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Orthopaedics > Knee > Flashcards

Knee Flashcards

1
Q

Ligaments in the knee

A

ACL
PCL
MCL
LCL

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2
Q

What are the clinical features of osteoarthritis

A

Hx - worse on prolonged activity, crepitus, background ache

Exam - crepitus, effusion, elsewhere such as DIP and PIP

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3
Q

Radiological findings

A

Loss of joint space
Osteophytes
Subchondrial cyts
Subarticular sclerosis

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4
Q

Types of OA

A 
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
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5
Q

What is OA primary associated with

A 
Inc BMI 
Genetic 
Age
Occupation 
Sport
Armed forces
Trauma
Surgery
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6
Q

Tx OA knee

A 
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
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7
Q

What is osgood-schlatters disease

A

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%

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8
Q

Tx osgood schlatters

A 
Limitation of activity 
Ice 
Oral anti-inflammatory 
Knee padding 
Physio 
If fails surgery may be needed to remove the tibial tuberosity when skeletally mature
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9
Q

What test is positive in patello-femoral OA

And what is it

A

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

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10
Q

What is patella-femoral pain syndrome

A

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

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11
Q

Tx patella-femoral syndromes

A

Rest
Quad and hip strengthening exercises
NSAIDS
No surg

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12
Q

What is patella tendinopathy

A

Micro/macro patella tendon tears
Associated with sudden sporting loads - jumpers knee
Not inflammatory it is degenerative
Can occur anywhere along the patella tendon

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13
Q

Tx patella tendinopathy

A

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

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14
Q

What is patella maltracking

A

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

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15
Q

Types of knee locking

A

True locking

Pseudo locking

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16
Q

What is true locking

A

When something in the knew joint gets stuck in one position and you cannot move it at all

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17
Q

What is pseudo locking

A

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

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18
Q

What causes true locking

A

Meniscus tear

Loose body

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19
Q

What do you need to assess in patella maltracking

A

Anatomy

Any rotational abnormalities

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20
Q

Tx of patella maltracking

A

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

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21
Q

What is the q angle

A

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

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22
Q

What is housemaids knee

A

Pre patellar bursitis

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23
Q

What can cause prepatellar bursitis

A

Kneeling
Infection
Crystalarthropathies
RA

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24
Q

Tx prepatellar bursitis

A

Aspirated +/- steroid injection
If persists may needs excision
Topical NSAIDS

25
Q

What should you always consider in prepatellar bursitis

A

Septic arthritis
- the aspiration will be able to differentiate
If you stain MCS it

26
Q

What is infrapatellar bursitis also known as and what causes in

A

Clergymans knee

Kneeling upright

27
Q

What are the colloquial names important in bursitis

A

Highlights the importance of occupation to the condition

And occupational changes may help with the conditions

28
Q

What causes patellar dislocation

A

Twisting lower leg and contraction of the quads = squatting

29
Q

What does the a patellar dislocation look like

A

Flexed with lateral deformity

30
Q

How to treat patellar dislocation

A

Firm medial pressure hilts extending the knee

31
Q

What to do once you’ve treated patellar dislocation and why

A

X ray
Check for patellar fracture
And check extensor mechanism of the knee

32
Q

What continued mx is needed of a treated patellar dislocation

A

Immobilise in a cast or brace

Rehabilitation with quad strengthening exercises

33
Q

What causes recurrent subluxation

A

Developmental abnormalities around the knee

Tight lateral retinaculum

34
Q

What happens in recurrent subluxation

A

Knees give way

35
Q

Who does recurrent subluxation happen in most

A

Girls who are knock kneed - valgus deformity

FHx, joint laxity, high riding patella, hypotrophic lateral femoral condyle

36
Q

Signs of recurrent subluxation

A

Inc lateral patellar movement

+ pain +reflex contraction of the quads +ve patellar apprehension test

37
Q

How to get a patellar fracture

A

Fall on a flexed knee

Dashboard injury in car

38
Q

How to mx a patellar fracture

A

No -displaced can be mx conservatively

Displaced - surgical

39
Q

What causes injury to the MCL

A

Blow to the lateral aspect of the knee whilst foot is flexed

40
Q

Signs of MCL injury

A

Effusion

+/- tenderness

41
Q

Tx MCL. Injury

A

Rest and support

Conservative

42
Q

How does an ACL injury happen

A

Twisting injury of the knee with the foot fixed to the ground

43
Q

Signs of ACL injury

A

Effusion
Haemarthrosis
+ve ant draw and Lachmans

44
Q

Tx ACL

A

Conservative - rest physio

May need surg - ligament reconstruction

45
Q

Is the PCL more or less frequently damaged than the ACL

A

Less because it is stronger

46
Q

How does the PCL become injured

A

Dash board car crash

47
Q

Sign PCL

A

Post drawer

48
Q

Mx PCL injury

A

Con mx due to PCL construction being difficult

49
Q

Which meniscus is most likely to teared and why

A

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

50
Q

Mechanisms of medial meniscus tear

A

Twists a flexed knee

51
Q

Mechanism of a lateral meniscus tear

A

Adduction and internal rotation

52
Q

Symp/sign meniscal tear

A

Locking true
Extension is limited due to displaced ligament lodging between the femoral and tibial condyle
Tender joint line and +ve mcmurrays

53
Q

Tx meniscal tear

A

Surg - repair - tear is in the vascular area otherwise wont heal

54
Q

What is the mcmurrays test

A

Bend and extend the knee and twist it to the to produce discomfort and locking

55
Q

What is osteochondritis dissecans

A

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

56
Q

What clinical presentation of cartilage defects

A 
Adolescence 
Young adult
Long Hx of effusion 
Locking caused by loose body 
Flakes of articular cartilage coming off
57
Q

Mx of cartilage defects

A

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

58
Q

Young osteoarthritis

A 
Under 50 
Physio steroid
Arthroscopy 
Unicompartmental osteotomy realign leg 
Biological resurfacing 
Over 50 partial joint replacement 
Replace joint that’s failing

Orthopaedics (7 decks)

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