Knee Pathology Flashcards
How does an anterior cruciate ligament tear present?
Tackled from behind
Pop or a crack
Severe pain
Immediate swelling, due to haemarthrosis
Positive lachman test
What tests can be used to assess the anterior cruciate ligament?
Anterior drawer test positive
Lachman test positive
What is the Lachman test?
Demonstrates significant forward translation of the tibia when the knee is in 20 degrees of flexion and the tibia is forced forward while the femur is stabilized
What is the management of anterior cruciate ligament tear?
RICE
Analgesia
NSAIDS
Physiotherapy
Customised bracing
ACL reconstruction
What is the most common ligament injury of the knee?
Medial collateral ligament tear
What causes a medial collateral ligament tear?
Severe valgus stress, such as skiing
How do medial collateral ligament tears present?
Direct blow to lateral aspect of leg, putting strain on medial ligament
Pop or a crack
Medial pain and tender joint line
Medial bruising on medial knee
Slowly devloping swelling
Tender femoral insertion of MCL
Painful in full extension
What is the management of medial collateral ligament tears?
RICE
NSAIDS
Physiotherapy
Brace for comfort
MCL reconstruction or repair
Give a complication of medial collateral ligament tears
Common peroneal nerve damage, resulting in foot drop
How do lateral collateral ligament tears present?
Direct blow to medial leg, putting pressure on lateral ligament
Sharp lateral pain and joint line tenderness
Feeling a crack
Slowly developing effusion
What is a meniscus?
Crescent shaped fibrocartilage that partially divides some synovial joints to provide stability
What are the functions of a meniscus?
Buffer between joint
Shock absorption
Lubrication
Limits flexion and extension
What is the most common meniscus tear?
Medial as most fixed structure
How do medial meniscus tears present?
Twisting around flexed knee
Painful click
Locking and inability to extend knee
Intermittent/slow swelling as not highly vascularised
Tender joint line at point of tear
Fail deep squat
What tests are used to assess the medial meniscus?
Thessaly’s test
MacMurray’s test
What is Thessaly’s test?
Patient rotates knee while standing
What is MacMurray’s test?
Knee is rotated while patient is lying down
What is the management of a medial meniscus tear?
RICE
Physiotherapy
- Hamstring and quadriceps strengthening
Analgesia
NSAIDS
Surgery
- Meniscal replacement
What is the unhappy triad?
medial meniscus, anterior cruciate ligament and medial collateral ligament all tearing at once
What is Osteochondritis Dissecans?
Joint disorder in which cracks form in the articular cartilage and subchondral bone, resulting in a pathological lesion/fragment separated from the joint
What is the most common location of Osteochondritis Dissecans?
Knee (posterolateral aspect of medial femoral condyle)
What causes Osteochondritis Dissecans?
Hereditary
Traumatic
Vascular
How does Osteochondritis Dissecans present?
Activity-related pain: Poorly localised
Recurrent effusions
Mechanical symptoms: Locking, block to full movement
Localised tenderness
Stiffness
How is Osteochondritis Dissecans managed?
Conservative Management
- Restricted weight-bearing
- ROM brace
Open fixation or Arthroscopy
How does baker’s cyst present?
Non tender lump below the popliteal fossa/behind knee
Becomes tense on leg extension
More likely to develop in patients with arthritis or gout and following a minor trauma to the knee
Often occuring in a child
What is bursitis?
What is Iliotibial band syndrome?
Common cause of lateral knee pain in runners
How is iliotibial band syndrome managed?
Activity modification and iliotibial band stretches
Physiotherapy referral if not improving
