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Injuries and medical problems in sport > Knee injuries > Flashcards

Knee injuries Flashcards

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Sports Trivia flashcards USMLE® Step 1 flashcards
1
Q

What is the pes anserinus?

A

The conjoined tendons of three muscles that insert onto the anteromedial surface of the proximal tibia:

  • sartorius
  • gracilis
  • semitendinosus
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2
Q

What is used as a graft for ACL repair?

A

Patella tendon (can use hamstring for younger athletes)

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3
Q

What is the name of the point of insertion for the IT band on the lateral thigh?

A

Gerdy’s tubercle
Smooth facet on the lateral aspect of the tibia
adjacent to tibio-fibular joint and just below knee

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4
Q

Name the main lateral structures of the knee from superficial to deep layers

A
  1. LAYER 1: IT tract, biceps femoris
  2. LAYER 2: Patellar retinaculum
  3. LAYER 3:
    - SUPERFICIAL: Anterolateral ligament, LCL + fabellofibular ligament
    - DEEP: Arcuate ligament, coronary ligment, popliteus tendon, popliteofibular ligament, capsule
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5
Q

Superficial lateral structures of the knee

A

IT tract, biceps femoris

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6
Q

Layer 2 of lateral structure of knee

A

Patellar retinaculum

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7
Q

Layer 3 of lateral structure of knee

A

SUPERFICIAL:

  • LCL
  • Fabellofibular ligament
  • Anterolateral ligament

DEEP:

  • arcuate ligament
  • coronary ligament
  • popliteus tendon
  • popliteofibular ligament
  • capsule
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8
Q

Layer 1 of medial knee structures

A

LAYER 1
- sartorius and fascia (patellar retinaculum)

LAYER 2

  • semimembranosus
  • superficial MCL
  • posterior oblique ligament

LAYER 3

  • Deep MCL
  • capsule
  • coronary ligament
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9
Q

Origin and insertion of the MCL

A

Originates posterior to the medial epicondyle

Inserts 1-6cm along medial aspect of tibia

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10
Q

ACL rupture is likely to be associated with which other injury?

A

lateral meniscus tear

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11
Q

Ddx traumatic/atraumatic knee pain

A
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12
Q

What questions do you ask about the knee symptoms? (and common ddx)

A
  • Pain (VAS, upstairs PFP, twisting menisci)
  • Instability (ACL, PCL)
  • Mechanical Sx (meniscus bucket handle – goes into the notch in the middle/loose body)
  • Stiffness
  • Swelling
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13
Q

How can different types of instability suggest different ddx?

A
  • Pivoting, twisting, cutting = ACL
  • Linear instability - quad weakness
  • Side-to-side = PCL
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14
Q

Mechanical knee symptoms and common ddx

A

locking, clicking, snapping

  • menisci
  • loose body
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15
Q

relevant questions to ask in Hx

A
  • Treatment received pitch-side –> date
  • Benefits of previous Tx
  • Athletic Hx, level of play/hours, skill level, goals
  • Type of sport
  • PMHx/review of Sx
  • Occupational Hx
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16
Q

Sequence of knee examination

A

1- inspection
2- palpation
3- ROM, strength
4- Patella- tilt, apprehension, translation, crepitus, J-sign, Q-angle
5- Meniscal tests
6- Ligamentous stability- drawer, lachman’s, varus/valgus
7- Gait

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17
Q

Causes of anterior knee pain

A
  • PFP
  • Hypertrophic fat pad syndrome
  • Patellar instability
  • Quadriceps tendonitis
  • Patellar tendonitis
  • Arthritis
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18
Q

Causes of medial knee pain

A
  • Meniscus tear
  • MCL injury
  • Pes anserinus bursitis
  • medial plica syndrome
  • hypertrophic fat pad syndrome
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19
Q

Causes of lateral knee pain

A
  • Meniscus tear
  • Biceps tendonitis
  • hypertrophic fat pad syndrome
  • ITB syndrome
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20
Q

Causes of diffuse knee pain

A
  • Osteoarthritis
  • Inflammatory arthritis
  • Septic arthritis
  • trauma –> haemarthrosis
  • PVNS
  • neoplastic
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21
Q

which meniscal tear is more common

A

medial (lateral more common in ACL tear)

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22
Q

common meniscal tear in older patients

A

degenerative- posterior horn of medial meniscus

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23
Q

describe the meniscal zones and their management

A

Red zone (outer third, vascularized therefore try to repair as increased chance of healing)

Red white (middle third)

White zone (inner third, avascular – will not heal, need debridement)

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24
Q

Sx meniscus tear

A
  • pain (joint line tenderness)- can be intermittent
  • locking/clicking (mech Sx)
  • delayed or intermittent swelling/effusion
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25
Q

Indications for non-operative Mx meniscal tear

A
  • <5mm stable peripheral tear
  • Stable vertical longitudinal tears (peripheral)
  • Infrequent and minimal mechanical Sx
  • Associated ligamentous instabilities
  • Medically unfit
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26
Q

O/E meniscus tear

A

joint line tenderness, effusion, McMurray’s

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27
Q

Ix for meniscal tears + what you would see

A
  • Radiographs, MRI

- Double PCL sign = bucket handle tear (vertical tear which may displace into the notch), fluid where meniscus should be

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28
Q

Mx meniscal tears

A

Operative = partial meniscectomy or arthroscopic meniscal repair (FasT-Fix)

Non-operative = if <5mm, in red (peripheral) zone, no Sx, unfit

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29
Q

What is the common Hx/Sx of an articular cartilage lesion?

A
  • usually follows trauma
  • joint line tenderness/localised pain
  • catching sensation
  • incidental/accompanies another injury
  • effusion
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30
Q

partial vs full thickness chondral lesions

A 
partial = avascular 
full = potential to fill with fibrocartilage (type 1 collagen)
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31
Q

problem with articular cartilage defects?

A

gives rise to loose bodies, painful and accelerates OA

32
Q

Grading of cartilage defects

A
33
Q

Imaging for articular cartilage tears

A
  • x-ray
  • CT- tibial tubercle to trochlear groove distance, Q angle
  • MRI with gadolinium
34
Q

Surgical Tx for AC lesions- indications/contraindications

A
  • Surgery grade 3/4 lesions

- Avoid in: obesity, inflammatory, degeneration

35
Q

What is OAT?

A

OAT replaces chondral defects with normal hyaline articular cartilage, a distinct advantage over microfracture.

A plug of the patient’s own healthy cartilage and bone is harvested from a non-weight bearing portion of the joint.

One or multiple strategically arranged plugs can be transferred to fill the defect.

36
Q

Surgical Tx of chondral lesions

A
  • microfracture
  • OATS
  • ACI and osteochondral allografft

The last 2 work best

37
Q

What is ACI?

A

Autologous chondrocyte implantation (ACI)

Effective for treating small areas of cartilage damage

38
Q

Describe the proces of microfracture for chondral lesions

A

Multiple small holes in the surface of the joint, which stimulates a healing response

39
Q

Microfracture for AC lesions- benefits

A
  • immediate post-op ROM on passive movement
  • Weight bearing 6-8 weeks
  • RTP after 4-9 months
40
Q

OATS- recovery period

A

NWBing 3 weeks
immediate full ROM
4 months return to sport

41
Q

ACI- recovery period

A
  • Immediate CP
  • NWBing till ROM/quads strength fully restored
  • FWB 10-12 weeks
  • offloading brace may be used
  • 12-18 months before high impact
42
Q

Classic Hx ACL tear

A
  • ‘pop’, collapse
  • immediate swelling
  • couldn’t continue to WB
  • Lack of confidence
  • episodes of giving way
43
Q

ACL tear O/E

A
  • positive anterior drawer
  • positive Lachman’s
  • effusion
  • quadricep avoidance gait (don’t fully extend knee)
44
Q

O/E, what severity ACL tear requires surgery

A

Grade II/III pivot shift

45
Q

classic injury that causes and ACL tear

A

non-contact pivoting

46
Q

Epidemiology of ACL tears

A

F5>M1 – landing biomechanics and NM activation patterns (quad dominant)

47
Q

Ix ACL tear

A

radiograph

MRI

48
Q

Preferred Mx ACL injury for jumpers vs footballers and the negatives of both

A

JUMPING ATHLETES

  • hamstring graft
  • RTP delayed 6 months

FOOTBALLERS

  • bone patellar tendon bone (BTB) autograft
  • bone-on-bone healing
  • reduced laxity in graft
  • 30% incidence anterior knee pain
49
Q

Post-op ACL

A
  • early ROM emphasized
  • extension + flexion
  • Closed chain exercises emphasised early
  • running 3-4 months
  • RTP 6-9 months
50
Q

Causes of PCL injuries

A

Dashboard injury

Hyperflexion of the knee with plantar-flexed foot

51
Q

Sx PCL injury

A 
Posterior knee pain but often subtle
Swelling.
Stiffness. 
Difficulty bearing weight.
Knee instability.
52
Q

O/E for PCL injury

A
  • positive posterior drawer
  • posterior sag
  • quadriceps active test
  • positive dial at 90deg +/- 30
53
Q

Mx isolated PCL tears

A

Brace for 4 weeks & rehab
No surgery
RTP 4-6 months when quads strength equal both sides

54
Q

Mx combined PCL and MCL/ACL/knee dislocation

A

Surgical reconstruction < 2 weeks

55
Q

non- operative Tx PCL injury first 6/52 Rehab

A
  • PWB
  • Hamstring/gastroc stretching
  • quad strengthening
  • Use of PCL that provides dynamic anterior drawer
56
Q

non- operative Tx PCL injury first 6-12/52

A
  • Increasing quad/gastroc strength + ROM
57
Q

non- operative Tx PCL injury 13-18/52

A
  • Running and sport-specific exercise

- RTP 4-6 month when quad strength equal

58
Q

post-op management ACL injury

A

2-3/52- Brace locked in full extension, passive ROM on2-3, quads isometric

6/52- WB as tolerated, quads isometric, closed chain, open kinetic chain extension (60-0)

> 6/52- WB as tolerated, 0-125 ROM, isotonic quads, leg press, rowing

Functional activity phase 6-9/12

59
Q

MCL injuries grade 1+2 rehab

A
  • grade 1+2 = hinged brace, NSAIDs
  • closed chain exercises
  • jogging once quad strength 80% contralateral
  • RTP once 80% max speed achieved

Grade 1 & 2 will heal – good blood supply (sup medial & inf medial geniculate arteries)

60
Q

Grde 1 vs grade 2/3 MCL injury RTP time

A

grade 1: 10-14 days
grade 2/3: 3-4 months
grade 3- operative – repair or reconstruction

61
Q

Grade 3 MCL Mx/rehab

A
  • 80% are combined injuries
  • Tibial sided tears require acute surgical repairs
  • PWB 4-6 weeks
  • Closed chain 6 weeks

Squatting, jogging, light agility, slow RTP

62
Q

MCL Sx

A
  • mostly combo with ACL
  • pop
  • pain medially
  • bruising and effusion
63
Q

Sx of LCL injuries

A
  • instability near full extension
  • Difficulty pivoting/climbing stairs
  • Lateral joint line pain and swelling
  • often with PCL/ACL
    may be accompanies with common peroneal nerve injury
64
Q

LCL Mx/rehab

A
65
Q

Patellar tendonitis- who is affected

A
  • jumping athletes

- repetitive, forceful eccentric contraction of extensor mechanism

66
Q

Sx patellar tendinitis

A

insidious onset of anterior knee pain at inferior border of patella – pain after or during activity

67
Q

O/E patellar tendinitis

A
  • Swelling over tendon
  • tenderness inf border of patella
  • Basset’s sign (tenderness to palpation at distal pole of patella in full extension but none in full flexion)
68
Q

Ix for patellar tendonitis- what would you see?

A

X-ray
- enthesophyte in chronic cases

USS

  • thickening of tendon
  • hypoechoic areas

MRI

  • tendon thickening
  • increased signal
  • loss of posterior border of fat pad
69
Q

Mx of patellar tendinitis

A
  • Eccentric exercise programme and stretching of quadriceps and hamstrings
  • US therapy
  • Chopat’s strap or taping
  • NO cortisone injections ⇒ risk of rupture
70
Q

Indications non-operative knee dislocation Mx

A
  • first time

- no fracture/habitual dislocator

71
Q

Indications operative knee dislocation Mx

A
  • displaced osteochondral fragments/loose bodies
  • MPFL repair
  • recurrent instability
  • malalignment (osteotomy)
72
Q

Non-operative Mx knee dislocation

A
  • 6/52 controlled motion
  • closed chain, short arc, quads strengthening
  • core/hip strengthening
  • j-brace
73
Q

Method of narrowing TG and TT distance (reducing chance of knee displacement)

A

Tibial tubercle osteotomy

74
Q

Most common knee ligament injury

A

MCL – excessive valgus stress e.g. skiing, rugby, football

75
Q

MCL Mx

A
76
Q

Posterolateral corner injury

A

LCL, popliteus tendon, popliteofibular ligament

Injuries and medical problems in sport (17 decks)

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