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MBBS Orthopedics > Knee > Flashcards

Knee Flashcards

1
Q

Stabilisers of the knee

A

o Strong capsule
o Intraarticular ligaments (ACL, PCL)
o Extraarticular ligaments (MCL, LCL)
o Muscles (quadriceps)

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2
Q

What is the Unhappy triad

  • aka
  • components
A

O’Donoghue triad

ACL + MCL + Medial Meniscus

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3
Q

How to tell between partial and complete tear of ligament

Grading of sprains

A

Partial: no abnormal mvt permitted, pain on attempted abnormal mvt
Complete: abnormal mvt permitted, little/no pain

Grade1: sprain
- joint still stable
- step off (<5mm translation)
Grade2: partial tear (5-10mm)
Grade3: complete tear (>10mm)
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4
Q

Mgx of ligamentous injuries

A
  • aspirate hemearthrosis
  • icepacks
  • funcitional brace/ padded bandage (if avulsion #: plaster cylinder or if displaced: ORIF)
    Conservative
  • physio: muscle strengthening (hamstring, quads)
    SX: ligamentous reconstruction
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5
Q

Indications for ligamentous reconstruction

A

ACL tear in young person/ sportsman

ACL/PCL + collateral ligament injury

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6
Q

ACL reconstruction procedure (3Rs) and grafts

A

Grafts:
- hamstrings (semitendinosus), gracilis, patella tendon bone (autograft/ allograft)

Reattachment
Reinforcement
Replacement

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7
Q

ACL injury

  • what # to look for
  • attachments
  • function
  • MOI
A
  • segond fracture

Attachments
- medial aspect of lateral femoral condyle and intercondyloid eminence of tibia

Function
- prevent anterior translation and internal rotation of tibia over femur

MOI

  • int rotation on hyperextended knee
  • varies blow to knee
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8
Q

Why ACL does not heal

A
  • synovial fluid keeps 2 ends apart
  • synovial fluid produces proteolytic enzymes which worsens damage
  • synovial fluid prevents formation of a fibrin clot at wound site
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9
Q

Attachments of PCL

A
  • Medial condyle of femur

- Posterior intercondylar area of tibia

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10
Q

Role of Menisci

A

o Increase stability of knee o Control complex rolling and gliding actions of joint o Distribute load during movement

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11
Q

Difference between medial and lateral meniscus

- why medial more easily injured

A

Medial: larger, kidney shaped

Medial affected more because
- Attached to MCL (less mobile)
- Absence of popliteus muscle insertions which can pull meniscus into more favorable position during sudden movements (as
with lateral meniscus)

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12
Q

Types of menisceal tears

A
  1. bucket handle tears (present with locking)

2. horizontal tears

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13
Q

Mgx of meniscus tear

A 
preservation if possiblie
1. Arthroscopic surgery
outer 3rd - attempt repair
mid: intermediate
inner 3rd: avascular and poor healing - total/ subtotal excision
2. post op physiotherapy
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14
Q

Classification of tibial plateau fractures

and management

A

Schatzker classification

if lateral condylar # only with no displacement/ depression<3mm: conservative (aspirate, immobilise)

all else, depression>3mm: ORIF

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15
Q

Types of patellar fractures and their management

A
  1. undisplaced: conservative - aspirate and plaster cylinder
  2. comminuted: backslab and early ROM else partial/ complete patellectomy
  3. transverse fracture with gap: internal fixation (tension band wiring and K wire) + plaster backslab
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16
Q

RF for recurrent patellar dislocation

A

o Generalised ligamentous laxity (marfan, down)
o Underdevelopment of lateral femoral condyle
o Maldevelopment of patella (too high or small or lateral)
o Abnormalities of lateral femoral condyle (flattening of intercondylar groove)
o Genu valgus (q angle)
o Tibial tubercle malalignment
o Primary muscle defect
o More common in girls

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17
Q

Mgx of recurrent patellar dislocations

A

Conservative:
- reduction, backslab
- physio: strengthen vests medialis
Sx:
- repair medial patellofemoral ligaments
- re-align extensor mech for more mechanically favourable angle of pull
- lateral release if lateral retinaculum too tight

18
Q

RF for patella maltracking

A
  • lateral patella tilt (malalignment of extensor mech/ vastus medialis weakness)
  • tightness to lateral side (attach to ITB, lat retinaculum tighter than medial)
  • weakness of VMO
  • large Q angle
  • valgus knee
  • internal femoral torsion
  • abnormal patella: high/ small
19
Q

Causes of mechanical overload to patellofemoral joint

A
  • malcongruence of patellofemoral surfaces
  • malalignment of extensor mechanism or relative weakness of vastus medialis causing patella to tilt, bear more heavily on one facet (maltracking)
20
Q

Q angle

  • how to measure
  • normal values
  • what increases it
A

Q angle is the angle formed by a line drawn from the ASIS to the central patella and a
second line drawn from the central patella to the tibial tubercle.

Q angle is <18 deg for males and <22 deg for females with knee in full
extension.
<8 deg for males and <9 deg for females w knee in 90 deg extension.

Increased by:

  • genu valgum
  • increased femoral anteversion
  • ext tibial torsion
  • laterally positioned tibial tuberosity
  • tight lateral retinaculum
  • large pelvis
21
Q

Differentials for anterior knee pain

A
  • patella femoral overload
  • patella tendinosis (jumper knee)
  • patella subluxation
  • osgood schlatters
  • plica syndome
  • hoffa syndrome
22
Q

Mgx of patellofemoral overload

A

Conservative
- lifestyle
- physio: VMO
- analgesia
Sx
- arthroscopy lavage and shaving of fibrillated cartilage
- lateral release and patellar realignment
- drill exposed subchondral bone: revas to help repair fibrocartilage
- patellectomy

23
Q

Osgood Schlatter disease

  • x ray finding
  • mgx
  • any effusion?
A

X ray: displacement/ fragmentation of tibial apophysis

Mgx: spontaneous recovery

  • apply ice
  • analgesia
  • rest, activity modification, restrict strenuous sports
  • physiotherapy (quad)
  • orthotic devices (knee brace)

no effusion - extra-articular

24
Q

Causes of swelling in front of knee joint

A
  • prepatellar bursitis (housemaid knee)

- infra patellar bursitis (clergyman knee)

25
Q

Differentials for swelling at back of knee

A

Skin/ SQ: lipoma, sebaceous cyst
Artery: popliteal artery aneurysm
Vein: saphena varix @ saphenopopliteal junction, DVT
Nerve: Neuroma
Cyst: Baker (a/w degen changes), Popliteal

26
Q

Differentials for swelling at back of knee

A
  • Skin/ SQ: lipoma, sebaceous cyst
  • Artery: popliteal artery aneurysm
  • Vein: saphena varix @ saphenopopliteal junction, DVT
  • Nerve: Neuroma
  • Enlarged bursae: semimembranosus
  • Cyst: Baker, Popliteal
27
Q

Baker cyst

  • what
  • associations
  • risk
A
  • posterior herniation of knee joint capsule, leading to escape of synovial fluid into posterior bursa
  • a/w degenerative charges: OA, RA, Charcot joint
  • risk: increases risk of venous stasis/ DVT (compression of popliteal vein)
28
Q

Differentials of swelling at side of knee joint

A
  • meniscal cyst
  • calcification of collateral ligament
  • bony swelling (rule out tumor)
29
Q

loose body in joint

  • suggestive history
  • causes
A

sudden locking
swollen joint
palpable LB

causes: injury, OA, synovial chondromatosis, Charcot joint

30
Q

Causes of Charcot joint

A

DM, peripheral neuropathy, tertiary syphilis, tabes dorsalis, syringomyelia, myelomeningocele, cauda equina

31
Q

Osteochondritis dissecans

  • what is it
  • mgx
A

What: AVN of fragment of subchondral bone predisposing overlying cartilage and subchondral bone itself to fragmentation

Early: conservative (lifestyle modification)
SX:
- arthroscopic removal of loose bodies
- if large fragment, insitu fixation with pins/ Herbert screws
- cartilage transplantation

32
Q

Measuring for genu varum and valgus

A

genu varum: distance between knees with leg straight and medial malleoli just touching <6cm

genu valgum: distance between medial malleoli when knees touching <8cm

33
Q

Causes of knee malalignments

A
  • trauma to growth plate (growth arrest)
  • infection
  • tumor
  • bone dysplasia
  • rickets (vitD deficiency)
  • Blount disease (infantile)
34
Q

Blount disease

  • what is it
  • RF
  • mgx
A

Idiopathic arrest of growth plate on medial side of tibia > progressive genu varum due to abnormal growth of posteromedial part of proximal tibia

RF:

  • overweight children
  • children walking early
  • female

Mgx:
<3yo: circumferential brace
>3yo: high tibial osteotomy

35
Q

Etiology of intoeing

  • infant
  • toddler
  • child
A

Infant: metatarsus adducts
Toddler: medial tibial torsion (look for neg thigh foot angle) - normal:15deg
Child: medial femoral torsion - femoral anteversion
> history of W sitting
> mgx: cross legged sitting

36
Q

Surgery for knee deformities

A

Young: epiphyseodesis - stapling one side of physics to slow growth on that side

Osteotomy:

  • valgus: supracondylar femoral
  • varus: high ribia

Joint reconstruction

37
Q

Why consider hip causes in knee pain

A

referred pain: obturator nerve crosses both joints

38
Q

Approach to knee pain

A
  • Referred pain
  • Generalised: OA, RA
  • Localised:
    > patellofemoral: patellar instability, PF overload, PFOA, osteoxchondral injury
    > joint: osteochondritis dissecans, loosebody, ligament tear, meniscal tear
    > periarticular: patellar tendinitis, ligament strain, bursitis, OSD
39
Q

Causes of knee swelling

A 
Traumatic
- effusion/ hemarthrosis (lig injury)
- traumatic reactive synovitis (meniscal)
Non traumatic
- septic/ crystal induced arthritis
- seroneg arthritis (PAIR: psoriasis, AS, IBD, Reiter)
- seropos arthritis (RA, SLE)
- AVN
- sickle cell dz
- synovitis
40
Q

Causes of knees giving way (instability)

A
  • ligament: ACL, PCL, LCL, MCL
  • recurrent dislocation of patellar/ subluxation
  • torn meniscus, loose body
  • OSD
  • RA
  • muscle weakness

MBBS Orthopedics (13 decks)

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