Knee Problems Flashcards
What is the differential diagnosis for a knee problem?
- Fracture
- Acute on chronic degenerative joint disease
- Meniscal injury
- Ligament injury
- Tendon injury
What history should you collect for a knee problem?
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)
How do meniscal injuries occur?
Twisting movement on a loaded fixed knee
How do meniscal injuries present?
- Painful ‘squelch’
- Slow swelling (quicker in the younger)
- Painful to weight bear
- Locked knee
How do ACL tears occur?
Forward momentum with a fixed leg +/- rotation
How do ACL tears present?
- ‘Pop’
- Quick swelling
- Often able to weight bear
How do collateral tears present?
- Lateralised pain
- Feel of ‘crack’ with sharp pain
- No or minimal effusion
- Bruising to one side
What examination should be carried out on the knee?
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
What can be seen on x-rays of knee problems?
- Fractures
- Loose bodies
- Ligament avulsions
- Osteochondral defect
- Degenerative joint disease
- Lipohaemarthrosis
What can be seen on ultrasound of knee problems?
- Tendon rupture
- Some meniscal tears
- Swelling
- Cysts
What are MRI scans used for?
- Clinical confirmation
- They have variable sensitivity and specificity but the are not good for DJD or mobile pathology
What is surgery used for in knees?
- Joint preservation
- Life-long care of the joint
What are the indications for surgery in knee problems?
- Failure of conservative treatment
- Demands of work
- Demands of sport
- Problems with daily activities
- Prevention of further joint injury
- Prevention of falls
What non-surgical options are there for treatment of knee problems?
- Restoration of function
- Physiotherapy
- Analgesia
- Swelling reduction
- Range of motion
- Normal movement
How can meniscal injuries be treated?
- Meniscal repair
- Partial meniscectomy
- Meniscal transplantation
Describe the structure of the menisci.
- 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
How are loads transmitted through the menisci?
Radial component of the loading force is balanced by tensile stresses developed in the circumferentially orientated collagen fibres
Describe 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 gets meniscal repairs?
- Young
- Sporty
- Fresh tears (up to 3 months)
- healthy meniscus
- Red/red or red/white
What repair techniques can be used for meniscal injuries?
- Open technique
- Outside-in
- Inside-out
- All inside
- Smith and Nephew
What is the Smith and Nephew technique for meniscal repair?
- 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
What is the prognosis of meniscal repairs?
- 90% success roughly
- 1:5 fail/ need re-arthroscopy and probable partial meniscectomy
- 1:5 fail at re-scope/MRI
How are ACL injuries managed?
- Full ACL rehabilitation
- ACL reconstruction
- Often concomitant other injuries
Why may someone undergo surgery for an ACL tear?
- Prevention of further injury
- Back to work
- Back to sport
- Prevention of osteoarthritis
What are the treatment options for osteochondral injuries?
- Debridement
- Reattachment of fragment
- Removal of bodies
- Microfracture chondroplasty
- ACI
