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MSK > Knee > Flashcards

Knee Flashcards

1
Q

What meniscus is 10x more likely to tear and why?

A

Medial meniscus

More fixed than lateral and therefore less able to move

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2
Q

What is a classic presentation of a bucket handle tear?

Why does it occur?

A

True locking - Inability to fully extend knee even actively

Tear flips over and becomes stuck in the joint line

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3
Q

How would a patient present with a meniscus tear?

A

Pain and tenderness along joint line

~Inflammatory effusion

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4
Q

What meniscus tears are most likely to heal themselves?

Why?

A

Longitudinal in peripheral 1/3rd

Peripheral 1/3rd has a much better blood supply

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5
Q

Younger and older patients can both get meniscal tears. Under what circumstances is each group most likely to get one?

A

Younger - sport + squats (twisting force on loaded knee)

Older - sponateneous rupture (mostly asymptomatic)

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6
Q

How is a bucket handle tear treated?

A

If caught early - arthroscopic repair

If late and v problematic - meniscectomy

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7
Q

How are all knee ligament ruptures investigated?

A

MRI

can also be visible on CT

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8
Q

Name some mechanical symptoms that can come with meniscal tear

A

Catching sensation

“locking” of knee

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9
Q

What ligament acts as the main stabiliser against internal rotation of tibia?

As a result this is often damaged by twisting of upper body away from planted foot

A

ACL

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10
Q

A patient has collapsed in a netball match after hearing a “pop”. The knee is painful and there is an effusion.

What has she most likely damaged?
What is the explanation for the effusion?

A

ACL

Bleeding in the joint due to rupture of the ACL - haemarthrosis

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11
Q

How long may it take for a player to return to contact sport after ACL?

A

Up to a year

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12
Q

Rather than repair, reconstruction takes place on ACL. How is this done?

A

Graft ligaments from other places and use them

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13
Q

What ligament is most likely to be damaged in a motorbike crash?

A

PCL - when knee is flexed or hyperextended

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14
Q

Patient complains of instability walking down stairs and recurrent hyperextension. On inspection there is popliteal pain and bruising.

What further examinations would be done?

A

Posterior drawer test - +ve if sign of posterior tibial sag

PCL rupture

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15
Q

What is more likely to heal by itself. MCL or LCL?

A

Medial collateral ligament - rarely requires surgery

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16
Q

How would you examine for MCL injury?

A

Valgus laxity/discomfort = MCL injury

17
Q

How are MCL injuries generally managed?

A

With a brace

18
Q

How would knee dislocation be able to happen?

A

If all 4 ligaments are ruptured

19
Q

What must regularly be done for a patient with recurrent knee dislocation?

A

Checks of peripheral pulses

High incidence of neurovascular injury

20
Q 
Match the following:
Genu varum
Genu valgus
Affects lateral region of knee
Affects medial region of knee
A

Genu varum - medial region of knee

Genu valgum - lateral region of knee

21
Q

Knee replacements can cause explained moderate or severe pain. True or false?

A

True - up to 20%

22
Q

Under what circumstances would a patient be considered for TKR?

A

SEVERE end-stage arthritis that is no longer controlled by conservative management causing SEVERE pain

Generally older patient

23
Q

What kind of ligament damage in particular can lead to early OA?

A

Meniscal tear

24
Q

What 5 parts make up the extensor mechanism?

A 
Quadriceps muscle
Quadriceps tendon
Patellar
Patellar tendon
Tibial tuberosity
25
Q

Match the following ages to what part of the extensor mechanism they are most likely to rupture:
<40 yo
>40 yo

How would each type of rupture appear on Xray?

A

> 40 yo - quadriceps tendon

<40 yo - patellar tendon

On Xray:
High patella -> patellar tendon rupture

Low patella - quadriceps tendon rupture

26
Q

How is extensor mechanism rupture managed?

A

Surgery

27
Q

If a patient presents with tendonitis, usually steroid injections can help. What part should not receive steroid injections as it can cause ruputre?

A

Extensor mechanism of the knee

28
Q

What test is used to examine the function of the extensor mechanism?

A

Straight leg raise test

29
Q

What is patellofemoral dysfunction?

A

A collection of conditions which can cause anterior knee pain

30
Q

Alongside anterior knee pain what other symptoms may a patient with patellofemoral dysfunction complain of?

What can also make the pain worse?

A

Grinding/clicking sensation

“Pseudolocking” -> inability to fully extend leg when sitting for long periods of time (does correct tho unlike true locking in meniscal tears)

Pain worse when going downhill

31
Q

What may a physio do to improve patellorfemoral dysfunction?

A

Try to strength medial quadriceps muscles

32
Q

What are the knee Ottawa rules that indicate a need for an xray?

A
  • Over 55
  • Inability to bear weight immediately/in ED
  • Inability to flex knee to 90 degrees
  • Tenderness over patella
  • Tenderness at head of fibula
33
Q

What is the difference between patellar and knee dislocations?

What one is more concerning and why?

A

Patellar - just the patella becomes unstable

Knee - whole tibia+fibula moves

Knee - can severe popliteal artery (at back of knee) and cause huge neurovascular damage

34
Q

What ligament ruptures in patellar dislocations?

What direction does this mean the patellar normally always moves?

A

Medial patellofemoral ligament

Laterally

35
Q

What causes a patellar dislocation?

A

Sudden quad contraction with a flexing knee

36
Q

A patellar dislocation is normally self-resolving. Why must the patient still come in to clinic?

A

To receive physio to prevent recurrence

Also sometimes given a velcro brace (think Amelia)

37
Q

How must a patient with knee dislocation be managed if they have:

  • Normal examination?
  • Clinical concern in examination (poor neurovascular response)
A

Normal = observe in hospital

Clinical concern = arteriogram/MRI

38
Q

Housemaid’s knee results from a bursitis of what?

A

Prepatellar bursitis

MSK (41 decks)

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