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GPEP MSK > Knee Injuries > Flashcards

Knee Injuries Flashcards

1
Q

ACL injury mechanism

A

Valgus twisting e.g. forcefully landing on leg when attempting to rapidly change direction
Generally non contact

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2
Q

Typical ACL injury presentation

A

Popping sound at the time of injury
Fall to the ground, unable to finish playing sports, need to be helped from the field.
Knee swells quickly. Unable to weight-bear.

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3
Q

If no fracture acute knee swelling indicates…

A

ACL injury

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4
Q

Mechanism of PCL injury

A

Direct blow to flexed knee

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5
Q

Typical presentation of PCL injury

A

Posterior knee pain, a subtle limp, a modest effusion, and reduced end-of-range knee flexion.

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6
Q

Mechanism of MCL/LCL injury

A

Significant varus or valgus strain. Normally requires contact injury.
Direct blow pushing knee sideways

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7
Q

Typical presentation of MCL/LCL injury

A

Medial or lateral pain. Feeling of instability.
No significant swelling (as it is extra-articular)

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8
Q

Is MCL or LCL injury more common?

A

MCL

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9
Q

Mechanism of meniscal injury

A

Loaded knee is twisted

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10
Q

Typical presentation of meniscal injury

A

Locking, blocking or catching
Mild effusion can develop

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11
Q

What type of knee injury is caused by ACL type injuries / hyperextension and is commonly seen in children?

A

Tibial eminence #

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12
Q

What type of knee injury is caused by jumping activities e.g. basketball, gymnastics, football and is commonly seen in adolescents?

A

Tibial tuberosity #

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13
Q

Mechanism patella #

A

Direct blow to knee or forceful contraction of quad against semi-flexed knee

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14
Q

Mechanism of tibial plateau #

A

Axial loading with varus or valgus stress
Falling onto an extended leg

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15
Q

Typical presentation of tibial plateau #

A

Tenderness over medial or lateral margins of proximal tibia
Often unable to weight-bear
May be associated with knee ligament injuries

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16
Q

Mechanism of patella dislocation

A

Twisting or direct blow on partially flexed knee

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17
Q

Typical presentation of patella dislocation

A

Very painful knee in flexed position with laterally displaced patella. May have large effusion.

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18
Q

Patella dislocations are more common in what age group

A

Adolescents

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19
Q

Mechanism of knee dislocation

A

High energy trauma

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20
Q

How common is knee dislocation?

A

Rare

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21
Q

Why worry about knee dislocation?

A

Potentially limb-threatening
Neurovascular compromise needs to be ruled out

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22
Q

Special tests on exam for ACL injury

A

Lachman and pivot shift tests

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23
Q

Special tests on exam for PCL injury

A

Posterior drawer test and posterior sag

24
Q

Special tests on exam for collateral ligament injury

A

Varus and valgus stress tests

25
Q

Special tests on exam for meniscal injury

A

McMurray’s test and Thessaly test

26
Q

Special tests on exam patella instability (dislocation)

A

Patellar apprehension test

27
Q

Suspect _________ in all major knee injuries (esp if significant deformity, swelling, and instability)

A

Knee dislocation

28
Q

Check the integrity of the extensor mechanism by performing ________ as these injuries can be missed.

A

Straight leg raise

29
Q

Check _____________ to rule out neurovascular compromise.

A

Pedal and popliteal pulses, motor function, and sensation distal to the injury

30
Q

If large effusion consider…

A

Knee fracture
Haemarthrosis suggestive of ligament or meniscal tears

31
Q

Ottawa knee rules - any one of the following indicates xray following acute knee injury

A

≥55yo
Tenderness at the head of the fibula
Isolated tenderness of the patella
Inability to flex knee to 90º
Inability to bear weight (inability to take four steps regardless of limping) immediately and at presentation

32
Q

Investigations after first patella dislocation

A

Arrange a knee AP lateral and skyline patella X-ray, looking for a fracture to the medial patella.

33
Q

Is USS useful in acute knee injuries?

A

Not usually

34
Q

Lipohaemarthrosis on xray indicates

A

Intra-articular #

35
Q

Refer acutely to ortho in what situations?

A

Any knee fracture
Knee dislocation
Injury to the extensor mechanism of the knee
Concerns about neurovascular status
Acutely locked knee

36
Q

Management if no # but swollen knee

A

Early physio → if not settling refer ortho

37
Q

Management if stable knee injury without large effusion and no specific diagnosis

A

Ice and analgesia (paracetamol, NSAID)
If effusion: RICE, tubigrip, crutches, physio and review in 2/52
If significant laxity, unable to weight bear or ongoing effusion at review → ortho
If no swelling at any stage reassure significant injury unlikely

38
Q

Acute management of ACL injury

A

Tubigrip (remove for sleep), RICE, consider crutches but recommend to weight-bear as able. First few days avoid twisting/jumping.
If large effusion consider aspiration for pain relief
Early physio

39
Q

Aim of physio in ACL injury

A

Strengthening of quads/hamstrings + ROM exercises → will help reduce effusion, improve ROM and strength

40
Q

Following ACL injury can take up to _________ to get back to sport

A

9 months

41
Q

When to acutely f/up ACL injury

A

2/52
If exam positive for ACL injury → ortho

42
Q

Surgical treatment of ACL injury can help prevent _____________

A

Further knee instability

43
Q

When is surgery usually done for ACL injuries

A

Preoperative rehab important - surgery done when FROM + good strength (unlikely <3/52 post injury)

44
Q

PCL and collateral ligament injuries - management if complete tear

A

Consider hinged brace

45
Q

PCL and collateral ligament injuries - management if incomplete tear

A

Analgesia, RICE, tubigrip, crutches for a few days then mobilise as able

46
Q

PCL and collateral ligament injuries - management if associated with other injuries (e.g. meniscal tear, cruciate rupture)

A

Refer ortho

47
Q

When to f/up PCL and collateral ligament injuries acutely

A

Review 1-2 weeks. If significant laxity → refer ortho

48
Q

Management meniscal tear

A

RICE, early physio and gradual mobilisation

49
Q

Meniscal tear usually settles over what time period

A

6-8 weeks (refer ortho if doesn’t settle)

50
Q

Management if acutely locked knee from meniscal tear

A

Most will unlock spontaneously with analgesia, rest and support → refer ortho

51
Q

General advice about return to work and sports for minor knee injuries

A

Usually after 2 to 3 weeks

52
Q

General advice about return to work and sports for complete ruptures

A

May be ≥6 weeks before returning to active sport

53
Q

General advice about return to work and sports for lateral‑sided ligament injuries and ACL injuries

A

May require surgery, and more time off work and sport

54
Q

Management of first patella dislocation and no # on xray

A

Physio

55
Q

Management of second + subsequent patella dislocations

A

If pt would consider surgery → refer ortho OPC

GPEP MSK (8 decks)

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