Knee and Lower Leg Flashcards
What are the menisci
shock absorbers of the knee - they share the load transmitted across the joint
What does the anterior cruciate ligament control
forward movement of the tibia on the femur
What does the posterior cruciate ligament control
Backward movement
What is a locked knee
one which will not extend fully
What is genu varum
Bow leg
What is genu valgum
knock knee
What us generalised swelling of the knee due to
an effusion or to synovial thickening
During the medial gutter sweep, where is the fluid being swept into
hollows into the supra-patellar pouch and back again
What does Lachmann’s test
the ACL
What investigation is used to determine which ligaments are torn is a dislocated knee
MRI
What type of patients are more likely to have a patella dislocation
children and young adults
How do patella dislocations arise
Fall or blow to the side of the knee
What other injury does a patellar dislocation involve
a tear of the medial capsule and quadriceps expansion
What is the treatment for a dislocated patella
Reduction usually by straightening the knee
What collateral ligament strain is more common
Medial is more common than lateral
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
ACL tear until proven otherwise
When do PCL injuries arise
Dashboard injuries
goalkeepers
How is a PCL injury diagnosed
Posterior sag and posterior draw sign
In what situation does a patient require urgent surgery
Locked knee with acute ACL rupture
What results in a comminuted fracture of the patella
Direct blow often against the dashboard of a car
What is the treatment for a fractured patella
Surgery to reduce and fix but this can be difficult
In what condition is a patient unable to perform a straight leg raise
Rupture of the quadriceps tendon
What is the treatment for a ruptured quadriceps tendon
Surgical repair followed by a period of immobilisation and rehabilitation with physiotherapy
How is a ruptured patella ligament different to a ruptured quadriceps tendon
Younger patients and more athletic with a history of patella tendinosis are more likely to have a rupture of patella ligament
How are displaced fractures of the tibia and fibula bettie treated where there is significant disruption of the joint surface
Open elevation of the joint surface with a bone graft
What are the treatment options for a tibial shaft fracture or fibula fracture
Internal fixation - most popular
External frame fixation
Conservative treatment
A close-fitting cast-brace
What are some complications of lower limb fractures
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
Can menisci tears heal
Yes
What are the commonest knee injuries
tears of the menisci
What are the typical features of a menisci tear
young male
twists the knee while it is flexed and the weight on that leg
Knee may lock
What are the signs of a menisci tear
swelling, tenderness over the meniscus, muscle spasm and perhaps loss of full extension
What meniscus is more likely to have a cyst
lateral meniscus
What is a popliteal cyst
a painless swelling in the popliteal fossa often fluctuating in size
Where do popliteal cysts arise from
one of the anatomical bursa
When should a popliteal cyst be removed
When giving symptoms
What are known as Baker’s cysts
Rheumatoid cysts infiltrating the calf muscles
What are some predisposing factors to OA of the knee
fractures infective conditions meniscus and ligamentous injuries osteochondritis dissecans RA
What is the treatment for OA in the knee
Conservative methods - lose weight, use stick, modify work and take analgesics and NSAIDs
What are the 2 surgical options for OA in the knee
Osteotomy
Arthroplasty
Who undergoes an osteotomy
younger patients - correct the abnormal alignment to allow the normal side of the knee to take more load
Where are the most common sites for acute osteomyelitis in children in the lower limb
upper end o the tibia and the lower end of the femur
What aids the treatment in all infective conditions around the knee
immobilisation of the joint
What are the features of chronic infections
chronic pain and swelling, usually with severe muscle wasting
What are some red flag signs of neoplastic conditions
Atypical pain
night pain
no history of injury
mass or swelling in a young patient
How do loose bodies tend to cause symptoms
By becoming trapped between the joint surfaces
What might loose bodies result from
Osteochondritis dissecans
osteochondral fractures
detached osteophytes usually in osteoarthritis
soft tissue fragments from a damaged meniscus
synovial chondromatosis
What is the treatment for a loose body
removed using the arthroscope or by open operation only if it causes symptoms
