Knee problems

Question 1

Go over the anatomy of the knee

Answer 1

ok lol

Question 2

what mechanism leads to ACL rupture?

Answer 2

rotation of knee w planted foot

Question 3

What are the signs of ruptured ACL

Answer 3

• effusion - rapid onset
• haemarthrosis
• +ve ‘anterior draw sign’
• pop felt or heard

Question 4

What is the management of ruptured ACL?

Answer 4

rest
physio
ligament reconstruction

Question 5

What is the mechanism of ruptured PCL and why is it less common than ACL

Answer 5

Hyperextension, less common as PCL is twice as strong as ACL

Question 6

When do ruptured PCLs tend to occur?

Answer 6

car crashes as knee strikes dashboard

Question 7

What can be found on examination to confirm PCL rupture?

Answer 7

positive posterior draw

increased posterior tibial displaced

Question 8

What is the mechanism leading to ruptured MCL

Answer 8

blow to lateral aspect of knee whilst foot is fixed

forced into valgus

Question 9

What are the signs of a ruptured MCL

Answer 9

effusion and tenderness

Question 10

What is the treatment of ruptured MCL

Answer 10

Rest and firm support, can be managed non-operatively in most patients

Question 11

What mechanism leads to a medial meniscal tear?

Answer 11

twist to flexed knee

Question 12

What mechanism leads to a lateral meniscal tear?

Answer 12

adduction and internal rotation

Question 13

What are the signs of a meniscal tear

Answer 13

limited extension
delayed knee swelling 
joint locking 
recurrent episodes of pain and effusions
tender joint line

Question 14

what direction does the patella usually dislocate

Answer 14

laterally

Question 15

What are the possible mechanisms leading to a patella dislocation

Answer 15

• direct trauma

- severe contraction of quads w knee stretched in valgus and external rotation of tibia on femur

Question 16

What is the recurrence rate of patella dislocation

Answer 16

20%

Question 17

What is the management of patella dislocation

Answer 17

1. reduction - firm medial
2. pressure whilst extending knee
3. XR - check for patella fracture
   immobilisation in cast/splint
4. rehabilitation w quad strengthening

Question 18

What are the possible mechanisms leading to a patella fracture

Answer 18

1. fall onto flexed knee

2. dashboard injury

Question 19

When do patella fractures require operative fixation

Answer 19

if displaced

Question 20

What causes patella tendinopathy

Answer 20

macro/micro patella tendon tears

Question 21

What is the Rx of patella tendinopathy

Answer 21

rest and NSAIDs

Steroid injections if no rest

Question 22

What is prepatellar bursitis also known as and why?

Answer 22

housemaids knee as it can be due to excessive kneeling

Question 23

What is the presentation of pre patellar bursitis?

Answer 23

hx of kneeling

pain and swelling

Question 24

what is the treatment of pre patellar bursitis

Answer 24

compressive wrap

NSAIDs +/- aspiration and immobilisation for 1 week

Question 25

What is Osgood Schlatters disease?

Answer 25

pain +/- swelling over tibial tuberosity

Question 26

What causes Osgood Schlatters disease?

Answer 26

traction apophysitis - inflammation and stress injury

associated w physical overuse

Question 27

what is seen on XR w osgood schlatters disease?

Answer 27

tibial tuberosity enlargement +/- fragmentation

Question 28

What is the treatment of osgood schlatters disease?

Answer 28

limit activity
ice 
oral anti-inflammatories
knee padding 
physio

Question 29

What is chondromalacia patellae

Answer 29

softening of articular cartilage of patella

Question 30

How does chondromalacia patellae present?

Answer 30

anterior knee pain on walking up and downstairs and rising from prolonged sitting

Question 31

What is the typical presentation of a patient with OA of the knee?

Answer 31

> 50 years, often overweight
Pain may be severe
Intermittent swelling, crepitus and limitation of movement may occur

Question 32

What are the 2 types of patella fracture?

Answer 32

i. Direct blow to patella causing undisplaced fragments

ii. Avulsion fracture

Question 33

What is a tibial plateau fracture?

Answer 33

break of proximal tibia involving knee joint

Question 34

Why are tibial plateau fractures significant?

Answer 34

tibial plateau one of the most critical load bearing areas of body

Question 35

In who do tibial plateau fractures most commonly occur ?

Answer 35

elderly

significant trauma in young

Question 36

What is the mechanism of tibial plateau fractures?

Answer 36

knee force into valgus or virus

knee fractures before ligaments rupture

Question 37

How are tibial plateau fractures classified?

Answer 37

Schatzker system

Question 38

Which parts of the knee does a virus and valgus injury affect in a tibial plateau fracture

Answer 38

varus - medial plateau

valgus - lateral plateau depressed fracture

Question 39

What is important to rule out in knee dislocation (tibial displacement)

Answer 39

vascular injury

ABPI

Question 40

Why does presence of a pulse in knee dislocation not necessarily mean there is no vascular injury?

Answer 40

geniculate arteries may provide collateral flow and palpable pulses masking a limb-threatening vascular injury

Question 41

What artery is most commonly injured in knee dislocation ?

Answer 41

popliteal