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Systems: MSK AB > Knee Problems > Flashcards

Knee Problems Flashcards

1
Q

What is the differential diagnosis for a knee problem?

A
  • Fracture
  • Acute on chronic degenerative joint disease
  • Meniscal injury
  • Ligament injury
  • Tendon injury
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2
Q

What history should you collect for a knee problem?

A

Environment

  • Sport or recreation
  • Workplace

Activity: sports, tackles, jumping

Energy
-How fast, how heavy

Systemic symptoms

Chronology and Event

  • Quick or slow onset
  • Previous injury or event
  • Hear or feel pop or crack
  • Swelling (early (haemarthrosis) or late onset)
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3
Q

How do meniscal injuries occur?

A

Twisting movement on a loaded fixed knee

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4
Q

How do meniscal injuries present?

A
  • Painful ‘squelch’
  • Slow swelling (quicker in the younger)
  • Painful to weight bear
  • Locked knee
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5
Q

How do ACL tears occur?

A

Forward momentum with a fixed leg +/- rotation

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6
Q

How do ACL tears present?

A
  • ‘Pop’
  • Quick swelling
  • Often able to weight bear
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7
Q

How do collateral tears present?

A
  • Lateralised pain
  • Feel of ‘crack’ with sharp pain
  • No or minimal effusion
  • Bruising to one side
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8
Q

What examination should be carried out on the knee?

A

Look

  • Scars, bruising and swelling
  • Joint line irregularity

Feel

  • Effusion
  • Crepitus
  • Heat
  • Tenderness
  • Tissue lumps or defects

Move: passive and active

  • Straight leg raise
  • Range of movement
  • Ligament testing
  • Dynamic testing
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9
Q

What can be seen on x-rays of knee problems?

A
  • Fractures
  • Loose bodies
  • Ligament avulsions
  • Osteochondral defect
  • Degenerative joint disease
  • Lipohaemarthrosis
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10
Q

What can be seen on ultrasound of knee problems?

A
  • Tendon rupture
  • Some meniscal tears
  • Swelling
  • Cysts
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11
Q

What are MRI scans used for?

A
  • Clinical confirmation

- They have variable sensitivity and specificity but the are not good for DJD or mobile pathology

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12
Q

What is surgery used for in knees?

A
  • Joint preservation

- Life-long care of the joint

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13
Q

What are the indications for surgery in knee problems?

A
  • Failure of conservative treatment
  • Demands of work
  • Demands of sport
  • Problems with daily activities
  • Prevention of further joint injury
  • Prevention of falls
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14
Q

What non-surgical options are there for treatment of knee problems?

A
  • Restoration of function
  • Physiotherapy
  • Analgesia
  • Swelling reduction
  • Range of motion
  • Normal movement
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15
Q

How can meniscal injuries be treated?

A
  • Meniscal repair
  • Partial meniscectomy
  • Meniscal transplantation
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16
Q

Describe the structure of the menisci.

A
  • Medial semi-circular
  • Lateral almost circular
  • Fibro and chondroblasts in matrix of type 1 collagen
  • Radial (tie) and circumferential (hoop) fibres
  • Superficial randomly orientated fibres
17
Q

How are loads transmitted through the menisci?

A

Radial component of the loading force is balanced by tensile stresses developed in the circumferentially orientated collagen fibres

18
Q

Describe the vascular anatomy of the menisci.

A
  • Perimeniscal capillary plexus originates from branches of the inferior medial and lateral geniculate arteries
  • Perimeniscal plexus forms circumferential vessels and penetrating radial vessels
19
Q

Who gets meniscal repairs?

A
  • Young
  • Sporty
  • Fresh tears (up to 3 months)
  • healthy meniscus
  • Red/red or red/white
20
Q

What repair techniques can be used for meniscal injuries?

A
  • Open technique
  • Outside-in
  • Inside-out
  • All inside
  • Smith and Nephew
21
Q

What is the Smith and Nephew technique for meniscal repair?

A
  • Device is passed through portal and through meniscus to a depth that enables ‘T’ to be deployed
  • Once ‘T’s are deployed, knots are tied outside joint and a know pusher is used to slide knots snuggly against the meniscus
22
Q

What is the prognosis of meniscal repairs?

A
  • 90% success roughly
  • 1:5 fail/ need re-arthroscopy and probable partial meniscectomy
  • 1:5 fail at re-scope/MRI
23
Q

How are ACL injuries managed?

A
  • Full ACL rehabilitation
  • ACL reconstruction
  • Often concomitant other injuries
24
Q

Why may someone undergo surgery for an ACL tear?

A
  • Prevention of further injury
  • Back to work
  • Back to sport
  • Prevention of osteoarthritis
25
Q

What are the treatment options for osteochondral injuries?

A
  • Debridement
  • Reattachment of fragment
  • Removal of bodies
  • Microfracture chondroplasty
  • ACI

Systems: MSK AB (43 decks)

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