Knee Injuries

Question 1

How does a patella dislocation normally present?

Answer 1

Flexed knee with lateral deformity

Question 2

How do you treat patella dislocation?

Answer 2

• Reduce with firm medial pressure while extending
• X ray
• Immobilisation in cast
• Quad strengthening rehab

Question 3

What is recurrent patellar subluxation?

Answer 3

• Developmental abnormality - tight lateral retinaculum
• Knee may give way
• Medial pain
• More common in girls and with valgus knees
• If patella dislocation happens once, more likely to happen again

Question 4

What is the typical MOI of a patella fracture?

Answer 4

Dashboard injury or fall on flexed knee

Question 5

How do you treat a non displaced patella fracture with intact extensor mechanism?

Answer 5

Conservative management

Question 6

How do you treat a displaced patella fracture?

Answer 6

Operative fixation

Question 7

Which collateral ligament is most commonly injured?

Answer 7

Medial collateral ligament

Question 8

What is the MOI of a medial collateral ligament injury?

Answer 8

Blow to lateral aspect of knee while foot is fixed (football)

Question 9

What are signs of a medial collateral ligament injury?

Answer 9

Effusion and tender

Question 10

How do you treat a medial collateral ligament injury?

Answer 10

• Rest and firm support
• Rarely surgery

Question 11

How do you treat a lateral collateral ligament injury?

Answer 11

• Rare and more extensive
• May need surgery if unstable

Question 12

What is the MOI of an anterior cruciate ligament tear?

Answer 12

Twisting injury with foot fixed (football)

Question 13

What are the signs of ACL tear?

Answer 13

• Effusion
• Haemarthrosis (70% - bc ligaments are v vascular)
• Positive anterior draw sign

Question 14

How do you treat an ACL tear?

Answer 14

• 3 week rest
• Physio
• Ligament reconstruction if young and unstable

Question 15

What is the MOI of a PCL tear?

Answer 15

• Car crashes
• Twice as strong as ACL so rarely damaged
• Rare menisci involvement

Question 16

How do you diagnose PCL tear?

Answer 16

Positive posterior draw test

Question 17

How do you treat PCL tear?

Answer 17

• Conservative
• Reconstruction less preferred

Question 18

What is the most common reason for knee arthroscopy?

Answer 18

Meniscal (semilunar) cartilage tear

Question 19

How does a meniscal tear present?

Answer 19

• Limited extension
• Patient can only tiptoe (locked knee)

Question 20

What is the MOI of a medial meniscal tear?

Answer 20

Follows twist to flexed knee

Question 21

What is the MOI of a lateral meniscal tear?

Answer 21

Adduction + internal rotation

Question 22

How do you diagnose ACL tear?

Answer 22

Positive draw sign

Question 23

What are the two key signs of a meniscal tear?

Answer 23

• Tender joint line
• Positive McMurray’s test

Question 24

How do you treat a meniscal tear?

Answer 24

• Conservative if small asymptomatic tear
• Arthroscopy
• Surgery - aims to preserve meniscus

Question 25

What are indications for knee arthroscopy in a meniscal tear?

Answer 25

• Locked knee
• Cysts
• Persisting symptoms after injury

Question 26

What is the typical knee injury triad?

Answer 26

ACL + MCL + medial meniscus tear
- Following valgus (lateral) stress with rotation of the knee

Question 27

What are the symptoms of recurrent patellar subluxation?

Answer 27

• Increased lateral patellar movement
• Pain and reflex contraction of quadriceps

Question 28

How do you manage recurrent patellar subluxation?

Answer 28

May need surgery to strengthen medial expansion