Knee conditions Flashcards
general treatment for someone with knee pain that presents to their GP
physio
which knee ligament strain is most common
MCL
inflammation of patellar ligament at tibial tuberosity
Osgood schlatters disease
crack in articular cartilage and underlying subchondral bone in teenages bc of shear stress on joint
osteochondritis dissecans (OCD)
teenager with joint ‘catching and locking’
osteochondritis dissecans (OCD)
in osteochondirits dissecans (OCD) if an area of the knee surface looses its blood supply what can happen
a bit of bone can break off
if someone gets osteoarthritis in the medial part of their knee, what kind of stance did they have (valgum or varum)
varum
opposite to what youd think
if someone gets osteoarthritis in the lateral part of their knee, what kind of stance did they have (valgum or varum)
valgum
opposite to what youd think
aetiology of osteoarthritis in the knee
any previous trauma, infection, injury etc etc
malalignment (varus or valgum)
first line treatment for knee osteoarthritis (3)
weight loss
increase activity
mobility aids
second line treatment for knee osteoarthritis (after weight loss, increase activity etc)
surgery - total knee replacement, partial knee replacement
who gets total knee replacements for knee osteoarthritis
end stage disease in elderly patients
who gets partial knee replacement for knee osteoarthritis
young patients
how long does a total knee replacement last
15-20 years
investigation for soft tissue knee injuries (2)
MRI - to see ligaments
xray - to exclude fracture
first line treatment for anyone with a ?soft tissue knee injury
pain relief = 1-10mg morphine sulphate
MCL rupture presentation (incl alignment) (2)
valgus instability (knock kneed) - think about if you removed MCL how there would be nothing to stop knee from going inwards
pain for several months (reassure patient this is normal)
treatment of MCL
probs nothing, heals well on its own
encourage early movement to prevent stiffness
aetiology of LCL
football tackles (remember bc their usually on the lateral side of leg)
presentation of LCL rupture (incl alignment) (2)
varum (bow legged)
hyperextension of knee
in a MCL rupture what else may also be damaged
ACL
in a LCL rupture what else may also be damaged
PCL
treatment of LCL
surgery if full tear (tendon graft)
complications of LCL rupture
common fibular nerve injury
aetiology of ACL rupture
sports injury
presentation of ACL rupture (3)
haemarthrosis (swelling with blood)
pain for a few days
locking/catching/twisting/popping
what fraction of people are fine after an ACL rupture
1/3
what fraction of people need to avoid certain activities but are otherwise fine after an ACL rupture`
1/3
what fraction of people need surgery after ACL rupture
1/3
which tests are positive in ACL rupture (2)
anterior drawer test
lachmans test
what test is;
bend knee at 90 degrees, put you hand behind tibia and try to pull it forward to see if it moves
what is it testing
anterior drawer test
ACL rupture
what test is;
leg in air at a 30 degree angle, put hand above and below tibia and try to pull tibia forward
what is it testing
lachman test
ACL rupture
investigation for ACL rupture
MRI
xray to rule out fractures
if someone gets a ligament surgical repair, what are they actually getting done
ligament graft from somewhere else in the body
treatment of ACL rupture
physio
surgery (1/3)
what tendons can be used for tendon grafts in the knee
Achilles tendon
medial 1/3 of patellar tendon
hamstring tendon
requirements for tendon after a tendon graft
good blood supply
are PCL ruptures common
no rare
recurrent hyperextension
instability descending stairs
bruising in popliteal fossa
‘sagging tibia’
PCL rupture presentation
positive examination for PCL rupture
posterior drawer test
what test is;
bend both knees at 90, push tibia backwards to see if it moves
what is it testing
posterior drawer test
PCL rupture
what happens if 3 or 4 ligaments rupture
dislocated knee
treatment of multiligament injury
surgery
unhappy triad of ruptures
medial collateral ligament
anterior cruciate ligament
medial meniscus ligament
(the medial/front ones!)
aetiology of meniscal tears
sporting injury/twisting injury
which meniscus is more likely to tear
why
medial
under more stressed
what is the largest type of meniscal tear
bucket handle tear
joint line tenderness sharp sudden localised pain effusion the next day 'catching and locking' springy block test positive steinmans test
meniscal tear
what test is this;
put fingers on joint line of knee
bend knee to 90 degrees
medially and laterally rotate knee, feeling for any joint line tenderness
what is it testing for
steinmans test
meniscal tear
treatment of meniscal tear if young and acute tear
surgery
treatment of acute meniscal tear if old/previous surgeries failed
partial meniscectomy
complication of all knee ligament tears
osteoarthritis
what is the blood supply to the meniscus
why is this significant in the healing process
peripheral 1/3 has blood supply
poor healing
definition of knee dislocation
3 or 4 of ligaments have ruptured
which nerve is commonly affected in knee dislocations
how does this present
common fibular
foot drop
who do PCL ruptures present in
rugby players
anterior tibial injury (eg in car crash)
treatment of knee dislocation
emergency surgery
treatment of knee dislocation if the patient has arthritis too
knee replacement
complications of knee dislocation (3)
popliteal artery injury
common fibular and tibial nerve injury
compartment syndrome
why are females more likely to get a patellar dislocation
more lax in ligaments
which group (age and sex) of people are most likely to get patellar dislocations
female teenagers
investigation of patellar dislocation
xray to look for fractures
in which direction does the patella (knee cap) usually dislocate (move) to
laterally
treatment of patellar dislocation
splint for 3 weeks, physio
which is more severe, patellar dislocation or knee dislocation
knee dislocation
which is more common patellar dislocation or knee dislocation
patellar dislocation
are recurrent patellar dislocations common
yes - 1 in 5
what condition typically occurs when you fall onto your knee when your quads are contracted
extensor mechanism rupture
what are the 5 components of the extensor mechanism
quads quads tendon patella patellar retinaculum patellar ligament
in a <40 year old, what component of the extensor mechanism is most likely to rupture
patellar tendon
in a >40 year old, what component of the extensor mechanism is most likely to rupture
quads tendon
how many components of the extensor mechanism do you need to rupture before you get an extensor mechanism rupture
one
which knee condition are chronic steroid users (body builders) most likely to get
extensor mechanism rupture
what is Osgood schlatters disease
apophysitis at tibial tubercle (insertion of the patellar tendon)
who does osgood schlatters disease typically occur in
adolescent boys
presentation of Osgood schlatters disease
bony lump at tibial tubercle
pain worse after exercise
examination test for extensor mechanism rupture
straight leg raise
treatment of extensor mechanism rupture (2 + 1 not + 1 stop)
surgery and physio
NOT INJECTION, STOP STEOIDS
anterior knee pain worse going downhill, clicking
patellofemoral dysfunction
valgus
MCL
varus
LCL
twisting/popping
ACL or meniscal tear
dashboard/hyperextension
PCL
getting up from squatting
meniscal tear
haemarthrosis
ACL
swelling (effusion) next day
meniscal tear
pain in joint line
meniscal tear
swelling in popliteal fossa
bakers cyst
what type of cyst is a bakers cyst and example of
ganglion cyst
what is a bakers cyst filled with
mucous/synovial fluid
treatment of bakers cyst
nothing, leave alone
why does mucous/synovial fluid build up in the popliteal fossa in a bakers cyst
weakness in synovial tendon sheath
