Knee Flashcards

Question

Inspection

Answer 1

• General alignment • Scars • Effusion

Answer 2

Tenderness to palpation • Joint lines • Most accurate for meniscal tear • Patellar tendon • Quadriceps tendon • Pes anserine bursa • Fibular head • Popliteal space • Gerdy’s tubercle

Answer 3

• Use goniometer • Locate axes of femur and tibia • Normal knee hyperextends

Answer 4

Lachman, Ant/Post Drawer, Pivot Shift, External Rotation‐Recurvatum, Valgus and Varus Stress, TEST THE GAIT

Answer 5

• Flex to 30 degrees • Compare to contralateral side • Grade 0 – no difference • Grade 1 – 1‐5 mm difference • Grade 2 – 5‐10 mm difference • Grade 3 ‐ > 10 mm difference • Feel for endpoint • Confirm with KT‐1000 • Most accurate test for ACL tear; A- good endpoint, B- no solid end point

Answer 6

* Flex to 90 degrees • • Grade 0 – Normal * Grade 1 – Normal step‐off * Grade 2 – Flush with tibial plateau * Grade 3 – Sags posterior to plateau

Answer 7

• Most difficult to perfect • Start extended, internally rotate, axial load, then flex slowly • Will feel a “clunk” if positive • Diagnostic for ACL disruption

Answer 8

• Performed at 0 and 30 degrees of flexion • Reasonably accurate for diagnosis of collateral ligament injury

Answer 9

• Meniscal test • Fully flex, internally (or externally rotate) then extend slowly • Pain and/or click

Answer 10

he examiner then places his or her own knee across the posterior aspect of the patient's thigh. The tibia is then compressed onto the knee joint while being externally rotated. If this maneuver produces pain, this constitutes a "positive Apley test" and damage to the meniscus is likely.

Answer 11

Stand on affected flexed leg, twist

Answer 12

• Tenderness to palpation • Compression Pain • Apprehension • Crepitation • Translation • J‐sign • Q‐angle

Answer 13

``` Ottawa knee rules (• Age >55 • Tenderness at head of fibula • Isolated tenderness at patella • Inability to flex knee 90 degrees • Inability to bear weight four steps immediately and in examination room), hemarthrosis, Not used routinely ```

Answer 14

Weight bearing PA 10* flexed MTP, lateral flexed 30*, Merchant (patellar view)

Answer 15

MTP view provides more accurate and more reproducible measurement of JSW than SEV.

Answer 16

• Replaces the “diagnostic arthroscopy” • Accurate for ligament and meniscal tears • Rule of thumb: “What will we do with this information?” • Many injuries can be assessed without MRI, but MRI is useful for diagnosis.

Answer 17

7 per 100,000 per year • Adolescents: 43 per 100,000 per year; Risks • Female • Family History • Prior History • Degree of Trauma (recurrent)

Answer 18

• Patella tendon • Patellofemoral ligaments • Patellotibial ligaments • Patellomeniscal ligaments ?

Answer 19

• Primary stabilizer to lateral displacement • 50‐60% of medial restraining force • First 20‐30 degrees of flexion • More in VMO dysplasia • Dynamized by VMO

Answer 20

• Initial dislocation • Redislocation: 15‐44% • Symptoms: 50% • Core strengthening rehab • VMO strengthening • Orthoses

Answer 21

Any patient with two documented patellar dislocations and exam findings of excessive lateral patellar mobility

Answer 22

disruption of meniscal integrity; Mechanism • Twist, “stepped wrong”, antecedent minor injury Clinical Diagnosis • Joint line tenderness, McMurray test • MRI to evaluate character of tear

Answer 23

• Non‐operative • Surgical meniscectomy • Arthroscopic repair

Answer 24

• 50% develop radiographic changes of arthritis in 10‐20 years. •Worse in women, obese, and lateral meniscus • Subsets exist • Traumatic tear • Degenerative tear

Answer 25

• Surgery decreases “giving way episodes, meniscus tears, and articular cartilage injuries. • 15‐20% have residual pain post‐operatively • 40‐50% have radiographic changes of arthritis at 10 yrs postoperatively • Many have persistent pivot‐shift with single‐bundle reconstruction

Answer 26

Return to sports: 4-6 months (sport and patient dependent); Regular visits up to 1 yr post-op; • Hinged knee brace locked in extension • FWB in full extension • CPM 0‐30°, increase by 10° per day for one week • Brace unlocked at one week • Crutches used until quadriceps control in achieved • Return to sports at 6 months

Answer 27

•Disruption of integrity of ACL • Twist on a planted foot, fall from height •Clinical diagnosis • Effusion, Lachman, Pivot shift • MRI to assess cartilage, bone, meniscus • Treatment variable

Answer 28

•Intra‐articular, extra‐ synovial • Two separate bundles • Anteriomedial • Posterolateral •Distinct biomechanical functions

Answer 29

Extension: • AM loosens • PL tightens; Flexion: • AM tightens • PL loosens

Answer 30

• High energy multi‐ligamentous knee injury • Risk of associated injuries • Common peroneal nerve injury (25%, 50% partially recover) • Vascular injury • Popliteal artery tethered proximally and distally • Neurovascular examination important • If ABI > 0.9, then serial observation • If ABI

Answer 31

• 27 million affected in the United States. • Third leading cause of years living with a disability (YLD) in the United States • 600,000+ total joint replacements performed per year • 50% of people develop OA 10 years after major joint injury

Answer 32

1) Educate patients 2) Regular contact 3) BMI >25 should lose 5% BW 4) Low impact aerobics 5) Maintain flexibility 6) Quad strengthening 7) Patellar taping for short term relief 8) Lateral heel wedges don’t work 9) Unable to make statements about … • valgus‐producing bracing • varus‐producing bracing • or accupuncture . 10) Don’t prescribe glucosamine and chondroitin 11) Use NSAIDS and/or Acetaminophen 12) Use Acet, topical NSAIDS, or COX‐2 inhibitors with GI problems 13) Steroid injections for short‐term relief 14) Cannot recommend hyaluronate products 15) Don’t use needle lavage 16) Don’t use arthroscopy for primary diagnosis of DJD 17) Meniscectomy or loose body removal is “an option”

Answer 33

•Acute osteochondral injury •Osteochondritis Dissecans •Chronic degenerative lesion •ROM, alignment, effusion, stability •Radiographs show loss of joint space, subchondral cysts or sclerosis, and osteophyte formation

Answer 34

• Grade 0: Normal cartilage • Grade I: Softening and swelling • Grade II: Superficial fissures • Grade III: Deep fissures, without exposed bone • Grade IV: Exposed subchondral bone

Answer 35

Marrow Stimulation, Autologous Plug Transplantation, Autologous Chondrocyte Implantation, Osteochondral Allograft Transplantation, Knee arthroplasty

Answer 36

• Microfracture • Allow mesenchymal stem cells access to defect. • CPM 6 hours per day for 6 weeks • Non‐weight bearing for 6 weeks. • Results highly dependent on the size of the defect • Especially larger than 2X2cm

Answer 37

• OATS or mosaicplasty • Replace cartilage defect with plug from relatively lower weight bearing segment • Weight bearing delayed 3 months. • Limited by donor size and donor site morbidity.

Answer 38

– Carticel or others • Cell therapy forming “hyaline like” cartilage • Limited by cost, two surgeries, outcomes similar to microfracture

Answer 39

• Transplantation of live cartilage • Can address large defects • Low risk of infection, limited availability, cost

Answer 40

• Performed through medial parapatellar approach • Goal is to restore alignment and achieve ROM • Balance knee is flexion and extension • Gaps should be equal

Answer 41

* Caused by direct impact to the anterior aspect of the knee • Can be associated with other injuries from dashboard mechanism Evaluation * Inability to perform straight leg raise indicates extensor mechanism disruption

Answer 42

• Non‐operative if non‐displaced • ORIF with tension band construct

Answer 43

High energy injury in younger population or low energy injury in older patients • Evaluation: radiographs, CT to determine extent of intra‐articular involvement

Answer 44

• Non‐operative in non‐displaced • External fixation for temporary treatment • ORIF to restore normal anatomy • Intramedullary nail for supracondylar fracture • Distal femoral replacement for some with prior total knee replacement

Answer 45

• Periarticular fracture varus or valgus load • Associated injuries • Meniscal tear, ACL tear, compartment syndrome, vascular injury • Radiographs, CT, consider MRI prior to surgical treatment

Answer 46

• Non‐operative if non‐displaced • External fixation for temporary or severe open injury • ORIF for articular stepoff or displaced fractures

Answer 47

Type I- split, Type II- split depression, Type III- central depression, Type IV- split fracture medial plateau, Type V- bicondylar fracture, Type VI- dissociation of metaphysis and diaphysis

Answer 48

• Approach depends on fracture type • Reduction and fill the metaphyseal bone void/defect with bone graft • Internal fixation with lock plate/plates