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Year 2 MSK > Knee > Flashcards

Knee Flashcards

1
Q

What two joints make up the knee?

A

Tibiofemoral

Patellofemoral

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2
Q

What caps the top of the tibia?

A

Menisci

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3
Q

What is the role of menisci?

A

They act as shock absorbers and distribute the weight across a wider area.

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4
Q

Name the four important ligaments within the knee

A

Medial & Lateral Collateral ligaments
Anterior Cruciate Ligament
Posterior Cruciate Ligament

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5
Q

What is the job of the ACL?

A

Prevents abnormal internal rotation of tibia

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6
Q

What is the job of the PCL?

A

Prevents hyperextension and posterior movement of the tibia

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7
Q

What does the MCL resist

A

Valgus forces

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8
Q

What does the LCL resist

A

Varus forces and external rotation

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9
Q

If a patient has Genu Varum where in the knee is the OA likely to be?

A

Medial

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10
Q

If a patient has Genu vagus where in the knee is the OA likely to be?

A

Lateral

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11
Q

History in meniscal tears

A

Twisting force on a loaded knee.
Localised pain along joint line, effusion develops.
Knee locks unable to fully extend.

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12
Q

History in ACL tears

A

Higher rotation onto a planted foot.
Patient hears a pop.
Haemarthrosis develops quickly with deep pain within the knee.
Patients complains of knee giving away when turning.

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13
Q

Valgus stress injury (tackle fro the side)

A

MCL torn but also risk of ACL rupture.

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14
Q

PCL tear

A

Direct blow to anterior tibia with knee flexed

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15
Q

Varus stress

A

Can rupture lateral collateral ligament, +/- PCL

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16
Q

What is the issue surrounding examination of a knee post injury?

A

Very painful for the patient. Swelling and apprehension can make it difficult.
MRI used acutely if severe injury suspected.
Otherwise reassess in 2-7 days

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17
Q

What percentage of the force applied to the knee does the menisci take?

A

60%

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18
Q

In what portion of the menisci is there a blood supply?

A

Outer 1/3

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19
Q

Which menisci are more likely to be damaged?

A

Medial are 10x more likely to be damaged than the lateral.

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20
Q

Why is the medial menisci more likely to be ripped?

A

As it is fixed whilst the lateral menisci are more mobile.

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21
Q

What are the four types of meniscal tear?

A

Longitudinal
Radial
Oblique
Horizontal

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22
Q

What is a large longitudinal tear called?

A

Bucket Handle

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23
Q

What is the clinical sign of a bucket handle tear?

A

Locking knee which is unable to fully extend.

24
Q

What imaging is used to confirm a diagnosis?

A

MRI

25
Q

When is meniscal repair considered?

A

In younger patients with a tear in the outer 1/3. Meniscus is sutured to its bed.
25% of repairs fail

26
Q

What is the other method of surgically treating meniscal tears

A

Athroscopy so removal of the menisci

27
Q

How does treatment vary in degenerative meniscal tears?

A

The menisci should not be removed as this works to only make the OA worse.

28
Q

What are the non surgical options in the treatment of meniscal tears?

A

Steroid injection

29
Q

What is main complaint in an ACL rupture?

A

Rotary instability, giving away on turning

30
Q

How quickly does swelling arise in any tendon rupture?

A

Within the hour.

Haemarthrosis due to the blood supply.

31
Q

What are the two options for ACL rupture treatment

A

Repair - not very effective

Reconstruction

32
Q

Which candidates are aimed straight for reconstruction?

A

Professional athletes and those wanting to continue high impact sports, as quickly as possible.

33
Q

What occurs in ACL reconstruction?

A

Tendon graft is passed through tibial and femoral tunnels and secured to the bone.

34
Q

What tendons are use as grafts in ACL reconstruction

A

Patellar
Semitendinosis
Gracilis

35
Q

How long with physiotherapy involved is the recovery time?

A

Up to a year

36
Q

In MCL tears what is the main complication post recovery?

A

Laxity and or pain on Valgus stress.

Tenderness over MCL insertion.

37
Q

How are acute MCL tears usually treated?

A

Hinged knee brace as MCL healing is expected in majority of partial and even full tears.

38
Q

In a chronic MCL instability what are the treatment options?

A

MCL tightening

Reconstruction with tendon graft.

39
Q

What makes up the extensor mechanisms in the knee?

A

Patellar tendon
Patellar
Quadriceps tendon
Quadriceps Muscles

40
Q

What age group do patellar tendon ruptures usually occur in?

A

<40

41
Q

What age group do quadricep tendon ruptures usually occur in?

A

> 40

42
Q

What are some predisposing condition for extensors mechanism ruptures?

A 
Tendonitis
Chronic steroid use or abuse
Diabetes
Rheumatoid arhtritis
Chronic renal failure
43
Q

What antibiotics increase the risk of tendon rupture?

A

Quinolones

Ciprofloxacin

44
Q

Why should steroid injections never be used to treat tendonitis?

A

As steroids break down muscle fibre leading to tendon rupture.

45
Q

What test should be used in a suspected extensor mechanism rupture.

A

Straight Leg Raise Test

46
Q

How will a partial tear in the Extensor mechanism present?

A

They will have some extensor mechanism function but reduced power.

47
Q

What is the treatment in extensor mechanism rupture?

A

Surgical tendon to tendon repair or reattachment.

48
Q

Clinical signs of an extensor mechanism rupture?

A

-ve straight leg raise
Palpable gap
X-ray or US imaging

49
Q

What is usual method of injury in an EMR?

A

Falling onto flexed knee with quadriceps contraction.

50
Q

Method of injury in an patellar dislocation?

A

Direct blow or sudden twist of the knee.

51
Q

In which direction does the patellar usually displace?

A

Laterally

52
Q

What factors increase your risk of a patellar dislocation?

A

Ligament laxity.
Female
Valgus knees
High riding patellar

53
Q

What is the risk of recurrent dislocations?

A

10%

54
Q

What ligament is damaged or torn in a patellar dislocation?

A

Patellofemoral ligament

55
Q

Treatment of a patellar dislocation

A

Manual manipulation to reset the patellar then a straight leg brace.
Recurrent then surgery to reconstruct patellofemoral ligament.

Year 2 MSK (19 decks)

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