Knee and Lower Leg

Question 1

What are the menisci

Answer 1

shock absorbers of the knee - they share the load transmitted across the joint

Question 2

What does the anterior cruciate ligament control

Answer 2

forward movement of the tibia on the femur

Question 3

What does the posterior cruciate ligament control

Answer 3

Backward movement

Question 4

What is a locked knee

Answer 4

one which will not extend fully

Question 5

What is genu varum

Answer 5

Bow leg

Question 6

What is genu valgum

Answer 6

knock knee

Question 7

What us generalised swelling of the knee due to

Answer 7

an effusion or to synovial thickening

Question 8

During the medial gutter sweep, where is the fluid being swept into

Answer 8

hollows into the supra-patellar pouch and back again

Question 9

What does Lachmann’s test

Answer 9

the ACL

Question 10

What investigation is used to determine which ligaments are torn is a dislocated knee

Answer 10

MRI

Question 11

What type of patients are more likely to have a patella dislocation

Answer 11

children and young adults

Question 12

How do patella dislocations arise

Answer 12

Fall or blow to the side of the knee

Question 13

What other injury does a patellar dislocation involve

Answer 13

a tear of the medial capsule and quadriceps expansion

Question 14

What is the treatment for a dislocated patella

Answer 14

Reduction usually by straightening the knee

Question 15

What collateral ligament strain is more common

Answer 15

Medial is more common than lateral

Question 16

What is the diagnosis for a sports person who has a twisting injury and who heard a snap or pop and unable to continue playing

Answer 16

ACL tear until proven otherwise

Question 17

When do PCL injuries arise

Answer 17

Dashboard injuries

goalkeepers

Question 18

How is a PCL injury diagnosed

Answer 18

Posterior sag and posterior draw sign

Question 19

In what situation does a patient require urgent surgery

Answer 19

Locked knee with acute ACL rupture

Question 20

What results in a comminuted fracture of the patella

Answer 20

Direct blow often against the dashboard of a car

Question 21

What is the treatment for a fractured patella

Answer 21

Surgery to reduce and fix but this can be difficult

Question 22

In what condition is a patient unable to perform a straight leg raise

Answer 22

Rupture of the quadriceps tendon

Question 23

What is the treatment for a ruptured quadriceps tendon

Answer 23

Surgical repair followed by a period of immobilisation and rehabilitation with physiotherapy

Question 24

How is a ruptured patella ligament different to a ruptured quadriceps tendon

Answer 24

Younger patients and more athletic with a history of patella tendinosis are more likely to have a rupture of patella ligament

Question 25

How are displaced fractures of the tibia and fibula bettie treated where there is significant disruption of the joint surface

Answer 25

Open elevation of the joint surface with a bone graft

Question 26

What are the treatment options for a tibial shaft fracture or fibula fracture

Answer 26

Internal fixation - most popular External frame fixation Conservative treatment A close-fitting cast-brace

Question 27

What are some complications of lower limb fractures

Answer 27

non-union of tibial fractures some degree of ischaemia of the deep muscles of the calf (Compartment syndrome) Stiffness of knee, ankle and foot may delay full rehabilitation

Question 28

Can menisci tears heal

Answer 28

Yes

Question 29

What are the commonest knee injuries

Answer 29

tears of the menisci

Question 30

What are the typical features of a menisci tear

Answer 30

young male twists the knee while it is flexed and the weight on that leg Knee may lock

Question 31

What are the signs of a menisci tear

Answer 31

swelling, tenderness over the meniscus, muscle spasm and perhaps loss of full extension

Question 32

What meniscus is more likely to have a cyst

Answer 32

lateral meniscus

Question 33

What is a popliteal cyst

Answer 33

a painless swelling in the popliteal fossa often fluctuating in size

Question 34

Where do popliteal cysts arise from

Answer 34

one of the anatomical bursa

Question 35

When should a popliteal cyst be removed

Answer 35

When giving symptoms

Question 36

What are known as Baker's cysts

Answer 36

Rheumatoid cysts infiltrating the calf muscles

Question 37

What are some predisposing factors to OA of the knee

Answer 37

``` fractures infective conditions meniscus and ligamentous injuries osteochondritis dissecans RA ```

Question 38

What is the treatment for OA in the knee

Answer 38

Conservative methods - lose weight, use stick, modify work and take analgesics and NSAIDs

Question 39

What are the 2 surgical options for OA in the knee

Answer 39

Osteotomy | Arthroplasty

Question 40

Who undergoes an osteotomy

Answer 40

younger patients - correct the abnormal alignment to allow the normal side of the knee to take more load

Question 41

Where are the most common sites for acute osteomyelitis in children in the lower limb

Answer 41

upper end o the tibia and the lower end of the femur

Question 42

What aids the treatment in all infective conditions around the knee

Answer 42

immobilisation of the joint

Question 43

What are the features of chronic infections

Answer 43

chronic pain and swelling, usually with severe muscle wasting

Question 44

What are some red flag signs of neoplastic conditions

Answer 44

Atypical pain night pain no history of injury mass or swelling in a young patient

Question 45

How do loose bodies tend to cause symptoms

Answer 45

By becoming trapped between the joint surfaces

Question 46

What might loose bodies result from

Answer 46

Osteochondritis dissecans osteochondral fractures detached osteophytes usually in osteoarthritis soft tissue fragments from a damaged meniscus synovial chondromatosis

Question 47

What is the treatment for a loose body

Answer 47

removed using the arthroscope or by open operation only if it causes symptoms