Knee Problems Flashcards
What are the common acute injuries of the knee?
Fracture Acute on chronic degenerative joint disease Meniscal injury Ligament injury Tendon injury
What do you need to consider when a patient presents with an acute knee injury?
Whether it is a flare up of a pre-existing degenerative conditions or if it is a new acute injury
What are the important parts of the history in a patient presenting with acute knee injury?
Environment - sport, workplace Activity - sports tackle/jumping Energy involved at time of injury Systemic symptoms Chronology - quick or slow onset, previous injury or event Hear or feel a pop/crack Swelling - early or late onset
What does immediate swelling suggest in acute knee injury?
Haemarthrosis
What movement causes meniscal injury?
Twisting movement on a loaded sized knee
What are the features of meniscal injury?
Painful “squelch”
Slow onset swelling, faster in young
May present with haemarthrosis in very young patients
Painful to weight bear
Locked knee - blocking fully extended position
What are the features of ACL tear?
Forward momentum, leg fixed +/- rotated
Pop
Quick swelling
Often able to weight bear
What are the features of collateral tears?
Lateralised pain
Feel of crack, sharp pain
No or minimal effusion
Bruising to one side
On clinical examination, what should you look for in a patient with acute knee injury?
Scars
Bruising
Swelling
Joint line irregularity
On clinical examination, what should you feel for in a patient with acute knee injury?
Effusion Crepitus Heat Tenderness Tissue lumps or defects Heat - can indicate infection but means increased blood supply to that area so can be due to just the injury
On clinical examination, what movements should you do/ask the patient to do with acute knee injury?
Passive and active Straight leg raise Range of movement Ligament testing Dynamic testing
Why is it best to examine a patient with an acute knee injury immediately?
After a few days pain will increase, range of movement will decrease and willingness of patient to move the injured area will decrease
What might be picked up on x-ray of a patient with an acute knee injury?
Fracture Loose bodies Ligament avulsion Osteochondral defect Degenerative joint disease Lipohaemarthrosis
What might be picked up on ultrasound of a patient with an acute knee injury?
Tendon rupture
Some meniscal tears
Swelling
Cysts
What are the uses of MRI in acute knee injury?
Used for clinical confirmation, variable sensitivity and specificity
Not good for DJD or mobile pathology
What are the indications for surgery following acute knee injury?
Failure of conservative treatment Demands of work Demands of sport Problems with daily activities Prevention of further joint injury Prevention of falls
What are the non-surgical managements of acute knee injury?
Restoration of function - walking, day-to-day activities Physiotherapy Analgesia Swelling reduction Range of motion Normal movement
Why is the meniscus important?
Protects joint surface and reduces risk of degenerative changes in later life - important to preserve
What are the surgical options for meniscal injury?
Partial meniscectomy
Meniscal repair
Meniscal transplantation - controversial, not widely used
Where in the menisci are the fibroblasts and chondroblasts?
In matrix of type 1 collagen
What is the fibrous structure of the menisci?
Circumferential hoop fibres
Superficial randomly oriented fibres
Radially oriented tie fibres
What is the radial component of the loading force on the menisci balanced by?
Tensile stresses developed in the circumferentially oriented collagen fibres
What is the vascular anatomy of the menisci?
Perimeniscal capillary plexus originates from branches of the inferior medial and lateral geniculate arteries
Perimeniscal plexus forms circumferential vessels and penetrating radial vessels
Who is typically affected by meniscal injury?
Young, athletic people
What are the repair techniques for meniscus injury?
Open technique
Outside-in
Inside-out
All inside
Describe the Smith and Nephew Technique
Device passed through portal and through meniscus to a depth that enables T to be deployed
Once T is deployed, knots are tied outside the joint and a knot pusher is used to slide nots snuggly against the meniscus
How many meniscal repairs fail/need re-arthroscopy and probable partial meniscectomy?
1/5
How many meniscal repairs fail at re-scope/MRI?
1/5
What needs to be considered in ACL reconstruction?
Acute or delayed
Effect on function
Effect on sport
What are the indications for surgery of ACL?
Prevention of further injury Back to work Back to sport Prevention of osteoarthritis Patients with symptomatic instability in spite of treatment
What are the treatment options for osteochondral injuries?
Debridement
Reattachment of fragment
Removal of loose bodies
Micro-fracture chondroplasty
Osteochondral injuries carry a higher risk of what?
Pain, osteoarthritis and persistent loss of function
