Knee Conditions

Question 1

Describe a “total” knee replacement

Answer 1

Resurfacing all 3 compartments of the knee

Question 2

Describe a “partial” knee replacement

Answer 2

Resurfacing 1 compartment of the knee (usually patellofemoral)

Question 3

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

Answer 3

True

Question 4

How do meniscal tears classically occur?

Answer 4

Twisting force, getting up from a squat

Question 5

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

Answer 5

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

Question 6

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

Answer 6

Bucket-handle mensical tear

Question 7

Define true “locking” of the knee

Answer 7

Mechanical block to full knee extension

Question 8

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

Answer 8

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

Question 9

How do ACL ruptures classically arise?

Answer 9

Great rotational force upon a planted foot

Question 10

What, clinically, usually accompanies an ACL rupture?

Answer 10

“pop” sound
Haemarthrosis
Rotatory instability (chronic)

Question 11

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

Answer 11

Medial collateral, causing valgus stress injury

Question 12

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

Answer 12

Posterior cruciate

Question 13

A varus stress injury causes rupture of which ligament?

Answer 13

Lateral collateral

Question 14

Which test is used to define a meniscal tear?

Answer 14

Steinmann’s test

Question 15

Which meniscal tear is more common - medial or lateral?

Answer 15

Medial

it is less mobile

Question 16

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

Answer 16

Longitudinal tear

Question 17

List the 4 types of meniscal tear

Answer 17

Longitudinal
Radial
Oblique
Horizontal

Question 18

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

Answer 18

False

Question 19

Why do meniscal tears have limited healing potential?

Answer 19

Small blood supply

Question 20

What clinical tests will help define ACL rupture?

Answer 20

Lachman test

Anterior drawer test

Question 21

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

Answer 21

True

Most get reconstruction

Question 22

What does reconstruction of ACL involve?

Answer 22

Tendon grafting (patellar/temitendinouus-gracilis)

Question 23

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

Answer 23

Tibial tuberosityPatellar tendonPatellaQuadriceps tendonQuadriceps

Question 24

How does the patellar/quadriceps tendon usually rupture?

Answer 24

Rapid contractile force (lifting heavy weight)

Question 25

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

Answer 25

Straight leg raise

Question 26

List clinical signs of patellofemoral dysfunction

Answer 26

Anterior knee pain worse going downhillGrinding/clicking sensationPseudolocking

Question 27

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

Answer 27

Medial

Question 28

Which ligament resists valgus stress?

Answer 28

Medial cruciate ligament

Question 29

Which ligament resists varus stress?

Answer 29

Lateral cruciate ligament

Question 30

What does the anterior cruciate ligament prevent?

Answer 30

Subluxation of tibia anteriorly

Question 31

What does the posterior cruciate ligament prevent?

Answer 31

Subluxation of tibia posteriorly | Hyperextension of knee

Question 32

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

Answer 32

Posterior cruciate ligament

Question 33

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

Answer 33

Medial (undergoes more stress)

Question 34

Meniscal tears heal easily. True/False?

Answer 34

False | Very limited healing potential (poor blood supply)

Question 35

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

Answer 35

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

Question 36

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

Answer 36

True | Little improvement, sometimes worse - typically steroid injections are used

Question 37

Describe grade 1 knee ligament tear

Answer 37

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

Question 38

Describe grade 2 knee ligament tear

Answer 38

Partial tear where some fascicles are disrupted

Question 39

Describe grade 3 knee ligament tear

Answer 39

Complete tear of the ligament

Question 40

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

Answer 40

Reconstruction (allograft, autograft or synthetic graft)

Question 41

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

Answer 41

ACL | Meniscus

Question 42

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

Answer 42

True

Question 43

What is osteoarthritis dissecans?

Answer 43

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

Question 44

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

Answer 44

Fibrocartilage

Question 45

List some cartilage regeneration techniques

Answer 45

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

Question 46

What is the function of the menisci of the knee?

Answer 46

Shock absorbers

Question 47

How can MCL injuries be managed?

Answer 47

Heal well - brace, physio | Surgery (rare)

Question 48

Which nerve can be damaged in LCL injury?

Answer 48

Common peroneal nerve

Question 49

How can LCL injuries be managed?

Answer 49

Urgent repair or reconstruction

Question 50

Which injury is suggested if the knee 'gives way'?

Answer 50

Meniscal injury

Question 51

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

Answer 51

MRI

Question 52

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

Answer 52

3/4

Question 53

How long does a knee replacement typically last?

Answer 53

15-20 years

Question 54

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

Answer 54

Osteotomy