Knee Conditions Flashcards
Chondromalacia patellae
Chondromalacia patellae (also known as CMP) is inflammation of the underside of the patella and softening of the cartilage
The condition may result from acute injury to the patella or chronic friction between the patella and a groove in the femur through which it passes during knee flexion.[6] Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.
The pain is typically felt after prolonged sitting
Plica Syndrome
Plica syndrome (also known as synovial plica syndrome) is a condition that occurs when a plica (a vestigial extension of the protective synovial capsule of the knee) becomes irritated, enlarged, or inflamed.
This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella. The most common location of plica tissue is along the medial (inside) side of the knee. The plica can tether the patella to the femur, be located between the femur and patella, or be located along the femoral condyle. If the plica tethers the patella to the femoral condyle, the symptoms may cause it to be mistaken for chondromalacia.
MCL Injury
MCL injuries mostly occur after an impact on the outside of the knee, lower thigh or upper leg, when the foot is in contact with the ground, and unable to move. The MCL on the inside of the knee will become stressed due to the impact, and a combined movement of flexion/valgus/external rotation will lead to tears in the fibres. The athlete might feel an immediate pain, and feel or hear a popping or tearing sound. [6]
Most of the patients feel pain when we apply force on the outside of a slightly bent knee, but there are no other symptoms
Tibial Plateau Fractures
A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint.[1] Symptoms include pain, swelling, and a decreased ability to move the knee.[1] People are generally unable to walk.[2] Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.[1]
The cause is typically trauma such as a fall or motor vehicle collision.[1] Risk factors include osteoporosis and certain sports such as skiing.[2] Diagnosis is typically suspected based on symptoms and confirmed with X-rays and a CT scan.[1] Some fractures may not be seen on plain X-rays.[2]
Tibial plateau fractures typically presents with knee effusion, swelling of the knee soft tissues and inability to bear weight. The knee may be deformed due to displacement and/or fragmentation of the tibia which leads to loss of its normal structural appearance. Blood in the soft tissues and knee joint (hemarthrosis) may lead to bruising and a doughy feel of the knee joint. Due to the tibial plateau’s proximity to important vascular (i.e. arteries, veins) and neurological (i.e. nerves such as peroneal and tibial) structures, injuries to these may occur upon fracture. A careful examination of the neurovascular systems is imperative. A serious complication of tibial plateau fractures is compartment syndrome in which swelling causes compression of the nerves and blood vessels inside the leg and may ultimately lead to necrosis or cell death of the leg tissues
Low energy fractures are commonly seen in older females due to osteoporotic bone changes and are typically depressed fractures. High energy fractures are commonly the result of motor vehicle accidents, falls or sports related injuries. These causes constitute the majority of tibial plateau fractures
Medial Meniscus Injury
2 types - Acute tears - These are commonly the result of a trauma or a sports injury (sports like tennis, jogging, soccer,…). Acute tears have different shapes (horizontal, vertical, radial, oblique and complex). If they do not respond to conservative management, surgical management may be indicated.
Chronic tears - These most often occur in elderly people, and are degenerative meniscal tears that occur after minimal trauma or stress on the knee. They are mostly treated with physical therapy and anti-inflammatory medication.
. The medial meniscus is also attached to the medial collateral ligament, which limits its mobility
The lateral meniscus is connected to the femur via the anterior (ligament of Humphrey) and posterior (ligament of Wrisberg) meniscofemoral ligaments, which can tension its posterior horn anteriorly and medially with increasing knee flexion.
Meniscal Degenerative tear / Forced rupture
Occurs in the absence of a trauma.
Is due to the age of the person and every day activities.
The meniscal tissue has deteriorated to a certain degree.
Men are more prone to a degenerative tear than women.
A degenerative tear can occur early in someone’s life, for example a young athletes, but it normally occurs in the fourth of the fifth decade of life. [4] [7]
A meniscus injury is generally caused by a torsional movement between the femur and the tibia under load without contact, or making an abrupt movement like a squat. Anything which allows the femur to slip too much forward or backward in relation to the tibia may cause some of the forces to be transmitted to the meniscus, resulting in a meniscus rupture.
There are also so-called silent meniscus tears; this is a radial tear in the lateral meniscus tear. In many cases one does not recognize acute trauma as the mechanical complaints are absent or only slightly present. In many cases, these are pain during and after sports activities although there be pain at the level of the lateral joint line when pressure is applied, and in certain cases a limited flexion, especially in squat, as well as a painful hyper flexion-rotation test.
Symptoms of Meniscal damage
These symptoms can result in the locking of the knee in case of ‘bucket-handle’ tears. It is also responsible for popping of the knee and you can also hear the knee clicking when the torn part of the meniscus moves under the femoral condyle. Other more disturbing symptoms include medial or lateral knee pain depending on the affected compartment, which is caused by an abnormal increase in tension of the joint capsule.
With a degenerative meniscus the symptoms are the same as in a traumatic meniscal lesion, although there may also can be problems with the patella or the cartilage. Symptoms are frequently worsened by flexing and loading the knee, activities such as squatting and kneeling are poorly tolerated.
The clinical presentation for a traumatic lesion / rupture:
- Joint line tenderness, Mc Murray test,[11] Thessaly test and squat test
- Symptoms are popping sound and intermittent residual pain.
- Occurs mostly in aged population. The age of onset is mostly over 50 years of age.
- Hyper-flexion of the knee for a long period of time under weight-bearing lead to excessive pressure.[12]
- Medial meniscus resists more pressure during weight bearing than the lateral meniscus and therefore it is more likely that tears occurs on the medial menisci.
LCL injuries
An injury of the lateral collateral ligament most often occurs from a varus force or by twisting the knee. Such an injury occurs in sports with a lot of quick changes in direction or with violent collusions. Examples are soccer, basketbal, skiing, footbal or hockey. An LCL injury can also be caused by repeated stress or when an elderly person falls.
