Knee Pathology Flashcards
What are meniscal tears?
Classically occurs when twisting strain on weight bearing flexed knee- footballers
Medial meniscus more affected as less mobile
What are the symptoms of meniscal tears?
Initial pain- can be intermittant and swelling hrs alter
Swelling subsides with rest but can recur after further injury
Locking of the knee
Spontaneous giving way of knee
What are the signs of meniscal tears?
Effusion and fixed flexion deformity
Medial joint line tenderness
Positive stress tests
What is the management of meniscal tears?
Arthroscopic repair in young/fit patients
If not repaired the avascular region can accumulate causing secondary OA
If in avascular zone
- partial menisectomy to prevent ongoing symptoms
- total menisectomy avoided due to increased risk OA
Degenerative tears due to OA- conservative until bad enough for joint replacement
What are ligament injuries?
Occur when force greater than tensile strength of ligament occurs e.g. trauma
Most common is ACL tear followed by MCL
What are the symptoms of ligament injuries?
Swelling in 1st hr= complete rupture
Pop at time of injury
Cannot weight bear post injury
Knee very unstable
What are the signs of ligament injuries?
No firm end point when testing ligament- will be soft
Partial tears- pain when testing
Positive anterior drawer test- ACL
Positive sag test and posterior drawer test- PCL
What is the management of ligament tears?
Conservative
- sprains/partial tears heal with physio
- adhesions complicate healing if joint is rested- active movement
- prolonged physio and patient education in older patients/low functional demands
- mainstay of treatment
Surgery
- ACL- arthroscopic tendon graft repair
- PCL- bony avulsion with early screw insertion
- Collaterol- surgery within 2wks of injury
What is patellar bursitis?
Pre patellar (housemaids) and inrapatellar (clergymans) due to unaccustomed kneeling
Anterior knee pain and fluctuant swelling
Avoid kneeling and steroid injections
What is a cause of posterior cruciate ligament rupture?
Hyperextension injuries such as being tackled
