Knee pathology

Question 1

sx: lateral knee pain during onset of running, then resolves; latearl condyle tenderness
dx: positive Ober test
tx: PT, NSAID, steroid injection

Answer 1

Iliotibial band syndrome

Question 2

sx: knee pain around the patella, worse w/ hyperflexion and prolonged sitting.
dx: apprehension test
tx: strengthening vastus medialis of quads, wt loss, NSAIDs, elastic knee sleeve

Answer 2

patellofemoral syndrome

Question 3

sx: synovial fluid effusion, sometimes from meniscal tear; popliteal mass
dx: US
tx: ice, assisted wt bearing, NSAID, steroid injection

Answer 3

Baker cyst

Question 4

sx: 10-15 y/o M, athletes, growth spurt; pain over anterior tibial tubercle esp w/ activity; swelling
dx: XR - ossification
tx: RICE, NSAID, quad stretching

Answer 4

osgood-schlatter disease

Question 5

MOI: axial loading, rotation, and direct trauma (MVA-bumper); Lateral > Medial

sx: pain, swelling, hemarthrosis. +/- peroneal nerve injury.
dx: XR, CT, or MRI
tx: Nondisplaced –> NWB cast 6-8 weeks; displaced –> ORIF

Answer 5

tibial plateau fracture

Question 6

MOI: axial loading (fall from height), direct injury

sx: pain, swelling, can’t bear wt
tx: IMMEDIATE ortho consult - r/o peroneal nerve and popliteal artery injury.; ORIF; usually poor healing

Answer 6

Femoral condyle fracture

Question 7

MOI: high-velocity trauma

sx: gross deformity; may reduce by itself
tx: IMMEDIATE ORTHO CONSULT. popliteal artery injury. Reduce via longitudinal traction

Answer 7

tibial-femoral dislocation

Question 8

MOI: valgus stress with twisting, F>M, lateral

dx: apprehension sign
tx: closed reduction, post-reduction xray, full extension knee immobilizer 3-6 weeks, strengthen quads

Answer 8

Patellar dislocation

Question 9

MOI: fall on flexed knee/ forceful quadriceps contraction. Males >40 h/o systemic disease (DM, gout, obesity, renal dz)

sx: palpable defect above knee (baja)
dx: straight leg raise, proximal knee pain w/ ambulation
tx: knee immobilizer, NWB/partial, RICE, surgery w/in 7-10 days

Answer 9

quadriceps tendon rupture

Question 10

MOI: fall on flexed knee / forceful quads contraction; M

Answer 10

patellar tendon rupture

Question 11

MOI: direct blow - fall on flexed knee, young patients

sx: pain, swelling, deformity, limited knee extension.
dx: Sunrise view XR
tx: nondisplaced: knee immobilizer, 6-wk leg cast. displace –> surgery

Answer 11

patellar fracture

Question 12

MOI: degenerative, trauma w/ rotation and axial loading. Medial>Lateral.
sx: locking, popping, giving way, effusion
dx: Mcmurray sign (pop or click w/ internal/external rotatioN), Apley test, joint line tenderness, effusion
Mgmt: NSAID, decreased wt bearing, arthroscopy

Answer 12

meniscal tear

Question 13

MOI: dashboard injury (anterior force to proximal tibia w/ knees flexed), usually assoc w/ other ligament injury
sx: anterior bruising tibia; effusion
dx: Pivot shift test, Posterior drawer test
Mgmt: operative

Answer 13

PCL injury

Question 14

MOI: 70% assoc w/ sports; deceleration, hyperextension, and internal rotation

sx: pop and swelling, hemarthrosis, knee buckling, can’t bear weight
dx: Lachman’s test, Pivot shift test, anterior drawer test; +/- segond fx (Pathognomonic)
tx: therapy vs surgical

Answer 14

ACL injury

Question 15

MOI: valgus with rotation (medial) or varus (lateral) stress
sx: pain, swelling, bruising, stiffness
Mgmt: conservative, PT, RICE

Answer 15

MCL, LCL injury