Knee injuries

Question 1

give some symptoms of ACL injury

Answer 1

immediate swelling 
intense pain 
pop sound and inciting event 
locking 
reduced range of motion

Question 2

if swelling does not appear within the first 24hours and/or if there is knee locking what is the likely injured structure

Answer 2

the meniscus

Question 3

what three structures are usually injured during a knee in toe out mechanism of knee injury

Answer 3

ACL
medial collateral ligament
lateral mensicus

Question 4

How do you perform a Lachman test and what would be seen if a person had suffered an ACL injury

Answer 4

flex knee at 30 and attempt to pull tibia forwards

would be anterior subluxation

Question 5

How do you perform the anterior draw test and what would be seen if there was an injury

Answer 5

flex knee to 90 and pull tibia anteriorally

would see anterior subluxation

Question 6

how do you perform the pivot-shift test and what would be seen if there was an injury present

Answer 6

patient laid on the bed, hip is flexed to 30

hold lower leg and ankle and internally rotate the tibia

apply valgus force and flex the knee

tibia will sublux and then reduce when the knee if flexed

Question 7

what type of injury can be diagnosed with a McMurray test

Answer 7

mensical tear

Question 8

how do you perform a McMurray test and what would be found if there was an injury present

Answer 8

flex knee to 90

hold bottom of foot and rotate the tibia

pain and clicking = tear

Question 9

what are the possible goals of carrying out a partial menisectomy

Answer 9

preserve un-injured mensicus
repair the injured meniscus
remove any debris which is restricting the range of motion

Question 10

what is the general process of operative treatment of ACL injury

Answer 10

1) remove the torn ACL
2) drill tunnels in the femur and tibia
3) pass graft through the tunnels
4) fix graft in place with screws

Question 11

what two structures can be used as the graft in an ACL repair

Answer 11

Patella tendon

hamstring tendon of semitendinosus or gracilis

Question 12

Explain why a BPB graft is considered superior to a hamstring graft for ACL reconstruction

Answer 12

has greater strength (140% ACL vs 70%)

will also be bone to bone healing within the tunnel which gives better healing

Question 13

explain the rational behind the placement of periostium on the tendon graft to help promote healing and explain why it is placed in that specific position

Answer 13

contains multipotent mesodermal cells which can form bone

placed so that it is at the entry point of the bone tunnel

Question 14

explain why the anatomical double bundle reconstruction is considered to be a better technique

and which bundles permit which type of stability

Answer 14

improves rotational stability

anterio-medial bundle gives translational stability
postero-lateral bundle gives rotational stability

Question 15

describe the attachments of the ACL

Answer 15

posterior aspect of the lateral condyle of the femur to the anterior aspect of the medial tibia

Question 16

what movement does the ACL primarily prevent

Answer 16

anterior translation of the tibia on the femur