Knee Problems

Question 1

What could it be

Answer 1

Fracture

acute on chronic degenerative joint disease

meniscal injury

ligament injury

Tendon injury

Question 2

What are important things to uncover in the incidence of knee injury?

Answer 2

Environment

• sport or recreation
• workplace

Activity: sports tackle, jumping

Energy

• how fast and how heavy

Presence of systemic symptoms

Chronology

• Quick or slow onset

Previous injury or event

Hear or feel a pop or crack

Inflammation

Swelling - early or late onset, early means haemoarthrosis

Question 3

What causes a meniscal knee injury?

Answer 3

twisting movement on a loaded fixed knee

Question 4

What are the features of a meniscal injury?

Answer 4

painful “squelch”

slow swelling (quicker in the young)

painful to weight bear

“locked” knee

Question 5

What causes an ACL tear?

Answer 5

Forward momentum, leg fixed with or without rotation

Question 6

What are the features of ACL tear?

Answer 6

“Pop”

Quick swelling

Often able to weight bear

Question 7

What are the features of collateral tears?

Answer 7

Lateralised pain

feel of “crack”, sharp pain

no or minimal effusion

bruising to one side

Question 8

What is in the feel part of the examination for the knee?

Answer 8

scars, bruising and swelling

joint line irregularity

Question 9

What do you feel for in a knee joint irregularity?

Answer 9

Feel for effusion

crepitus

heat

tenderness

tissue lumps or defects

Question 10

What do you test for in the movement section of the physical examination of the knee?

Answer 10

Passive and active

Straight leg raise

range of movement

ligament testing

dynamic testing

Question 11

What do you look for in X-rays of broken knees?

Answer 11

fracture

loose bodies

ligament avulsion (pulling or tearing away)

osteochondral defect (damage to the cartilage and underlying piece of bone)

degenerative joint disease

lipohaemarthrosis

Question 12

What is seen on ultrasound of knee injuries?

Answer 12

Tendon rupture

Meniscal tears

Swelling

Cysts

Question 13

What is MRI used for?

Answer 13

Clinical confirmation

Variable sensitivity and specificity

Not good for DJD or mobile pathology (degenerative joint diseases)

Question 14

What are the indications for surgery in the knee?

Answer 14

Failure of conservative Rx

Demands of work

Demands of sport

Problems with daily activities

prevention of further joint injury

prevention of falls

Question 15

What are the non-surgical management strategies?

Answer 15

restoration of function

physiotherapy

analgesia

swelling reduction

range of motion

normal movement

Question 16

What are menisci?

Answer 16

In the knee they are two pads of fibrocartilaginous tissue which serves to disperse friction in the knee joint between the lower leg and the thigh.

Question 17

What direction do the fibres in the menisci take?

Answer 17

Circumferential “hoop” fibres

Superficial randomly oriented fibres

Radially oriented “tie” fibres

Question 18

Whcih arteries does the perimeniscal capillary plexus develop from?

Answer 18

Develops from the inferior medial and lateral geniculate arteries

Question 19

What vessels of the perimeniscal plexus supply the meniscus?

Answer 19

Perimeniscal plexus forms circumferential vessels and penetrating radial vessels

Question 20

How does the blood supply to the meniscus vary with age?

Answer 20

The blood flow of the meniscus is from the periphery (outside) to the central meniscus. Blood flow decreases with age and the central meniscus is avascular by adulthood, leading to very poor healing rates.

Question 21

What are the two main types of meniscal injuries?

Answer 21

There are two general types of meniscus injuries, acute tears that are often the result of trauma or a sports injury and chronic or wear-and-tear type tears.

Question 22

What is the treatment for acute and chronic meniscal injury?

Answer 22

Acute - usually surgery

Chronic - Chronic tears are treated symptomatically: physical therapy with or without the addition of injections and anti-inflammatory medications. If the tear causes continued pain, swelling, or knee dysfunction, then the tear can be removed or repaired surgically.

Question 23

What are the possible repair techniques?

Answer 23

Open Technique

Outside - In

Inside - Out (in this instance you have created a portal from the outside to the inside of the knee which is a potential route for infection - this technique isn’t used particularly much anymore

All Inside

Smith and Nephew

Fast fix (all inside) - this device is used on parts that will heal (red on red or red on white)

Question 24

What is the failure rate of meniscal repair?

Answer 24

1: 5 fail/need re-arthroscopy and probable partial meniscectomy
1: 5 “fail” at re-scope/MRI

Question 25

What are the reasons for surgery on ACL?

Answer 25

Prevention further injury

Back to work

Back to sport

Prevention of osteoarthritis - debateable

Question 26

What is osteochondral injury?

Answer 26

Injury of the bone and the articular cartilage

Question 27

What are the treatment options for osteochondral injuries?

Answer 27

Debridement

Reattachment of fragment

removal of loose bodies

microfracture chondroplasty

ACI