Knee conditions

Question 1

What is the medial meniscus attached to?

Answer 1

Deep medial collateral ligament

Question 2

What is the function of the meniscii?

Answer 2

Aid force transmission

Increase stability

Question 3

What are the two types of meniscal tear?

Answer 3

Acute

Degenerative

Question 4

What is an acute meniscal tear caused by?

Answer 4

Twisting esp. in deep flexion

Question 5

What is a degenerative meniscal tear caused by?

Answer 5

OA

Question 6

What type of meniscal tears are more common?

Answer 6

Medial meniscal tears

Question 7

What does damage to MCL usually result in?

Answer 7

Medical meniscal tear

Question 8

What is the presentation of a meniscal tear?

Answer 8

Pain
Clicking
Locking
Intermittent sweling

Question 9

What is the examination of meniscal tears like?

Answer 9

LOOK:
?effusion
FEEL:
?tender joint line at point of tear
MOVE:
?mechanical block to movement
?McMurrays test positive
?fail deep squat
?Thassaly's test positive

Question 10

What is McMurrays test?

Answer 10

Evaluates for meniscal tear in knee

Question 11

What is Thessaly’s test?

Answer 11

Evaluates for meniscal tear in knee

Question 12

What are the investigations for a meniscal tear?

Answer 12

XR

MRI

Question 13

What is the most sensitive test for meniscal tear?

Answer 13

MRI

Question 14

What is the management for meniscal tear?

Answer 14

Unlikely to heal = poor blood supply
Non-operative: rest, NSAIDs, physio (muscle strengthening)
Operative; arthroscopy (repair or resection)

Question 15

What is osteoarthritis?

Answer 15

Degenerative change of synovial joints
Progressive loss of articular cartilage
Secondary bony changes

Question 16

What is OA characterised by?

Answer 16

Worsening pain and stiffness in affected joint

Question 17

Where does the ACL run between?

Answer 17

From between tibial eminences to lateral wall of intercondylar notch of femur

Question 18

What is the innervation of the posterior articular nerve?

Answer 18

Posterior articular never

branch of tibial nerve

Question 19

What is the function of the ACL?

Answer 19

Primary restraint to anterior translation of the tibia relative to femur
Secondary restraint to tibial rotation and varus/valgus stress

Question 20

What is the most common method of ACL tear?

Answer 20

Non-contact pivot injury

Question 21

What is the presentation of an ACL tear?

Answer 21

Pop or crack
Immediate swelling
Unable to continue activity- can walk in straight line
Deep pain

Question 22

What is the examination for ACL tear?

Answer 22

LOOK:
?effusion
FEEL
MOVE:
?anterior draw test
?Lachmann's test
?pivot shift

Question 23

What are the investigations for ACL tear?

Answer 23

XR

MRI

Question 24

What menisci can be damaged simultaneous with ACL tear?

Answer 24

Lateral

Question 25

What is the management of ACL tear?

Answer 25

Non-operative: focussed quadricep programme | Operative: ACL reconstruction

Question 26

What muscle can be used as a graft for ACL reconstruction?

Answer 26

Hamstrings

Question 27

What is the function of the superficial MCL?

Answer 27

Primary restraint to valgus stress

Question 28

What is the function of the deep MCL?

Answer 28

Contributes to full knee extension Attaches to medical meniscus Continuous with joint capsule

Question 29

What is the most common ligament injury of the knee?

Answer 29

MCL tear

Question 30

How does MCL tear usually occur?

Answer 30

Severe valgus stress

Question 31

What are associated injuries of MCL tear?

Answer 31

ACL tear | Meniscal tear

Question 32

What is the presentation of an MCL tear?

Answer 32

``` Pop or crack Pain ++ (medial) Unable to continue activity Bruising medial knee Localised swelling ```

Question 33

What is the examination for MCL tear?

Answer 33

``` LOOK: ?medial swelling ?bruising FEEL: ?tender medial joint line ?tender femoral insertion of MCL MOVE: ?painful in full extension ?opening on valgus stress ```

Question 34

What are the investigations for MCL tear?

Answer 34

XR | MRI

Question 35

What is the treatment for MCL tear?

Answer 35

Non-operative: rest, NSAIDs, physio, brace | Operative: for severe tears, repair or reconstruction

Question 36

What is osteochondritis dissecans?

Answer 36

Pathological lesion affecting articular cartilage and subchondral bone

Question 37

What are the 2 forms of osteochondritis dissecans?

Answer 37

Juvenile - growth plates still open | Adult

Question 38

What is the cause of osteochondritis dissecans?

Answer 38

Hereditary Traumatic Vascular - adult

Question 39

Where are most cases of osteochondritis dissecans found?

Answer 39

Posterolateral aspect of medial femoral condyle

Question 40

How does osteochondritis dissecans present?

Answer 40

Activity related pain - poorly localised Recurrent effusions Mechanical symptoms: locking, block to full movement

Question 41

What is the examination of osteochondritis dissecans?

Answer 41

``` LOOK: ?effusion FEEL: ?localised tenderness MOVE: ?stiffness ?block to movement ?Wilson's test ```

Question 42

What are the investigations for osteochondritis dissecans?

Answer 42

XR | MRI

Question 43

What is the treatment for osteochondritis dissecans?

Answer 43

Non-operative: restricted weight-bearing, ROM brace | Operative: arthroscopy or open fixation