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MSK > Knee conditions > Flashcards

Knee conditions Flashcards

1
Q

what can cause a meniscal tear ?

A

acute - twisting, especially in deep flexion

degenerative - osteoarthritis

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2
Q

how does a meniscal tear present ?

A

pain
clicking
locking
intermittent swelling

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3
Q

what are signs of a meniscal tear ?

A

look - effusion
feel - tender joint line at point of tear
move - mechanical block to movement, mcmurrays test positive, fail deep squat, thessalys test positive

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4
Q

what is McMurray’s test ?

A

flex knee
externally rotate foot
valgus stress at knee

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5
Q

what is Thessaly’s test ?

A

stand on affected leg, flex knee to 20 degrees

twist body side to side

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6
Q

how do you investigate a meniscal tear ?

A

X ray - arthritis, fracture

MRI - high false positive rate

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7
Q

is a meniscal tear likely to heal and why ?

A

unlikely to heal

poor blood supply

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8
Q

what are non-operative treatments for a meniscal tear ?

A

rest
NSAIDs
physio - thigh strengthening

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9
Q

what are operative managements for meniscal tears ?

A

arthroscopy - repair, resection

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10
Q

what is osteoarthritis ?

A

degenerative change of synovial joints
progressive loss of articular cartilage
secondary bony changes
worsening pain and stiffness

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11
Q

where does the ACL run ?

A

from between tibial eminences

to lateral wall of intercondylar notch of femur

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12
Q

what is the blood and nerve supply to the ACL ?

A

blood - middle geniculate artery

nerve - posterior articular nerve, branch of posterior tibial

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13
Q

what is the function of the ACL ?

A

primary - prevent anterior displacement of joint

secondary - restrain tibial rotation and various/valgus stress

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14
Q

what causes an ACL tear ?

A

non-contact pivot injury

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15
Q

are men or women more prone to ACL tear and why ?

A

females more prone 4.5:1

landing biomechanics and neuromuscular activation patterns - quads

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16
Q

how does an ACL tear present ?

A

heard pop or crack
immediate swelling - haemarthrosis
unable to continue playing - can still walk in straight line
deep pain

17
Q

what are the signs of an ACL tear ?

A

look - effusion

move - anterior draw positive, lachmanns test positive, pivot shift

18
Q

how do you investigate ACL tear ?

A

Xray - second fractures avulsion of anterolateral ligament

MRI

19
Q

how do you treat an ACL tear ?

A

non-operative - focused quadriceps programme

operative - reconstruction, +/-partial meniscectomy +/-ligament repair or augmentation, hamstring graft

20
Q

what is the difference between the superficial and deep MCL ?

A

superficial - primary restraint to valgus stress

deep - contributes in full knee extension, attaches to medial meniscus, continuous with joint capsule

21
Q

what is the most common ligament injury of the knee ?

A

MCL tear

22
Q

what causes an MCL tear ?

A

severe valgus stress

usually contact related

23
Q

what is the presentation if an MCL tear ?

A 
heard pop or crack
very painful medial side
unable to continue playing
bruising medial knee
localised swelling
24
Q

what are the signs of an MCL tear ?

A

look - medial swelling, bruising
feel - tender medial joint line, tender femoral insertion of MCL
move - painful full extension, opening on valves stress

25
Q

how do you investigate an MCL tear ?

A

Xray - can be normal, calcification at femoral insertion

MRI

26
Q

what is non-operative management of an MCL tear ?

A 
mostly non-op
rest
NSAIDs
physio
brace
27
Q

when is operative management used for MCL tear ?

A

severe tears

failed non-operative management

28
Q

what are the options for operative management of MCL tear ?

A

repair avulsions - midsubstance tear with good tissue

reconstruction - damaged tissue

29
Q

what is osteochondritis dissecans ?

A

pathological lesion affecting articular cartilage and subchondral bone

30
Q

what are the two forms of osteochondritis dissecans ?

A

juvenile - 10 - 15 years while growth plate still open

adult

31
Q

what are the causes of osteochondritis dissecans ?

A

hereditary
traumatic
vascular - adult form

32
Q

what is the most common location for osteochondritis dissecans ?

A

knee - posterolateral aspect of medial femoral condyle

33
Q

how does osteochondritis dissecans present ?

A

poorly localised, activity-related pain
recurrent effusions
mechanical symptoms - locking, block to full movement

34
Q

what are signs of osteochondritis dissecans ?

A

may be normal
look - effusion
feel - localised tenderness
move - stiffness, block to movement, Wilson’s test (dangle legs, internal rotation painful)

35
Q

how do you investigate osteochondirits dissecans ?

A

xray - with tunnel view

MRI - lesion size, status of cartilage and subchondral bone, oedema suggest instability of fragment

36
Q

how do you treat osteochondritis dissecans ?

A

non-operative - restricted weight-bearing, ROM brace

operative - arthroscopy (subchondral drilling, fix loose fragments), open fixation

MSK (29 decks)

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