Knee Problems Flashcards
What is a meniscus?
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
Describe the structure of a meniscus?
Type 1 collagen - fibrocartilage
Contain both radial and circumferential fibres
Describe the vasculature of a meniscus? Specifically the knee
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
What are the most common acute knee problems?
- Fracture
- Meniscal tear
- ACL tear
- MCL tear
- OSTEOCHONDRITIS DISSECANS
What questions are important to the history in the context of a knee injury?
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?
What does early swelling mean?
Probably Haemarthrosis i.e. blood in the joint suggesting:
- Certain meniscal tears
- Tearing certain vascularized ligaments
- Broken into the bone
What would you check for on exam of an injured knee?
- Scars, bruising or swelling
- Joint line irregularity
- Effusion
- Crepitus
- Heat
- Tenderness
- Lumps/defects
- Movement, both passive and active
What tests can be used for knee injuries?
X-ray
US
MRI
What would an X-ray detect?
Fracture Loose Body Ligament Avulsion Osteochondrol defect (both bone/cartilage torn off) Degenerative e.g. OA Lipohaemarthrosis due to fracture
What would an US detect?
Tendon Rupture
Meniscal tears
Swelling
Cysts
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?
Characteristic of a meniscal tear
A twisting motion along with slow swelling and the locked knee are typical
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?
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
When would we consider surgical therapy for a knee injury?
- Conservative Rx fails
- Work or sporting demands
- Daily activity difficulties
- Preventing further injury
- Preventing falls
What types of repair are there for meniscal tears?
- Meniscal repair, best technique is the All-inside technique
- Partial meniscectomy
- Meniscal Transplant
How do we treat a ACL tear?
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
How do we treat an osteochondral injury?
- Debridement
- Reattach fragment
- Remove loose bodies
- Microfracture chrondroplasty
- ACI (Autologous Chrondrocyte Implantation)
What is ACI?
Treatment for osteochondral injury
It involves growing cartilage from stem cells that can be implanted onto the injured area to regrow damaged tissue
What non-surgical treatments do we have for knee injuries?
Physio
Analgesia
Swelling reduction
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?
Meniscial tear
What is the treatment for a meniscal tear
Non-operative treatment
- Rest
- NSAIDs
- Physio
Operative
Arthroscopy: keyhole surgery
• Repair
• Resection
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?
ACL TEAR
what tests should be done for an ACL test
- Anterior draw
- Lachmanns
- Pivot shift
- XRAY
- MRI
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?
MCL tear
tests for MCL Tear
- open on valgus stress
- XRAY
- MRI
Treatment for MCL
Non-operative • Majority • Rest • NSAIDs • Physio • Brace for comfort
Operative
- severe tears
- Failed non-operative management
- Repair
- Reconstruct
Patient presents with activity related pain, recurrent effusions and locking/blocking of knee movement. what do they have?
Osteochondritis dissecans
tests for OD?
- Wilson’s test
- XRAY
- MRI
Treatment for OD?
Non-operative
•Restricted weight-bearing
•Rom brace
Operative
•Arhtroscopy
•Open fixation
Function of MCL
Superficial: resistant to values stress
Deep:
-Knee extension
