knee ligament and meniscal injuries Flashcards
what could be the cuase of anterior knee pain?
- patellar subluxation or dislocation
- tibial apophysitis
- jumpers knee
- patellofemoral pain
what could be the cause of medial knee pain?
- MCL sprain
- medial meniscal tear
- pes anserine bursitis
- medial plica syndrome
what could be the cause of lateral knee pain?
- LCL sprain
- lateral meniscal tear
- ITB tendionitis
what could be the cause of posterior knee pain?
- bakers cyst
- PCL injury
explain MCL injuries
- 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
explain grade 1 MCL tear
minor can take few days-week and a half to heal enough for reutrn to normal sport and activtiesi
explain grade 2 MCL tear
2-4 weeks to heal
explain grade 3 MCL tear
4-8 weeks to heal, unless ACL also damanged
how can you test MCL?
-valgus stress test
what are symptoms of MCL tear?
- anatalgic gait
- point tender over MCL, including joint line
- mild swelling
- limited terminal extension
explain LCL injuries
- 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
what are the symptoms of an LCL tear?
-similar to MCL with exception of location and history of varus stress
what are the signs/objective findings of an LCL tear?
- point tender over LCL
- rarely find associated JLT
- +varus stress test at 30
- +varus stress test at 0 may indicate other structures injured
how can you test the LCL
varus stress test
dial test
what are the symtoms of an ACL tear?
- feeling a pop
- immediate swelling
- deep pain in knee
- knee feels like giving away
- may feel warm to touch
what are the female athlete considerations to ACL tears?
- wider pelvis
- increased Q angle w fem add and IR
- increased flexilibty
- narrower femoral notch
- less developed thigh muscles
- hormones
what are the special test for ACL?
- anterior drawer test
- lachman test
- lever test
- pivot shift test
what is the unhappy triad?
- valgus stress
- MCL
- medial meniscus- more commonly lateral
- ACL
why do surgeons recommend ACL reconstruction?
- restore knee stability
- prevent meniscal damage
- protect articular cartilage
- prevent arthritis
- avoid degenerative changes
what are some autograft examples>?
- patellar tendon=gold standard
- hamstring
- quad tendon
what are allografts?
cadaver -patellar tendon -achilles tendon -ITB -anterior tib for older patients
explain the PCL
one of the strongest ligaments in the body
- very rarely injured in athletics
- most common mechanism is knees hitting dashboard
how do you know if you have a PCL injury
- 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
what is the management of a PCL tear grades I and II?
- RICE
- quad strengthening
- grade III may need bracing or surgery but usualy do fine
what are the sytmpoms of a PLC tear?
- 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
what is the management of PLC?
-knee very unstble
-chronic instability or failed ACL reconstruction
-early repair srugically
-cant replace normal PLC function
many potential injured structures
what is the shape of the medial meniscus
C
what is the shape of the lateral meniscus
circle
what are the signs/symptoms of meniscal tear?
- 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
what are some mechanism or injury for meniscsal tears?
squatting all the way down
twisting of knee
what are the types of meniscal tears
-
bucket handle tear is big one
what are the 5 meniscal injury clinical features?
- history of mechanical catching or locking
- joint line tenderness
- pain w forced knee hyperextension
- pain w maximum passive knee flexion
- pain or audible click with mcmurray manuever
what is a good prognosis for meniscal healing?
- younger than 35
- peripheral damage
- longitudinal tear
- short tear
- acute injury
- stable knee
what is a bad prognosis for meniscal healing?
- older patient
- central damage
- complete tear
- bucket handle tear
- chronic injury
- unstable knee
what is meniscal tear treatment
- pain may improve w change in activiry or nonsteroidantiinflamm meds
- may need surgey
