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MSK- Pelvis and Lower Limb > Knee- Cartilage Injuries, Arthritis, Patello-Femoral Dysfunction > Flashcards

Knee- Cartilage Injuries, Arthritis, Patello-Femoral Dysfunction Flashcards

1
Q

The knee joint consists of what compartments?

A

Medial and lateral compartments of the tibiofemoral and patellofemoral joints

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2
Q

The surfaces of the knee joint are all covered with what?

A

Hyaline cartilage

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3
Q

Within which sub-joint of the knee are the menisci found?

A

Tibiofemoral joint

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4
Q

The menisci of the knee ensure congruence between where?

A

The concave femoral condyles and the flat tibial plateaus

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5
Q

What are the roles of the menisci?

A

Shock absorbers, and act to distribute load evenly

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6
Q

What is the role of the ACL?

A

Prevent abnormal internal rotation of the tibia

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7
Q

How is the ACL tested?

A

By assessing anterior translation of the tibia

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8
Q

What are the roles of the PCL?

A

Prevents hyperextension and anterior translation of the femur

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9
Q

How is the PCL tested?

A

By assessing posterior translation of the tibia

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10
Q

What is the role of the MCL?

A

Resist valgus stress

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11
Q

What are the roles of the LCL?

A

Resist varus stress and abnormal external rotation of the tibia

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12
Q

Most injuries of the knee joint can predispose to OA. What are some common predisposing injuries?

A

Joint instability, malalignment, ACL deficiency, meniscal tears

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13
Q

If you have gene varum, what type of knee OA will you have?

A

Medial compartment OA

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14
Q

If you have gene valgum, what type of knee OA will you have?

A

Lateral compartment OA

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15
Q

Knee joint instability will predispose to what type of knee OA?

A

Patellofemoral

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16
Q

What are some non-operative management options for knee joint OA?

A

Weight loss, stick, exercise, analgesics, activity modification

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17
Q

When are steroid injections used for knee OA?

A

Only for acute flare ups

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18
Q

When can an osteotomy of the proximal tibia be used as a treatment for knee OA?

A

Varus knees with isolated medial compartment OA (usually younger patients)

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19
Q

What is the aim of an osteotomy of the proximal tibia as a treatment for isolated medial compartment OA?

A

Shift the load to the lateral compartment. Useful for manual workers where a knee replacement would fail.

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20
Q

What are the disadvantages of an osteotomy for the treatment of isolated medial compartment OA?

A

There can sometimes be neuropathic pain after. Will only last 7-10 years and after this procedure a knee replacement would not be as successful

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21
Q

When should knee replacements be offered to those with knee arthritis?

A

In older patients with severe disability and conservative management is no longer effective

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22
Q

What is the difference between a total and partial knee replacement?

A

A total replacement resurfaces all 3 compartments while a partial replacement only resurfaces 1

23
Q

If a knee replacement is successful, how long will it last?

A

15-20 years

24
Q

What are some risks of knee replacement surgery?

A

Unexplained pain, stiffness, DVT/PE

25
Q

Why should knee replacements not be used in younger patients?

A

Higher chance of requiring revision surgery later which then has a higher rate of failure

26
Q

Who has unicompartmental knee replacement been proposed as a treatment for?

A

Patients with isolated medial or lateral compartment OA and also for younger patients

27
Q

If failure occurs following a UKR, can a TKR be used?

A

Yes

28
Q

Which ligament of the knee is usually excised in TKRs and which is also often sacrificed?

A

Usually always excised = ACL, often sacrificed = PCL

29
Q

Ongoing pain and effusion after a knee injury warrants further investigation to look for what?

A

Cartilage defects

30
Q

What investigations can be used to assess for cartilage damage?

A

X-ray, MRI, arthroscopy

31
Q

Articular cartilage injuries can occur in response to trauma, or they can be atraumatic. Give some examples of atraumatic causes?

A

Osteochondritis dissicans, osteoarthritis, inflammatory arthritis

32
Q

What type of cartilage injuries can heal and why?

A

Only full thickness injuries can heal and they are the only ones to receive a blood supply

33
Q

During healing of cartilage injuries, what takes the role of articular cartilage?

A

Fibrocartilage (not as good as hyaline but does the job)

34
Q

What is osteochondritis dissicans?

A

Part of the joint temporarily loses blood supply, which causes dead bone and cartilage to fragment off

35
Q

Who does osteochondritis dissicans typically occur in?

A

Adolescents

36
Q

How is osteochondritis dissicans treated?

A

Can heal or resolve spontaneously in kids, or it can be fixed/removed

37
Q

How should acute injuries involving large osteochondral fractures with a substantial portion of bone be treated?

A

Fixed with pins

38
Q

How should cartilage injuries from a non-weight bearing area or those with little bone attached be treated?

A

Arthroscopic removal

39
Q

Cartilage repair surgeries will not work if what is already present?

A

Osteoarthritis showing radiographic changes, inflammatory arthritis or joint instability

40
Q

If a child presents with knee pain, what should you always check for?

A

The hips for SUFE

41
Q

What knee condition commonly occurs in people who are on their knees a lot?

A

Bursitis

42
Q

What is Osgood-Schlatter’s disease?

A

Anterior knee pain in adolescents, will go away with time

43
Q

What is an autograft?

A

Tissue from the patient

44
Q

What is an allograft?

A

Tissue from a donor

45
Q

How many bundles does the ACL have? How many are reconstructed?

A

2 bundles, 1 reconstructed

46
Q

What is patello-femoral dysfunction?

A

Any disorder of the patellofemoral articulation, resulting in anterior knee pain

47
Q

What conditions does patella-femoral dysfunction include?

A

Chondromalacia patellae, adolescent anterior knee pain, lateral patellar compression syndrome

48
Q

What is chondromalacia patellae?

A

Softening of the hyaline cartilage

49
Q

The quadriceps muscle pulls the patella in what direction?

A

Lateral

50
Q

Patello-femoral dysfunction is commoner in who? Why?

A

Females (wider hips meaning more lateral pull of quadriceps) and adolescents (ligamentous laxity)

51
Q

Apart from being female and adolescent, what are some other risk factors for patello-femoral dysfunction?

A

Joint hyper mobility, genu valgum, femoral neck anteversion

52
Q

Patients with patello-femoral dysfunction tend to complain of what?

A

Anterior knee pain, worse going downhill, a grinding or clicking sensation, stiffness after prolonged sitting (pseudo locking)

53
Q

What are the treatment options for patello-femoral dysfunction?

A

> 90% of cases resolve with physiotherapy, aimed at rebalancing the quadriceps muscles. Taping can alleviate symptoms. Surgery is a last resort.

MSK- Pelvis and Lower Limb (5 decks)

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