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Orthopaedics > Knee ligament injuries > Flashcards

Knee ligament injuries Flashcards

1
Q

What does the ACL do?

A

stabilise the knee joint by being the primary restraint to limit anterior translation of the tibia and contribute to rotational stability

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2
Q

When does an ACL tear usually occur?

A

When there is history of twisting the knee while weight bearing, from landing from a jump

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3
Q

How will an ACL tear usually present?

A

Rapid joint swelling and significant pain, instability

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4
Q

What specific tests are done for an ACL tear?

A

Lachmans test and anterior draw test

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5
Q

What is Lachmans test?

A

putting the knee at 30 degrees of flexion and stabilise the femur, pull the tibia forward to assess the amount of anterior movement of the tibia compared to the femur

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6
Q

What is the anterior drawer test?

A

flexing the knee to 90 degrees and placing the thumbs in the joint line and index finder on the hamstring tendons posteriorly, force is then applied anteriorly to demonstrate tibial excursions

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7
Q

What are the differential diagnosis for ACL tear?

A

Fracture, meniscal tear, collateral tear, quadriceps or patellar ligament tear

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8
Q

What investigations would need to be done for an ACL tear?

A

radiograph of the knee to exclude bony injuries and see if lipohaemarthrosis is present, MRI scan for diagnosis

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9
Q

What is the initial management for an ACL tear?

A

Rest, Ice, Compression, Elevation

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10
Q

What is the conservative management for an ACL tear?

A

rehabilitation, strength training of the quadriceps to stabilise the knee, canvas knee splint

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11
Q

What is the surgical treatment for an ACL tear?

A

tendon or an artificial graft with prehabilitiation before hand

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12
Q

What are the complications of ACL tear?

A

post traumatic osteoarthritis

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13
Q

What is a PCL tear and how would i present?

A

high energy trauma to proximal tibia, immediate posterior knee pain, instability and positive posterior draw test

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14
Q

What is the medial collateral ligaments function?

A

to act as a values stabiliser of the knee

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15
Q

When does the MCL usually tear?

A

external rotational forms are applied to the lateral knee such as a impact to the outside of the knee

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16
Q

What is a grade I MCL tear?

A

mild injury, minimally torn fibres and no loss of MCL integrity

17
Q

What is a grade II MCL tear?

A

moderate injury with an incomplete tear and increased laxity of the MCL

18
Q

What is a grade III MCL tear?

A

severe injury, with complete tear and gross laxity of the MCL

19
Q

What are the clinical features of a MCL tear?

A

trauma to lateral aspect of the knee, immediate medial joint line pain, swelling, increased laxity when testing the MCL via the values stress test, tender along joint line, may be able to weight bear

20
Q

How can grade II and III MCL tear be distinguished on medial stress testing?

A

Grade II is lax in 30 degrees of knee flexion but solid in full extension, grade III is lax in both

21
Q

what are the differential diagnosis for MCL tear?

A

fractures, meniscal injury and collateral ligament tears

22
Q

What is the gold standard for MCL tear scanning?

A

MRI

23
Q

What is the management for a grade I MCL tear?

A

RICE, analgesia, strength training, full exercise in 6 weeks

24
Q

What is the management of grade II MCL tear?

A

Analgesia with a knee brace and weight bearing/strength training, full exercise in 10 weeks

25
Q

What is the management for grade III MCL tear?

A

analgesia with knee brace and crutches, 12 weeks full exercise

26
Q

What are the complications of an MCL tear?

A

instability of the joint, damage to the saphenous nerve

27
Q

What is a meniscal tear?

A

the c shaped fibrocartilage found in the knee joint tears

28
Q

What is the function of the meniscus in the knee?

A

shock absorbers and increase articulating surface area

29
Q

What is the medial meniscus attached to?

A

MCL, the lateral is not attached to the LCL

30
Q

What is the most common cause of meniscal tear?

A

trauma related injury (twisted knee while flexed and weight bearing) and degenerative disease

31
Q

What are the types of meniscal tears?

A

Vertical, longitudinal, transverse, degenerative

32
Q

What are the clinical features of meniscal tears?

A

tearing sensation, intense sudden onset pain, swelling, locked in flexion and unable to extend if the meniscal tear causes a free body

33
Q

What happens on examination of the meniscal tears?

A

tinderness in the joint line, joint effusion, limited knee flexion, McMurrarys test and Apleys grind test

34
Q

What are the differential diagnosis of meniscal teats?

A

fracture, cruciate ligament tear, collateral ligament tear, osteochondritis dissecans

35
Q

What imaging would you do for meniscal tears?

A

Plain radiograph to exclude fracture and then MRI

36
Q

What is the management for meniscal tears?

A

rest and elevation, compression and ice, atroscopic surgery if the teat is in the outer third of the meniscus can be sutured together or if the inner third can be trimmed

37
Q

What are the complications of meniscal tears?

A

osteoarthritis, knee arthroscopy can cause DVT, damage to local structures, saphenous nerve and vein, peroneal nerve and popliteal vessels

Orthopaedics (23 decks)

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