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Year 4: Orthopaedics > Knee Problems + Trauma > Flashcards

Knee Problems + Trauma Flashcards

1
Q

what type of joint is the knee

A

synovial joint

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2
Q

what type of cartilage covers the surfaces of the knee joint

A

hyaline cartilage

- retropatellar thickest cartilage in body

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3
Q

what is the function of the menisci in the knee

A

“shock absorbers” - act to distribute load evenly

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4
Q

what 4 ligaments are in the knee

A

Anterior + posterior cruciate ligaments

Medial + lateral collateral ligaments

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5
Q

what is the function of the ACL

A

ACL prevents abnormal internal rotation

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6
Q

what is the function of the PCL

A

PCL prevents hyperextension

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7
Q

what is the function of the MCL

A

MCL resists valgus force

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8
Q

what is the function of the LCL

A

LCL resits varus force

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9
Q

what problems in the knee may result in early OA

A

Meniscal tears
ACL rupture
Malaligment

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10
Q

what side of the knee is affected by OA in genu varum

A

medial OA

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11
Q

what side of the knee is affected by OA in genu valgum

A

lateral OA

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12
Q

what treatment can help young patients with isolated medial compartment OA

A

osteotomy of proximal tibia

  • bone cut for re-aligment
  • shifts load to lateral compartment
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13
Q

when should total knee replacements be considered

A

substantial pain + disability where conservative measures are no longer effective

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14
Q

meniscal injuries classically occur due to what

A

twisting force on a loaded knee

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15
Q

presentation of a meniscal injury

A

localising pain to medial / lateral joint line
effusion
knee locking - difficulty straightening leg
feeling of knee giving way

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16
Q

which meniscus is more commonly injured

A

medial

- it is more fixed + less mobile than the lateral

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17
Q

what causes true knee locking

A

mechanical block to full extension caused by torn meniscus becoming stuck in the joint line

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18
Q

what is pseudo-knee locking

A

occurs in OA
knee joint becomes temporarily stuck with difficulty straightening
resolves spontaneously or patient will have developed trick to relieve the issue

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19
Q

how do ACL ruptures occur

A

twisting injury- high rotational force

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20
Q

presentation of ACL rupture

A

“pop” may be felt/ heard
haemarthrosis within 1 hour
deep pain
rotatory instability

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21
Q

how do MCL ruptures occur

A

from a Valgus stress

e.g. rugby tackle from side

22
Q

how do PCL ruptures occur

A

“dashboard injury”

- direct blow to anterior tibia with knee flexed

23
Q

what is Steinmanns test

A

+ve in acute meniscal tears (young patients, high energy injury)
- pain on tibial rotation localising to the affected compartment

24
Q

meniscal tears are often related to what other injury

A

ACL rupture

25
Q

what is a bucket handle meniscal tear

A

large longitudinal tear flips out of normal position and becomes stuck in intercondylr notch
– locking of knee

26
Q

what is a degenerate meniscal tear?

what condition is it a sign of?

A

spontaneous tear / due to innocuous injury
sign of OA
Steinmanns test will be negative

27
Q

why do meniscal injuries have limited healing potential

A

only have blood supply to outer 1/3rd

healing potential decreases with age

28
Q

hallmarks of ACL rupture on examination

A

rotatory instability with giving way on turning
+ve Lachmans test
excessive anterior translation of the tibia on anterior drawer test

29
Q

what is important in treatment of ACL rupture

A

pysio!!

- same results as surgical reconstruction

30
Q

treatment of PCL rupture

A

conservative management

- only those with severe laxity / recurrent instability / frequent hyperextension will be considered for surgery

31
Q

how are MCL ruptures treated?

how well do they heal?

A

hinged knee brace

heal well - instability uncommon

32
Q

what other surrounding structures may also be damaged in an LCL tear

A

common peroneal nerve

popliteal artery

33
Q

a complete knee dislocation results from a rupture of what

A

rupture of all 4 ligament

- required surgery due to degree of instability

34
Q

what constitutes the extensor mechanism of the knee

A

tibial tuberosity
patellar tendon
quadriceps tendon
quadriceps muscle

35
Q

how is the extensor mechanism tested

A

ability to perform straight leg raise = intact

36
Q

how is the extensor mechanism injured

A

rapid contractile force

e.g. after lifting heavy weight

37
Q

what antibiotics can increase risk of tendon rupture

A

quinolones

38
Q

what other things increase risk of extensor mechanism rupture

A 
tendonitis
chronic steroid use
RA
CKD
Diabetes
39
Q

why should steroid injections be avoided in treatment of extensor mechanism ruptures

A

high risk of tendon rupture

40
Q

on Xray what would the following suggest

  1. high lying patella
  2. low lying patella
A

high lying - patella tendon rupture

low lying - quadriceps tendon rupture

41
Q

symptoms of patellofemoral dysfunction

A

anterior knee pain (worse going downhill)
grinding/clicking at front of knee
pseudolocking after long periods of inactivity

42
Q

treatment of patellofemoral dysfunction

A

pysiotherapy - particularly strengthening vastus medalis

taping may alleviate symptoms

43
Q

what might cause a patellar dislocation

A

direct blow

sudden twisting of knee

44
Q

what patients get distal femoral fractures? how do they occur?

A

osteoporotic bone - fall onto flexed knee

45
Q

why will a distal femoral fracture adopt a flexed position

A

pull from gastrocnemius muscle

46
Q

treatment of distal femoral fracture

A

fixed with plate + screws

47
Q

why is a complete knee dislocation a surgical emergency

A

high risk of vascular injury + nerve damage

high risk of compartment syndrome

48
Q

what type of fracture are tibial plateu fractures

A

intra-articular

- classified by schatzker system

49
Q

what nerve might be damaged in a medial tibial plateau fracture? what is the clinical sign?

A

common peroneal nerve – Foot drop

50
Q

treatment of tibial plateu fracture

A

open reduction internal fixation

Year 4: Orthopaedics (13 decks)

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