Knee & Hip Problems

Question 1

What are the common mechanisms of injury to knee ligaments and menisci and what are the associated clinical features?

Answer 1

Meniscal tear: acute or degenerative. Medial more common. Present with pain, clicking, locking and intermittent swelling. X-ray and MRI.

ACL injury: usually non contact pivot injury. Presents with immediate swelling, unable to walk straight, “pop” or crack noise, deep pain. X ray and MRI.

MCL injury: superficial and deep, usually under severe valgus stress and contact related. Presents with pop or crack, pain on medial side, unable to continue, bruising medial knee, localised swelling. X-ray and MRI.

Osteochondritis dissecans: lesion affecting articular cartilage and subchondral bone. Presents with activity related pain. Recurrent effusions, mechanical symptoms eg locking, block to full movements. X-ray and MRI.

Question 2

What are the principles of management and rehabilitation of knee injuries?

Answer 2

Non operative management 
Rest, NSAIDs, physiotherapy to strengthen surrounding muscles, brace
Operative
Arthroscopy (repair, resect)
Reconstruction
Open fixation

Question 3

What are the common injuries to the hip and what are the associated clinical features?

Answer 3

Bursitis: inflammation of the bursa, caused by trauma, overuse, abnormal movement either distant or local. Present with pain, point tenderness, lateral hip side. X-ray, MRI, USS.

Avascular Necrosis: death of bone due to loss of blood supply. Trauma and systemic risk factors eg steroid, alcoholism, sickle cell, lymphoma, leukaemia. Presents with insidious onset of groin pain, pain with stairs, impact, uphill, limp. X-ray and MRI.

Impingement (FAI): commonly cam (more bone on head of femur) lesions or pincer (more bone on acetabulur rim). Presents with groin pain, worse on flexion and mechanical symptoms eg block to movement, pain on certain manoeuvres. Positive FADIR text. X-ray and MRI.

Labral Tear: FAI, trauma, OA, dysplasia, collagen diseases cause this. Present with groin or hip pain, snapping sensation, jamming or locking. X-ray, MRI arthrogram, diagnostic injection.

Question 4

What are the principles of management and rehabilitation of hip injuries?

Answer 4

Non operative

• NSAIDs
• rest / activity modification
• physiotherapy to correct posture, movement, stretching, strengthen
• injections of steroids
• biphosphonates for AVN
• anticoagulants for AVN

Operative

• bursectomy
• AVN: Corey decompression, rotational osteotomy
• total hip replacement
• arthroscopy
• resection
• impingement: periacetabular osteotomy
• arthroplasty