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Abs MSK > Knee Problems > Flashcards

Knee Problems Flashcards

1
Q

function of menisci

A

distribute load from convex femoral condyles to relatively flat tibial articular surfaces

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2
Q

which meniscus is fixed

A

medial

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3
Q

which meniscus is more mobile

A

lateral

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4
Q

which compartment does the knee pivot on

A

the medial compartment

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5
Q

function of MCL

A

resists valgus stress

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6
Q

function of LCL

A

resists varus stress

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7
Q

function of ACL

A

resists anterior subluxation of the tibia and internal rotation of the tibia in extension

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8
Q

function of PCL

A

resists posterior subluxation of the tibia (or anterior subluxation of the femur) and hyperextension of the knee

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9
Q

when do meniscal tears usually occur in younger people

A

sports injury

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10
Q

what accompanies 50% of ACL ruptures?

A

meniscal tear

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11
Q

how should you investigate ligament or meniscal tears?

A

MRI

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12
Q

which meniscus is more likely to tear?

A

medial (10x more likely)

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13
Q

why do meniscal tears have limited healing potential?

A

only the peripheral 1/3 has blood supply

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14
Q

which pattern of meniscal tear will not heal?

A

radial

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15
Q

what treatment should be considered in young patients with acute peripheral tears?

A

arthroscopic repair

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16
Q

what does an acute locked knee signify?

A

displaced bucket handle meniscal tear

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17
Q

how is a suspected bucket handle meniscal tear assessed clinically

A

heel height test

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18
Q

what treatment is given for bucket handle meniscal tear

A

urgent surgery - either arthroscopic repair or a partial menisectomy

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19
Q

what are degenerate meniscal tears a sign of?

A

early sign of OA

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20
Q

grade 1 ligament injury

A

sprain - some fibres torn but macroscopic structure remains in tact

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21
Q

grade 2 ligament injury

A

partial tear - some fascicles disrupted

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22
Q

grade 3 ligament injury

A

complete tear

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23
Q

features of MCL injury

A

usually heal well
not the case when combined with ACL or PCL rupture
treatment with knee brace, early motion and physio

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24
Q

which ligament is the main stabiliser against internal rotation of the knee

A

anterior cruciate ligament

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25
Q

can the ACL be repaired?

A

no it must be reconstructed

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26
Q

how is the ACL reconstructed

A

autograft from patellar tendon or hamstrings

allograft from achilles tendon

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27
Q

1/3 rule of ACL injury

A

1/3 compensate and are able to function well
1/3 can avoid instability by avoiding certain activities
1/3 do not compensate and have frequent instability meaning they will never return to high impact sport

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28
Q

what percentage of ACL ruptures end up having surgical reconstruction

A

40%

29
Q

when do LCL injuries occur

A

excessive varus and hyperextension

relatively uncommon

30
Q

will the lateral collateral ligament heal

A

no - can therefore cause varus and rotator instability

31
Q

in what condition is there a high incidence of LCL injury

A

common peroneal nerve palsy

32
Q

what commonly occurs in combination with LCL injury

A

PCL or ACL injury

33
Q

what causes a PCL injury

A

direct blow to the anterior tibia, or a hyperextension injury

34
Q

how does PCL injury present

A

popliteal knee pain and bruising

35
Q

consequences of PCL injury

A

instability, recurrent hyperextension, feeling unstable going downstairs

36
Q

what causes knee dislocation (not patellar)

A

serious, high energy injury

37
Q

complications of knee dislocation

A

popliteal artery injury
nerve injury
compartment syndrome

38
Q

what causes patellar dislocation

A

rapid turning or direct blow

39
Q

risk factors for patellar dislocation

A 
female 
adolescent 
ligamentous laxity 
valgus knee 
torsional abnormalities
40
Q

in what percentage of people does patellar dislocation recur?

A

10%

41
Q

what causes an extensor mechanism rupture

A

fall onto a flexed knee with quadriceps contraction

42
Q

risk factors for extensor mechanism rupture

A 
previous tendonitis 
steroid use 
chronic renal failure 
rheumatoid arthritis 
diabetes 
ciprofloxacin use
43
Q

features of haemarthrosis

A

usually warm
generalised pain
swelling within an hour
usually associated with ACL rupture or fracture

44
Q

features of effusion

A

develops over a period of 24hr

associated with meniscal or chondral injury

45
Q

what is osteochondritis dissecans

A

atraumatic cartilage defect which occurs when an area of the surface of the knee loses its blood supply and the cartilage +/- bone can fragment off

46
Q

what happens during cartilage healing

A

healing is with fibrocartilage rather than hyaline cartilage which has greater friction and less wear resistance

47
Q

name 4 cartilage regeneration techniques

A

drilling/microfracture
osteochondral autograft/allograft
mosaicplasty
MACI - membrane induced autologous chondrocyte implantation

48
Q

which cartilage regeneration technique is simplest and cheapest

A

microfracture

49
Q

which cartilage regeneration technique is used for larger defects/bone loss

A

osteochondral allograft

50
Q

predisposing factors to OA

A

articular cartilage injury, fracture, joint instability, genu varum/valgus, fracture malunion, degenerate meniscal tear, infection

51
Q

when is knee replacement done

A

older patients with end stage arthritis

52
Q

how long are new knees expected to last

A

15-20yrs

53
Q

what is injured in the unhappy triad

A

ACL, medial collateral ligament and medial meniscus

54
Q

typical mechanism of injury in meniscal tear

A

twisting force on a loaded knee

55
Q

when may pseudo locking occur

A

arthritis

56
Q

how do ACL injuries occur

A

high rotational force, turning upper body laterally on a planted foot

57
Q

joint line tenderness

A

feature of meniscal tear

assessed by Steinmanns test

58
Q

patterns of meniscal tear

A

longitudinal, radial, oblique and horizontal

59
Q

what may large longitudinal tears result in

A

bucket handle tear - means a large meniscal fragment is able to displace anteriorly or into the intercondylar notch

60
Q

examination findings ACL rupture

A

knee swelling

excessive anterior translation of the tibia on the anterior drawer/Lachman test

61
Q

when do osteochondral/chondral injuries occur

A

impact or shear of articular surface or due to a direct blow

62
Q

how should injuries involving large osteochondral fragments with a substantial portion of bone be fixed

A

fixed with pins

63
Q

how should injuries involving non-weight bearing areas be treated

A

arthroscopic removal

64
Q

how may the patellar or quadriceps tendon rupture

A

rapid contractile force which can occur after lifting a heavy weight, after a fall or spontaneously in a severely degenerate tendon

65
Q

who tends to be affected by patellar tendon rupture

A

younger patients (

66
Q

who tends to be affected by quadriceps tendon rupture

A

older patients (>40)

67
Q

what is patellofemoral dysfunction

A

disorders of the patellofemoral articulation which results in anterior knee pain

68
Q

what may also occur when the patella dislocates

A

medial patellofemoral ligament tear and osteochondral fracture
lipohaemarthrosis

Abs MSK (14 decks)

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