Knee Injury

Question 1

A 20 year old man fell whilst skiing, his bindings did not release and he suffered a twisting injury to his right knee. He presents with severe pain and tenderness in the knee and marked swelling of the joint. How would you assess and manage him?

Answer 1

Impression
Given twisting injury of knee, am predominantly concerned about ACL injury +/- meniscus +/- MCL given mechanism but would want to rule out other soft tissue and bony injuries of the knee

DDX

• Ligament: LCL, MCL, PCL
• Meniscal tear
• Fracture (avulsion fractures)
• Patellar dislocation/fracture
• Tibiofemoral dislocation (?popliteal artery injury)

Question 2

Knee injury - History

Answer 2

History

• MIST AMPLE
• pain - SOCRATES
• REDS: neurovascular sx (6P’s of acute ischaemia, any distal neurological sx)
• PSHx
• Social: work/job

Question 3

Knee injury - Examination

Answer 3

Examination

• General inspection, vitals
• knee examination: inspection, joint effusion, assess ROM and special tests for ligamentous laxity.
• Assess neurovascular status with sensation and distal pulses.

Question 4

Knee injury - Investigations

Answer 4

Investigations
Diagnostic
- X-Ray AP and skyline for bony deformities
- MRI for soft-tissue injury (meniscal, ligamentous, etc)
- US for vascular injury

Pre-op bloods (although likely for outpatient surgical repair if appropriate)

Question 5

Knee injury - Management

Answer 5

Management
- Vascular surg if acute ischaemia, otherwise ortho review

Supportive

• immobilise limb
• prep for theatres (NBM, IV fluids, etc)
• Analgesia

Definitive
Depends on underlying injury
- ACL: reconstructive surgeryw will allograft
- Meniscus: expectant vs surgical management with arthroscopy +/- suturing or meniscectomy.
- Fractures: cast, rest. involve ortho.