knee ligament and meniscal injuries

Question 1

what could be the cuase of anterior knee pain?

Answer 1

• patellar subluxation or dislocation
• tibial apophysitis
• jumpers knee
• patellofemoral pain

Question 2

what could be the cause of medial knee pain?

Answer 2

• MCL sprain
• medial meniscal tear
• pes anserine bursitis
• medial plica syndrome

Question 3

what could be the cause of lateral knee pain?

Answer 3

• LCL sprain
• lateral meniscal tear
• ITB tendionitis

Question 4

what could be the cause of posterior knee pain?

Answer 4

• bakers cyst

- PCL injury

Question 5

explain MCL injuries

Answer 5

• most common mechanism is blow to lateral knee w valgus force
• may be injured by non-contact and or rotational stress
• at full ext; MCL, joint capsule and pes anserine tendons resist valgus force
• 20-30 degrees flexion, MCL is primary restraint to valgus force

Question 6

explain grade 1 MCL tear

Answer 6

minor can take few days-week and a half to heal enough for reutrn to normal sport and activtiesi

Question 7

explain grade 2 MCL tear

Answer 7

2-4 weeks to heal

Question 8

explain grade 3 MCL tear

Answer 8

4-8 weeks to heal, unless ACL also damanged

Question 9

how can you test MCL?

Answer 9

-valgus stress test

Question 10

what are symptoms of MCL tear?

Answer 10

• anatalgic gait
• point tender over MCL, including joint line
• mild swelling
• limited terminal extension

Question 11

explain LCL injuries

Answer 11

• rarely an isolated injury
• less common than MCL
• frequently also injuries PLC and compromises stability
• blow to medial knee: varus stress
• IR of tibia may also contribute
• may also injure cruciates and capsule
• rule out peroneal nerve injury
• poor blood supply: does not heal well and may need siurgery

Question 12

what are the symptoms of an LCL tear?

Answer 12

-similar to MCL with exception of location and history of varus stress

Question 13

what are the signs/objective findings of an LCL tear?

Answer 13

• point tender over LCL
• rarely find associated JLT
• +varus stress test at 30
• +varus stress test at 0 may indicate other structures injured

Question 14

how can you test the LCL

Answer 14

varus stress test

dial test

Question 15

what are the symtoms of an ACL tear?

Answer 15

• feeling a pop
• immediate swelling
• deep pain in knee
• knee feels like giving away
• may feel warm to touch

Question 16

what are the female athlete considerations to ACL tears?

Answer 16

• wider pelvis
• increased Q angle w fem add and IR
• increased flexilibty
• narrower femoral notch
• less developed thigh muscles
• hormones

Question 17

what are the special test for ACL?

Answer 17

• anterior drawer test
• lachman test
• lever test
• pivot shift test

Question 18

what is the unhappy triad?

Answer 18

• valgus stress
• MCL
• medial meniscus- more commonly lateral
• ACL

Question 19

why do surgeons recommend ACL reconstruction?

Answer 19

• restore knee stability
• prevent meniscal damage
• protect articular cartilage
• prevent arthritis
• avoid degenerative changes

Question 20

what are some autograft examples>?

Answer 20

• patellar tendon=gold standard
• hamstring
• quad tendon

Question 21

what are allografts?

Answer 21

cadaver
-patellar tendon
-achilles tendon
-ITB
-anterior tib 
for older patients

Question 22

explain the PCL

Answer 22

one of the strongest ligaments in the body

• very rarely injured in athletics
• most common mechanism is knees hitting dashboard

Question 23

how do you know if you have a PCL injury

Answer 23

• falling up the stairs/dashboard
• swellling within 1-2 hours
• pop
• giving away
• acute hemarthrosis
• limited ROM due to effusion
• • posterior drawer and sag sign

Question 24

what is the management of a PCL tear grades I and II?

Answer 24

• RICE
• quad strengthening
• grade III may need bracing or surgery but usualy do fine

Question 25

what are the sytmpoms of a PLC tear?

Answer 25

• history of trauma
• hyperextension
• varus injury
• blow to anteromedial aspect of knee

-acute swelling
-generalized knee pain
-may have tingling or numbness in common fibular nerve
-+ posterior drawer/sag, varus stress, dial test
unrecognized leads to ACL reconstruction failure

Question 26

what is the management of PLC?

Answer 26

-knee very unstble
-chronic instability or failed ACL reconstruction
-early repair srugically
-cant replace normal PLC function
many potential injured structures

Question 27

what is the shape of the medial meniscus

Answer 27

C

Question 28

what is the shape of the lateral meniscus

Answer 28

circle

Question 29

what are the signs/symptoms of meniscal tear?

Answer 29

• acute: sudden onset and associated with twisting injury especially in people less than 40
• chronic: people older than 50 may not have known injury
• pain worse with movement, better at rest
• may have collateral or cruciate ligament injury
• may complain of locking
• joint line tenderness
• almost always effusion but slower than ACL

Question 30

what are some mechanism or injury for meniscsal tears?

Answer 30

squatting all the way down

twisting of knee

Question 31

what are the types of meniscal tears

-

Answer 31

bucket handle tear is big one

Question 32

what are the 5 meniscal injury clinical features?

Answer 32

1. history of mechanical catching or locking
2. joint line tenderness
3. pain w forced knee hyperextension
4. pain w maximum passive knee flexion
5. pain or audible click with mcmurray manuever

Question 33

what is a good prognosis for meniscal healing?

Answer 33

• younger than 35
• peripheral damage
• longitudinal tear
• short tear
• acute injury
• stable knee

Question 34

what is a bad prognosis for meniscal healing?

Answer 34

• older patient
• central damage
• complete tear
• bucket handle tear
• chronic injury
• unstable knee

Question 35

what is meniscal tear treatment

Answer 35

• pain may improve w change in activiry or nonsteroidantiinflamm meds
• may need surgey