Knee Pathologies

Question 1

Patellofemoral pain syndrome presentation

Answer 1

Common in young athletes, can be with limb malalignment, muscle imbalance etc
Patella ache felt after prolonged sitting/climbing stairs
+ve Clarke’s test
Medial retropatellar tenderness

Question 2

Patellofemoral pain syndrome treatment

Answer 2

Rest with quadricep + hip strengthening physio
NSAIDs helps for a few months
Rarely surgery

Question 3

What is bipartite patella

Answer 3

Congenital fragmentation of patella, tends to be incidental finding on XR
If painful, excision of fragment may help

Question 4

Hoffa’s fat pad syndrome presentation

Answer 4

Painful impingement of infrapatellar fat pad caused by maltracking of patella, usually caused by overextension of knee
Extending bent knee while pressure on patellar tendon margin elicits pain
MRI shows impingement ± hydrarthrosis/haemarthrosis

Question 5

Osgood-Schlatter disease presentation

Answer 5

Tibial tuberosity apophysitis affecting 10-15 yrs (Sinding Larsen Johansson’s (Jumper’s knee) 1-2 yrs and pain under kneecap)
Supposedly repeated traction causes inflammation + avulsion, association with overuse
Pain below knee worse on quadricep contraction
Tuberosity looks enlarged + tender on XR
Clinical diagnosis

Question 6

Osgood-Schlatter disease treatment

Answer 6

Usually self-limiting
Rest, ice, NSAIDs, physio
Tibial tubercle excision if conservative measures fail

Question 7

Bursitis types (knee)

Answer 7

Prepatellar (housemaid’s knee) - pain on kneeling
Infrapatellar (clergyman’s) - pain lower as kneel more upright
Semimembranous - pain in popliteal fossa, differs from Baker’s cyst which is herniation from synovium

Question 8

Knee OA risk

Answer 8

Women >55 yrs at greatest risk
2º caused by post-traumatic, post-op, post-infection, malposition, mechanical instability, osteochondritis dissecans
Linked to high BMI, age, occupation, genetics

Question 9

Knee OA presentation

Answer 9

Pain on initiating movement
Stiffness following inactivity which resolves in <30 mins
Generally varus deformity
Crepitus and limited ROM
Osteophytes

Question 10

Knee OA treatment

Answer 10

NSAIDs (topical), weight loss
Local steroid injections short-term benefits
Osteotomy then total knee replacement

Question 11

Meniscal cysts presentation

Answer 11

Young man, past trauma, insidious cyst development
Pain over joint line, lateral cysts more common
Swelling may disappear with full flexion
MRI often shows torn radial meniscus so knee gives way

Question 12

Meniscal cyst treatment

Answer 12

Arthroscopic decompression

Question 13

Baker’s cyst presentation

Answer 13

Synovium fluid bulge behind knee tends to be asymptomatic in young
Posterior knee swelling + ache

Question 14

Baker’s cyst treatment

Answer 14

Analgesia, usually spontaneous recovery