Knee Problems Flashcards

1
Q

What is a meniscus?

A

A crescent-shaped piece of fibrocartilage that partially divides some synovial joints to provide stability

There are 2 - medial is semi-circular and lateral is almost circular

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2
Q

Describe the structure of a meniscus?

A

Type 1 collagen - fibrocartilage

Contain both radial and circumferential fibres

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3
Q

Describe the vasculature of a meniscus? Specifically the knee

A

Inf Medial geniculate & Lateral geniculate arteries –> Perimeniscal capillary plexus –> Circumferential & penetrating radial vessels.

Further from the periphery (where the plexus is) it gets less vascular, tears here won’t heal even if you stitch them back together

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4
Q

What are the most common acute knee problems?

A
  • Fracture
  • Acute on Chronic Degenerative disorders
  • Meniscal injury
  • Ligament injury
  • Tendon injury
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5
Q

What questions are important to the history in the context of a knee injury?

A

1) Environment i.e. specific sport, workplace & activity at moment of injury?
2) Energy of injury
3) Systemic Symptoms
4) Chronology incl. onset and previous events
5) Hear or feel a pop/crack?
6) Swelling & how early?

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6
Q

What does early swelling mean?

A

Probably Haemarthrosis i.e. blood in the joint suggesting:

  • Certain meniscal tears
  • Tearing certain vascularized ligaments
  • Broken into the bone
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7
Q

What would you check for on exam of an injured knee?

A
  • Scars, bruising or swelling
  • Joint line irregularity
  • Effusion
  • Crepitus
  • Heat
  • Tenderness
  • Lumps/defects
  • Movement, both passive and active
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8
Q

What tests can be used for knee injuries?

A

X-ray
US
MRI

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9
Q

What would an X-ray detect?

A
Fracture
Loose Body
Ligament Avulsion
Osteochondrol defect (both bone/cartilage torn off)
Degenerative e.g. OA
Lipohaemarthrosis due to fracture
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10
Q

What would an US detect? [4]

A

Tendon Rupture
Meniscal tears
Swelling
Cysts

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11
Q

Young sporty patient describes twisting their knee and hearing a painful “squelch”.
Its painful to weight bear and some time later began to swell.
On exam the knee is locked i.e. can’t extend?

A

Characteristic of a meniscal tear

A twisting motion along with slow swelling and the locked knee are typical

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12
Q

Patient describes landing after a jump, changing direction and hearing a pop followed by swelling of their knee.
They can weight bear but its painful?

A

ACL tear

Sudden direction changes with forward momentum such as stopping suddenly or landing a jump along with rotation cause ACL tear.
Being highly vascularised this tear causes quick swelling

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13
Q

Patient presents with sharp pain on the lateral knee along with bruising. They say they heard a crack?

A

Lateral Collateral Ligament Tear

Sharp lateralised pain, feeling a crack and bruising with no effusion is characteristic of a collateral ligament tear.
Because tearing the ligament tears the capsule the effusion leaks into the surrounding tissues causing bruising and none/minimal effusion

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14
Q

When would we consider surgical therapy for a knee injury?

A
  • Conservative Rx fails
  • Work or sporting demands
  • Daily activity difficulties
  • Preventing further injury
  • Preventing falls
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15
Q

What types of repair are there for meniscal tears?

A
  • Meniscal repair, best technique is the All-inside technique
  • Partial meniscectomy
  • Meniscal Transplant
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16
Q

How do we treat a ACL tear?

A

ACL rehab first

ACL reconstruction if needed

17
Q

How do we treat an osteochondral injury?

A
  • Debridement
  • Reattach fragment
  • Remove loose bodies
  • Microfracture chrondroplasty
  • ACI
18
Q

What is Autologous chondrocyte implantation

A

Treatment for osteochondral injury

It involves growing cartilage from stem cells that can be implanted onto the injured area to regrow damaged tissue

19
Q

What non-surgical treatments do we have for knee injuries?

A

Physio
Analgesia
Swelling reduction

20
Q

ACL rupture features [2]

2 clinical tests

A

Crack, pop sound
Rapid swelling
Anterior drawer test
Lachman’s test

21
Q

PCL rupture mechanism [2]

A

Hyperextension

Flexed knee hitting dashboard in RTA

22
Q

Collateral ligaments features [3]

A

Bruising
Crack
Minimal swelling

23
Q

Meniscal tear [3]

Clinical test

A

Delayed knee swelling
Squelch
Joint locks
Thessaly’s test

24
Q

Knee Osteoarthritis [4]

A

> 50, overweight
Intermittent swelling
Crepitus
Limited ROM

25
Q

What are occupations are these associated with and what is the difference in the presentation of knee pain:
Infrapatellar bursitis
Prepatellar bursitis

A
Infrapatellar bursitis 
- Clergyman's knee
- Associated with kneeling
Prepatellar bursitis
- Housemaid-s knee
- Associated with upright kneeling
26
Q

Chondromalacia patellae
Ax
Ep
Pain characteristic

A

Ax: Softening of the cartilage of the patella
Ep: Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting

27
Q

Osteochondritis dissecans

A

Pain after exercise

Intermittent swelling and locking