Knee pathology

Question 1

Meniscus tears

Answer 1

Mechanism - twisting strain whilst weight bearing
Presents with joint line pain, catching, popping, locking, giving way
May also have effusion (within 4 hours)
Medial meniscus most commonly torn (unhappy triad)
- medial meniscus, MCL and ACL triad of tears

McMurray’s / Apley’s test positive - too paintful

Question 2

Investigation

Answer 2

X ray

MRI to calssify

Question 3

Management

Answer 3

Conservative - limitation of activity, NSAID

Surgery - Arthroscopic meniscectomy or repair of peripheral tears in young patients (better functional outcome)

Question 4

ACL tears

Answer 4

Foot planted on ground, leg is twisted, often hear a pop
Presents with pain, haemarthrosis, IMMEDIATE effusion (<1 hour)
Positive anterior drawer test - way too painful

Chronic injury presents with knee giving way and is risk factor for knee OA

Question 5

Investigations

Answer 5

Xray, MRI to confirm if partial tear

Question 6

Management

Answer 6

Depends on patient needs (degree of tear, age, job, quadriceps bulk, general)

Conservative - physio, NSAIDs
Surgical only if functional demand - arthroscopic ACL repair with autograft/allograft ligament repair

Question 7

Medial collateral ligament sprain

Answer 7

Presents with pain along the ligament, instability when vales, localised swelling
Check ACL and medial meniscus to

Mx: conservative, NSAID

Question 8

Patella fracture

Answer 8

Direct blow or racial load to flexed knee (Car crash)

Check extensor mechanism by straight leg raise
Can feel the fracture gap
X ray will show lipo/haemarthrosis (fat-blood fluid level seen)

Management
Conservative - if able to straight leg raise and no articular step off >2mm => brace for 4-6 weeks

Surgical - use K wires for cerclage

Question 9

Osgood-Schlatter’s disease

Answer 9

Traction apophysitis, inflammation of the patellar ligament at insertion of tibial tuberosity

TEENAGERS, painful swelling, pain on kneeling

Ix
X ray - ossicle formation
US - may show inflammation

Mx
Conservative - maintain athletic activities, NSAIDs, rest PRN

Question 10

Iliotibial band syndrome

Answer 10

lateral knee pain in runners/ weight lifters
Present with tenderness on lateral epicondyle
Due to tight IT band fascia rubbing on the femur

Mx
Conservative - foam rolling, NSAIDs, stretches