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MSK Cramming > Knee, Bone Metastases > Flashcards

Knee, Bone Metastases Flashcards

1
Q

Primary function of the ACL and PCL in the knee

A

Prevent anterior and posterior motion (respectively)

Act as a 4 bar linkage preventing knee rotation, and allowing for femoral rolling on knee flexion.

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2
Q

Function of the patella

A

Acts as a fulcrum for knee extension from flexion by increasing the quad lever arm

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3
Q

Function of the meniscus

A

To distribute load across the tibia/femur joint and maintain joint congruity. The lateral meniscus shifts more than the medial during flexion.

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4
Q

Collagen type found in the menisci

A

Type I collagen (not articular cartilage)

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5
Q

Q angle

A

Angle between the tibial shaft and the patella that approximates the pull of the quadriceps

Increasing the Q angle (normal is up to 15 degrees) will increase chances of a lateral displacement of the patella

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6
Q

Tests used to evaluate the ACL

A

Anterior drawer/ Lachman’s

Pivot angle

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7
Q

Ligaments of the knee capable of healing

A

MCL and LCL only (PCL and ACL are intra-articular)

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8
Q

Ligament of the knee that is the primary restraint to lateral dislocation of the patella

A

Medial patellofemoral ligament

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9
Q

Grades of Knee Injuries (3)

A

1: Damaged ligaments without laxity
2. Partial ligament tear with laxity
3. Full tear of ligament

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10
Q

Three phases of ligament healing (extra-articular only)

A
  1. Inflammation, clotting
  2. Proliferative, increased cell density and revascularization. Collagen is disorganized
  3. Remodeling, reduced cell density, alignment of collagen to forces

Note that full immobilization will impede remodeling

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11
Q

Treatment required for ACL tears

A

Since ALC will not heal on its own, surgical reconstruction is needed

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12
Q

Radiographic Findings in osteoarthritis (4)

A

Asymmetric joint space narrowing (RA is symmetric)
Osteophytes
Sclerosis
Subchondral cysts

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13
Q

Clinical presentation of osteoarthritis

A

Typically affects knee or large joints, or hand

Pain is worst as day progresses (best in morning or on weekends)

Knee is the most commonly affected joint

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14
Q

Risk factors for developing OA of any joint (5)

A

Genetics
Trauma or misalignment of joint (especially hip problems in children)
Obesity or increased loads
Meniscectomy
Joint instability such as an untreated ACL tear which also tears the meniscus

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15
Q

Treatment options fo OA

A

Decrease loads/ joint use via insoles, low impact exercise, or work limitations
Lose weight
Improve ROM with stretching exercises
Improve strength and balance

If needed, arthroscopy and meniscectomy, but typically not any more effective than PT

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16
Q

Cause of patellofemoral pain syndrome

A

Develops from sudden increases in activity or training errors

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17
Q

Presentation of patellofemoral pain syndrome

A

Diffuse, aching, anterior knee pain

18
Q

Motion most associated with meniscal tears

A

Twisting of the knee in young patients or degeneration in old

19
Q

Clinical presentation of meniscal tear

A

Joint line pain and tenderness
Pain increases with twisting or squatting
Knee may click or catch while binding/extending

20
Q

Treatment of meniscal tears

A

Should get an MRI to evaluate extent of damage
Menisci may heal if only torn in vascular outer third
Observation appropriate in older individuals
Cartilage transplant (after meniscectomy) or surgical correction in athletes

21
Q

Motions associated with ACL tear

A

Jumping, pivoting, landing

Most are not associated with sports

22
Q

Imaging needed for ACL tears

A

MRI to assess damage and determine if a meniscal tear is also present (50%)

23
Q

Treatment used for ACL tears

A

Sedentary: non-operative
Active: ACL reconstruction (will not heal), using harvested tissue from achilles or hamstrings

24
Q

Most Common soft tissue sarcomas in adults

A

Liposarcoma

Undifferentiated fibrosarcoma

25
Q

Most common ST sarcomas in children

A

Rhabdomyosarcoma

Synovial sarcoma

26
Q

Imaging studies typically used in soft tissue sarcomas

A

X-ray to assess bone involvement and periosteal reaction
MRI to assess tumor shape and involvement
Chest CT to examine for lung involvement

27
Q

Most common malignant bone tumors of children

A 
Osteogenic sarcoma (blastic)
Ewing's sarcoma (lytic)
28
Q

Most common benign bone lesions in children

A

Unicameral bone cysts

Fibrous dysplasia

29
Q

Undifferentiated fibrosarcomas

A

MALIGNANT AGGRESSIVE soft tissue sarcoma seen in adults that commonly involves the lungs

30
Q

Liposarcoma

A

Less aggressive (than undiff fibrosarcoma) ST sarcoma that can spread to the peritoneum or abdominal viscera

31
Q

Location of most synovial sarcomas

A

Hands and feet (but not derived from synovial cells)

32
Q

Treatment options for unicameral bone cysts

A 
Resolve on own
Only use treatment if painful or persistent after skeletal maturity. Cysts may recur.
- Bone graft
- Injection
- Cryotherapy
33
Q

Pathologic presentation of fibrous dysplasia

A

skeletal deformity with propensity for fracture or limb bowing (including arms)

34
Q

Albright’s syndrome

A

Fibrous dysplasia combined with:

  • Precocious puberty
  • Cafe au lait
35
Q

Histologic and radiographic findings in fibrous dysplasia

A

Lytic lesion with ground glass

Small segments of bone in a fibrous stroma

36
Q

Significant finding in Ewing’s sarcoma

A

Blue cells that stain positive for glycogen

37
Q

Treatment options for Ewing’s sarcoma

A

If bones are expendable: give surgery and chemotherapy

If bones are not expendable: give radiation only with similar results

38
Q

Most common locations of cancer metastasis to bone

A

Pelvis, spine, femur, humerus

39
Q

Factors influencing treatment options for patients with malignant bone metastases

A

Amount of pain
Size of lesion
Risk of having fracture (should always stabilize PRIOR to radiation)

40
Q

Lifespan prognosis of achondroplasia and Osteogenesis imperfecta

A 
Achondro = normal
BBD = shortened

Both are AD disorders

41
Q

Amino acid missing in osteogenesis imperfecta

A

Lacking glycine in collagen triple helix

MSK Cramming (9 decks)

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