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MSK > Knee Problems > Flashcards

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
  • Meniscal tear
  • ACL tear
  • MCL tear
  • OSTEOCHONDRITIS DISSECANS
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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?

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

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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14
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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15
Q

How do we treat a ACL tear?

A 
ACL rehab first (PRICEM):
- Protected weight bearing
- Rest
- Ice
- Compression
- Elevation 
- Meds - Analgesics & NSAIDs to alleviate pain/swelling
ACL reconstruction if needed
\+/- partial menisectomy +/- ligament repair or augmentation
•Hamstring graft
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16
Q

How do we treat an osteochondral injury?

A
  • Debridement
  • Reattach fragment
  • Remove loose bodies
  • Microfracture chrondroplasty
  • ACI (Autologous Chrondrocyte Implantation)
17
Q

What is ACI?

A

Treatment for osteochondral injury

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

18
Q

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

A

Physio
Analgesia
Swelling reduction

19
Q

Patient presents with pain, clicking, locking and intermittent swelling.
They test positive for Mcmurrays test and Thassaly’s test. They joint line feels tender. what do they have?

A

Meniscial tear

20
Q

What is the treatment for a meniscal tear

A

Non-operative treatment

  • Rest
  • NSAIDs
  • Physio

Operative
Arthroscopy: keyhole surgery
• Repair
• Resection

21
Q

Patient presents with deep pain on lateral side of knee. Intermittent swelling and says they have heard a pop/crack. they are no longer able to play/ walk in a straight line.
What do they have?

A

ACL TEAR

22
Q

what tests should be done for an ACL test

A
  • Anterior draw
  • Lachmanns
  • Pivot shift
  • XRAY
  • MRI
23
Q

Patient presents with Pain/ bruising on medial side of knee and says they heard a POP/CRACK sound.
They were unable to continue playing have pain on full extension.
They have tender medial joint. what do they have?

A

MCL tear

24
Q

tests for MCL Tear

A
  • open on valgus stress
  • XRAY
  • MRI
25
Q

Treatment for MCL

A 
Non-operative 
•	Majority 
•	Rest 
•	NSAIDs 
•	Physio
•	Brace for comfort

Operative

  • severe tears
  • Failed non-operative management
  • Repair
  • Reconstruct
26
Q

Patient presents with activity related pain, recurrent effusions and locking/blocking of knee movement. what do they have?

A

Osteochondritis dissecans

27
Q

tests for OD?

A
  • Wilson’s test
  • XRAY
  • MRI
28
Q

Treatment for OD?

A

Non-operative
•Restricted weight-bearing
•Rom brace

Operative
•Arhtroscopy
•Open fixation

29
Q

Function of MCL

A

Superficial: resistant to values stress

Deep:
-Knee extension

MSK (40 decks)

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