament tears

A

Severe medial tear due to blow to lateral knee (valgus stress)

Low grade due to non-contact valgus and external rotation injuries (i.e. skiing)

24
Q

Clinical features of medial collateral ligament tears

A 
Medial knee pain 
No or minimal effusion (MCL attached to capsule so fluid just leaks out into tissues causing bruising) 
Bruising to one side (ecchymosis) 
Laxity to valgus stress 
May hear or feel pop if severe
25
Q

Mechanism of injury in ACL tear

A

Posterior blow to tibia
OR
Rotation injury with foot fixed to ground (knee buckles during pivot)

26
Q

Clinical features of ACL tear

A

Pop
Quick swelling (haemarthrosis)
Inability to return to activity
+ve anterior draw sign

27
Q

What may you see on an x-ray of ACL tear

A

Haemarthrosis

Segond fracture

28
Q

Treatment of ACL tear

A 
Full ACL rehab - rest and physio 
ACL reconstruction (if athlete or increased knee instability)
29
Q

What other injury is common with ACL tears

A

Avulsion fractures of the tibial intercondylar region

30
Q

What is osteochondritis dissecans

A

An osteochondral fragment separates from underlying bone, typically from the lateral side of the medial femoral condyle

31
Q

Symptoms of osteochondritis dissecans

A

Pain after exercise
Intermittent knee swelling
Locking - may occur

32
Q

Treatment of osteochondritis dissecans

A

Reattachment of fragment (if seen acutely)
Removal of loose bodies
Microfracture chondroplasty
Artificial cartilage implantation

33
Q

Investigations for patient with knee pain

A

MRI - clinical confirmation but do x-ray first

X-ray - check for #, loose bodies, ligament avulsion, osteochondral defect, DJD

USS - tendon rupture, meniscal tear, swelling, cyst

34
Q

What history do you want to know from a patient with knee pain

A 
Environment - sport, work
Activity - sports tackle, jumping
Energy - how fast / heavy 
Systemic symptoms 
Chronology - is it quick or slow onset, previous injury?
Hear or feel pop
Swelling - early or late

E - MSK (29 decks)

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