Knee injuries

Question 1

Meniscal tears most commonly occur during what kind of movement?

Answer 1

Twisting the knee

Question 2

Describe the typical clinical features of a meniscal tear

Answer 2

Knee:

• Pain
• Swelling
• Reduced ROM

Question 3

Which special tests can be used on examination of the knee to detect a meniscal tear?

Answer 3

• McMurray’s test

- Apley grind test

Question 4

What is the usual first-line imaging investigation for establishing a diagnosis of meniscal tear?

What is the gold standard investigation?

Answer 4

• First line: MRI

- Gold standard: arthroscopy

Question 5

Describe the conservative, medical and surgical management of a meniscal tear

Answer 5

Conservative:

• RICE
• Physiotherapy

Medical:
- Analgesia (NSAIDs)

Surgical:
- Arthroscopic surgery

Question 6

Which ligament in the knee is most commonly injured?

Answer 6

Anterior cruciate ligament (ACL)

Question 7

ACL injury typically occurs during what kind of movement?

Answer 7

Twisting the knee

Question 8

Describe the typical clinical features of ACL injury

Answer 8

Knee:

• Pain
• Swelling
• Reduced ROM

Question 9

Which special tests can be used on examination of the knee to detect ACL injury?

Answer 9

• Anterior drawer test

- Lachman test

Question 10

What is the usual first-line imaging investigation for establishing a diagnosis of ACL injury?

What is the gold standard investigation?

Answer 10

• First line: MRI

- Gold standard: arthroscopy

Question 11

Describe the conservative, medical and surgical management of ACL injury

Answer 11

Conservative:

• RICE
• Physiotherapy

Medical:
- Analgesia (NSAIDs)

Surgical:
- Arthroscopic surgery

Question 12

Describe the pathophysiology of Osgood-Schlatter disease

Answer 12

Inflammation at the tibial tuberosity where the patellar tendon inserts

Question 13

In which age group is Osgood-Schlatter disease most common?

Answer 13

Teenagers

Question 14

What sign will you typically find on inspection of the anterior knee in Osgood-Schlatter disease?

Answer 14

Visible lump on the anterior aspect of the knee (which is initially tender, but becomes non-tender over time as the bone heals)

Question 15

Typically, knee pain is exacerbated by (…?) in Osgood-Schlatter disease

Answer 15

Physical activity

Question 16

Describe the conservative and medical management of Osgood-Schlatter disease

Answer 16

Conservative:

• RICE
• Physiotherapy

Medical:
- Analgesia (NSAIDs)

Question 17

What is a Baker’s cyst?

Answer 17

Fluid-filled sac (cyst) in the popliteal fossa

Question 18

What causes a Baker’s cyst?

Answer 18

• Can occur following knee injury, e.g. meniscal tear

- Most commonly occur secondary to degenerative changes (osteoarthritis) in older adults

Question 19

Describe the typical clinical features of a Baker’s cyst

Answer 19

Knee:

• Pain
• Swelling
• Reduced ROM

Question 20

On examination of the knee, what sign is characteristic of a Baker’s cyst?

Answer 20

Foucher’s sign:

• Lump is most apparent when patient is stood (knee is fully extended)
• When knee is flexed, lump gets smaller or completely disappears

Question 21

Which investigation can be used to confirm the diagnosis of a Baker’s cyst?

Answer 21

USS

Question 22

Is any treatment required for an asymptomatic Baker’s cyst?

Answer 22

No

Question 23

Describe the conservative, medical and interventional management options for a symptomatic Baker’s cyst

Answer 23

Conservative:

• RICE
• Physiotherapy

Medical:
- Analgesia (NSAIDs)

Interventional:
- Aspiration of the cyst