Knee Flashcards
Ligaments in the knee
ACL
PCL
MCL
LCL
What are the clinical features of osteoarthritis
Hx - worse on prolonged activity, crepitus, background ache
Exam - crepitus, effusion, elsewhere such as DIP and PIP
Radiological findings
Loss of joint space
Osteophytes
Subchondrial cyts
Subarticular sclerosis
Types of OA
Primary - degenerative Degeneration of the articulations cartilage, and its surface of a joint With no predisposing factors Secondary - underlying precipitant Post-trauma Post-op Post infection Mechanical instability Malposition Osteochondroses dissecans
What is OA primary associated with
Inc BMI Genetic Age Occupation Sport Armed forces Trauma Surgery
Tx OA knee
Exercise to improve local muscle strength and general aerobic fitness - irrespective of age Physio TENS OT Topical capsaicin Topical NSAIDS + PPI Steroid injections Hyalourinic acid injections Surg Arthroscopy Osteotomy Arthroplasty
What is osgood-schlatters disease
Tibial tubercle apophysitis
Pain and swelling over the tibial tuberosity
Children 10-15 yo
Theory suggest that the repeated traction causes inflammation and chronic avulsion of the secondary ossification centre of the tibial tuberosity
Pain below the knee is worse of physical activity and quad contraction
Tuberosity enlarged and tender
Self limiting >90%
Tx osgood schlatters
Limitation of activity Ice Oral anti-inflammatory Knee padding Physio If fails surgery may be needed to remove the tibial tuberosity when skeletally mature
What test is positive in patello-femoral OA
And what is it
Clarke’s test
Discomfort due to degenerative changes in the patella-femoral joint
Knee flexed and extended as pressure is applied to the patella compressing the patellofemoral joint causing discomfort
What is patella-femoral pain syndrome
Young athletes - runners, overuse, limb malalignment, muscle imbalance , patella tracking abnormality
Patella ache after sitting /climbing/descending stairs
Recent trauma inc activity
Patella subluxation/dislocation Hx
+ve Clark’s test
Inc/dec patella mobility
Tx patella-femoral syndromes
Rest
Quad and hip strengthening exercises
NSAIDS
No surg
What is patella tendinopathy
Micro/macro patella tendon tears
Associated with sudden sporting loads - jumpers knee
Not inflammatory it is degenerative
Can occur anywhere along the patella tendon
Tx patella tendinopathy
Con - rest and physio
Med NSAIDS
Steroid injection not into the tendon but around the tendon
Platelet rich plasma injections but the efficacy of these needs to be further evaluated before NICE recommends then for regular practise
Eccentric training exercises
What is patella maltracking
The definition of maltracking refers to the dynamic malpositioning of the patella within the trochlear groove that occurs during active range of motion of the knee usually tracks lateral to the groove. Patellar maltracking is typically observed during physical examination, and the “J” sign is a commonly cited manifestation of this
Types of knee locking
True locking
Pseudo locking
What is true locking
When something in the knew joint gets stuck in one position and you cannot move it at all
What is pseudo locking
Feel at though you can’t move the knee because you are in so much pain
There isn’t something in your knee preventing you from moving your leg
Our body is causing a muscle spasm triggered by the pain accompanied by an inability to move the knee
Other symptoms include - catching sensation, brief locking sensation, free or open sensations of the knee
What causes true locking
Meniscus tear
Loose body
What do you need to assess in patella maltracking
Anatomy
Any rotational abnormalities
Tx of patella maltracking
Refer to physio if not any better
Refer to a knee specialist - look for skeletal abnormalities trochlear dysplasia or muscle vastus medius of the quads may not function properly
What is the q angle
Measure the line drawn from the ASIS the centre of the patellar and then the line from centre of the patellar to the tibial tuberosity if there is an inc angle there is anatomical malalignment causing patella maltracking
What is housemaids knee
Pre patellar bursitis
What can cause prepatellar bursitis
Kneeling
Infection
Crystalarthropathies
RA
Tx prepatellar bursitis
Aspirated +/- steroid injection
If persists may needs excision
Topical NSAIDS
What should you always consider in prepatellar bursitis
Septic arthritis
- the aspiration will be able to differentiate
If you stain MCS it
What is infrapatellar bursitis also known as and what causes in
Clergymans knee
Kneeling upright
What are the colloquial names important in bursitis
Highlights the importance of occupation to the condition
And occupational changes may help with the conditions
What causes patellar dislocation
Twisting lower leg and contraction of the quads = squatting
What does the a patellar dislocation look like
Flexed with lateral deformity
How to treat patellar dislocation
Firm medial pressure hilts extending the knee
What to do once you’ve treated patellar dislocation and why
X ray
Check for patellar fracture
And check extensor mechanism of the knee
What continued mx is needed of a treated patellar dislocation
Immobilise in a cast or brace
Rehabilitation with quad strengthening exercises
What causes recurrent subluxation
Developmental abnormalities around the knee
Tight lateral retinaculum
What happens in recurrent subluxation
Knees give way
Who does recurrent subluxation happen in most
Girls who are knock kneed - valgus deformity
FHx, joint laxity, high riding patella, hypotrophic lateral femoral condyle
Signs of recurrent subluxation
Inc lateral patellar movement
+ pain +reflex contraction of the quads +ve patellar apprehension test
How to get a patellar fracture
Fall on a flexed knee
Dashboard injury in car
How to mx a patellar fracture
No -displaced can be mx conservatively
Displaced - surgical
What causes injury to the MCL
Blow to the lateral aspect of the knee whilst foot is flexed
Signs of MCL injury
Effusion
+/- tenderness
Tx MCL. Injury
Rest and support
Conservative
How does an ACL injury happen
Twisting injury of the knee with the foot fixed to the ground
Signs of ACL injury
Effusion
Haemarthrosis
+ve ant draw and Lachmans
Tx ACL
Conservative - rest physio
May need surg - ligament reconstruction
Is the PCL more or less frequently damaged than the ACL
Less because it is stronger
How does the PCL become injured
Dash board car crash
Sign PCL
Post drawer
Mx PCL injury
Con mx due to PCL construction being difficult
Which meniscus is most likely to teared and why
Medial meniscus
Bucket handle tear - due to the it being securely attached the joint capsule and consequently more frequently torn compared to the lateral meniscus
Mechanisms of medial meniscus tear
Twists a flexed knee
Mechanism of a lateral meniscus tear
Adduction and internal rotation
Symp/sign meniscal tear
Locking true
Extension is limited due to displaced ligament lodging between the femoral and tibial condyle
Tender joint line and +ve mcmurrays
Tx meniscal tear
Surg - repair - tear is in the vascular area otherwise wont heal
What is the mcmurrays test
Bend and extend the knee and twist it to the to produce discomfort and locking
What is osteochondritis dissecans
Joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone
Usually causes pain and swelling of the affects joint which catches and locks during movement
What clinical presentation of cartilage defects
Adolescence Young adult Long Hx of effusion Locking caused by loose body Flakes of articular cartilage coming off
Mx of cartilage defects
Difficult to tx due to not being able to regrow the articular cartilage
Microfracture - holes in the subchondrial bone to encourage scar tissue formation - fibrocartilage formed not hyaline
OATS - cartilage transfer mosaicplasty move less important cartilage such as behind the patellar to more important weight bearing areas
Autologous chondrocytes implantation - grow in lab and insert them under the membrane
SC implantation- inject into the bone to try to grow more articular cartilage
Young osteoarthritis
Under 50 Physio steroid Arthroscopy Unicompartmental osteotomy realign leg Biological resurfacing Over 50 partial joint replacement Replace joint that’s failing
