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Y2 MSK > Knee Conditions > Flashcards

Knee Conditions Flashcards

1
Q

Describe a “total” knee replacement

A

Resurfacing all 3 compartments of the knee

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2
Q

Describe a “partial” knee replacement

A

Resurfacing 1 compartment of the knee (usually patellofemoral)

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3
Q

There is a greater incidence of pain assoc. with knee replacements compared to hip replacements. True/False?

A

True

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4
Q

How do meniscal tears classically occur?

A

Twisting force, getting up from a squat

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5
Q

Where do patients usually localise meniscal tear injury? How is the pain described?

A

Sudden sharp pain at joint line of the knee
Medial (majority)
Lateral (occasionally)

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6
Q

If a patient describes a “locked knee”, what pathology should be suspected?

A

Bucket-handle mensical tear

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7
Q

Define true “locking” of the knee

A

Mechanical block to full knee extension

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8
Q

What is the difference between locking and pseudolocking of the knee?

A

Pseudolocking will resolve spontaneously/patient describes trick manoevure to overcome the locking

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9
Q

How do ACL ruptures classically arise?

A

Great rotational force upon a planted foot

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10
Q

What, clinically, usually accompanies an ACL rupture?

A

“pop” sound
Haemarthrosis
Rotatory instability (chronic)

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11
Q

A rugby tackle from the side will usually cause which ligament to damage?

A

Medial collateral, causing valgus stress injury

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12
Q

A direct blow to the anterior tibia with the knee flexed (car crash) may rupture which ligament?

A

Posterior cruciate

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13
Q

A varus stress injury causes rupture of which ligament?

A

Lateral collateral

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14
Q

Which test is used to define a meniscal tear?

A

Steinmann’s test

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15
Q

Which meniscal tear is more common - medial or lateral?

A

Medial

it is less mobile

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16
Q

Which type of meniscal tear causes a bucket-handle tear?

A

Longitudinal tear

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17
Q

List the 4 types of meniscal tear

A

Longitudinal
Radial
Oblique
Horizontal

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18
Q

Degenerative meniscal tears are usually Steinmann’s positive. True/False?

A

False

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19
Q

Why do meniscal tears have limited healing potential?

A

Small blood supply

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20
Q

What clinical tests will help define ACL rupture?

A

Lachman test

Anterior drawer test

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21
Q

Primary repair of ACL rupture is not effective. True/False?

A

True

Most get reconstruction

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22
Q

What does reconstruction of ACL involve?

A

Tendon grafting (patellar/temitendinouus-gracilis)

23
Q

What structures are involved in the extensor mechanism of the knee?

A

Tibial tuberosityPatellar tendonPatellaQuadriceps tendonQuadriceps

24
Q

How does the patellar/quadriceps tendon usually rupture?

A

Rapid contractile force (lifting heavy weight)

25
Q

What clinical test helps define whether the extensor mechanism of the knee is intact?

A

Straight leg raise

26
Q

List clinical signs of patellofemoral dysfunction

A

Anterior knee pain worse going downhillGrinding/clicking sensationPseudolocking

27
Q

Which meniscus in the knee is more fixed and less mobile - medial or lateral?

A

Medial

28
Q

Which ligament resists valgus stress?

A

Medial cruciate ligament

29
Q

Which ligament resists varus stress?

A

Lateral cruciate ligament

30
Q

What does the anterior cruciate ligament prevent?

A

Subluxation of tibia anteriorly

31
Q

What does the posterior cruciate ligament prevent?

A

Subluxation of tibia posteriorly

Hyperextension of knee

32
Q

A patient who has difficulty descending stairs may have rupture of which ligament in the knee?

A

Posterior cruciate ligament

33
Q

Which meniscal tear - medial or lateral - is more common?

A

Medial (undergoes more stress)

34
Q

Meniscal tears heal easily. True/False?

A

False

Very limited healing potential (poor blood supply)

35
Q

What is a “bucket handle tear”, how does it present and how is it treated?

A

Meniscus flap gets caught in intercondylar notch
Presents as locked knee
Arthroscopic repair/menisectomy

36
Q

Meniscal tear due to degenerative damage is pointless to operate on. True/False?

A

True

Little improvement, sometimes worse - typically steroid injections are used

37
Q

Describe grade 1 knee ligament tear

A

Tear of some ligament fibres but macroscopically everything is in tact (sprain)

38
Q

Describe grade 2 knee ligament tear

A

Partial tear where some fascicles are disrupted

39
Q

Describe grade 3 knee ligament tear

A

Complete tear of the ligament

40
Q

ACL rupture repair never really works - what is done instead?

A

Reconstruction (allograft, autograft or synthetic graft)

41
Q

If a patient suddenly twists, which ligaments are susceptible to tear?

A

ACL

Meniscus

42
Q

Only full thickness cartilage injury can heal. True/False?

A

True

43
Q

What is osteoarthritis dissecans?

A

An area of the surface of the knee loses its blood supply and cartilage, sometimes causing bone to fragment off

44
Q

When hyaline cartilage heals, what type of cartilage replaces it?

A

Fibrocartilage

45
Q

List some cartilage regeneration techniques

A

Microfracture
Grafting
Mosaicplasty
MACI (membrane-induced autologous chondrocyte implantation)

46
Q

What is the function of the menisci of the knee?

A

Shock absorbers

47
Q

How can MCL injuries be managed?

A

Heal well - brace, physio

Surgery (rare)

48
Q

Which nerve can be damaged in LCL injury?

A

Common peroneal nerve

49
Q

How can LCL injuries be managed?

A

Urgent repair or reconstruction

50
Q

Which injury is suggested if the knee ‘gives way’?

A

Meniscal injury

51
Q

What imaging is used to diagnose ligament injuries in the knee?

A

MRI

52
Q

How many ligaments need to be torn for a knee dislocation?

A

3/4

53
Q

How long does a knee replacement typically last?

A

15-20 years

54
Q

What is used as an alternative to knee replacement, in young patients presenting with early OA?

A

Osteotomy

Y2 MSK (30 decks)

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