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2 MSK Clinical Conditions > Knee (Session 4) > Flashcards

Knee (Session 4) Flashcards

1
Q

If the fracture completely splits the patella (extensor mechanims=disrupted) distal to insertion of quadriceps, what will the patient be unable to do?

A

Perform a straight leg raise

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2
Q

What is the usual mechanism of injury for pre-patella burisitis?

A
  • Repetitive trauma
  • Fall onto knee
  • Blunt trauma
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3
Q

How will a patient present following a collateral ligament injury?

A
  • Pain
  • Swelling
  • Unstable feeling
  • Knee not supporting body weight
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4
Q

How does septic arthritis different from reactive arthritis?

A
  • Reactive arthritis= Sterile inflammatory process (can result from extra-articular infection)
  • Septic arthritis= Invasion of joint space by microorganisms
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5
Q

Which other ligament do the collateral ligaments work with to prevemt excessive posterior motion of the tibia on the femur?

A

PCL

Posterior cruciate ligament

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6
Q

What is the most common direction for the patella to dislocate and why?

A

Laterally

Due to Q angle of knee (line of pull of quadriceps tendon and patellar ligament)

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7
Q

What is the distinctive finding for an infection of a prosthetic joint (physical findings for this are often minimal)?

A

Draining sinus from underlying affected joint

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8
Q

What are the three types of possible swellings around the knee?

A
  • Bony (Osgood-Schlatter’s disease)
  • Soft tissue
    • Localised- lymph node, popliteal artery aneurysm
    • Lymphodema of lower limb
  • Fluid
    • Inside joint- effusion
    • Outside joint- soft tissue haematoma
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9
Q

What are the 2 types of acute knee effusion?

A
  1. Haemarthrosis (ACL rupture until proven otherwise)
  2. Lipo-haemarthrosis (fracture until proven otherwise- fat release from bone marrow)
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10
Q

How are PCL injuries managed?

A

Conservatively:

  • Bracing
  • Rehabilitation
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11
Q

Name some symptoms of OA of the knee

A
  • Crepitus
  • Effusion
  • Knee buckling/giving way (esp when going downstairs)
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12
Q

What is the usual mechanism of injury for a distal femoral shaft fracture in the elderly?

A

Fall from standing

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13
Q

After reduction of the knee joint following a knee dislocation, what needs to be carried out?

A

MRA

(Magnetic Resonance Angiography)

to fully asses vascularity of leg

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14
Q

What % of skeletal injuries do patella fractures account for?

A

1%

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15
Q

What does the following image show?

A

Effusion of left knee

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16
Q

Give some factors which predispose to patellar dislocation?

A
  1. Generalised ligamentous laxity
  2. Weak quadriceps
  3. Shallow trochlear
  4. Long patellar ligament
  5. Previous dislocations
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17
Q

How does a patient with a meniscal injury usually present?

A

Intermittent pain

Pain localised to joint line

Knee clicking, catching, locking

Sensation of giving way

Swelling (delayed as menisci largely avascular)

Chronic effusion (due to synovitis)

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18
Q

Why does a torn LCL have a higher chance of causing knee instability?

A

Medial tibial plateau- deeper and more stable socket for femoral condyle than laterl tibial plateau

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19
Q

What are the risk factors for developing septic arthritis?

A
  • Extremes of age
  • Diabetes mellitus
  • Rheumatoid arthritis
  • Immunosuppression
  • IV drug use
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20
Q

Where does a knee effusion often present within the knee?

A

Suprapatellar bursa

= extension of synovial cavity of knee joint

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21
Q

What is the usual mechanism of injury for a tibial plateau fracture?

A

Axial loading with varus/valgus angulation of knee

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22
Q

How are patellar fractures treated? (displaced and undisplaced)

A
  • Displaced:
    • Reduction
    • Surgical fixation
  • Undisplaced:
    • Protected- splinting, crutches
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23
Q

What pathogens cause septic arthiritis?

A
  1. Staphylococcus aureus
  2. Staph. epidermis
  3. Neisseria gonorrhoeae
  4. Strep. viridans
  5. Strep. pneumoniae
  6. Group B Streptococci
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24
Q

What does it mean if the OA of the knee is Tri-compartmental?

A

Arthritis affecting 3 compartments:

  1. Medial femorotibial
  2. Lateral femorotibial
  3. Patellofemoral
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25
Q

Which collateral ligament (of the knee) is torn more commonly (LCL or MCL)?

A

MCL

BUT torn LCL- higher chance of causing knee instability

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26
Q

How does a meniscal injury usually occur?

A

Sudden twisting motion of weight-bearing knee in high degree of flexion

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27
Q

What is the defined time for the development of an ‘acute effusion’?

A

<6 hours after injury

(Delayed= >6 hours after injury)

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28
Q

In acute varus strain, which ligament is at risk?

A

LCL

Lateral collateral ligament

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29
Q

How is OSD managed?

A

Usually resolved with ice and rest

Bony prominence usually remains permanently

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30
Q

What % of the population are affected by OA of the knee?

A

12%

(35% over 75 years)

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31
Q

How are femoral shaft fractures treated?

A

Surgical fixation

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32
Q

What is another name for pre-patellar bursitis?

A

Housemaid’s knee

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33
Q

Apart from the usual triad of symptoms, what other symptoms may someone with septic arthritis present with?

A
  • Erythema
  • Swelling
  • Warmth
  • Tenderness
  • Limitation of active and passive range of motion
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34
Q

What is the most common joint affected by septic arthritis?

A

Knee (50%)

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35
Q

Other than a palpable defect in the patella, what other sign with a patient present with if they have experienced a patella fracture?

A

Haemarthrosis (blood in joint)

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36
Q

How many of the 4 ligaments must be ruptured in order to dislocate the knee?

A

at least 3/4

  1. MCL
  2. LCL
  3. ACL
  4. PCL
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37
Q

What is the usual mechanism of injury for a femoral shaft fracture in children/young adults?

A

High velocity trauma

(fall from height/road accident)

38
Q

How many Total Knee replacements (TKR) are performed each year in the UK?

A

110,000

39
Q

Why are prosthetic joints a risk factor for septic arthritis?

A
  • Intraoperative contamination
  • Haematogenous spread from distant infective focus

Polymethacrylate cement used- inhibits WBC and complement function

Delayed wound healing= major risk factor

Patient may become symptomatic months/years after inital operation

40
Q

Why does a patient with a femoral shaft fracture have a risk of developing hypovolaemic shock?

A

Blood loss- closed femoral fracture: 1000=1500mL

Blood loss- open femoral fracture: may be double

41
Q

What is shown in the following image?

A

Semimembranosus bursitis

Swelling in popliteal fossa- fluid forces its way out of joint and into bursa

42
Q

What’s another name for infra-patella bursitis?

A

Clergyman’s knee

(Repeated microtrauma caused by kneeling)

43
Q

How is a patella disloaction treated?

A
  1. Manually extending knee- reduce patella
  2. Immobilisation
  3. Physiotherapy
44
Q

What are the 2 main mechanisms of injury for a patella fracture?

A
  1. Direct impact injury
  2. Eccentric contraction of quadriceps
45
Q

What usually cause OSD?

A

Teenagers- playing sport- localised pain and swelling

(bilateral 20-30% of cases)

46
Q

Which cruciate ligament is injured more commonly and why?

A

ACL as= weaker than PCL

47
Q

In acute valgus strain, which ligament is at risk?

A

Medial collateral ligament

48
Q

What is a bipartite patella?

A

Normal anatomical variant (8% of population)

Failure of union of secondary ossification centre

Often mistaken on x-rays for patella fracture

49
Q

Which artery may become involved if there is significant displacement of the fracture in a distal femoral fracture?

A

Popliteal

50
Q

What can be seen in the following image?

A
  • Tibial plateau fracture
  • Lipohaemarthrosis (arrow)
51
Q

What may cause ‘delayed effusion’ of the knee?

A

Reactive synovitis

Response to injury- increased volume of synovial fluid

52
Q

Name 3 types of deformities that may be caused by osteoarthirits at the knee joint?

A
  1. Varus deformity (see image)
  2. Valgus deformity
  3. Fixed flexion deformity (knee cannot fully extend)
53
Q

What does this image show?

A

Tibial plateau fracture

(can be unicondylar/bicondylar)

(Lateral tibial condyle fractures=most common)

54
Q

What is the most common cause of patella dislocation?

A

Trauma:

  • Twisting injury in slight flexion
  • Direct blow to knee

(Mostly affects athletic teenagers)

55
Q

If a patient has torn their ACL, how do they usually present?

A
  • Feels popping sensation in knee
  • Immediate swelling
  • Instability
  • Rotational instability
56
Q

What’s the difference between varus and valgus angulation?

A
57
Q

Why do most patients develop a degree of post-traumatic osteoarthritis in the affected joint?

A

Articular cartilage = always damaged

58
Q

What is Osgood-Schlatter’s disease? (OSD)

A

Inflammation of apophysis (site of insertion) of patella ligament into tibial tuberosity

59
Q

What is the most common mechanism of a PCL injury?

A

Dashboard injury

Knee=flexed

Large force applied to upper tibia

  • displacing posteriorly
60
Q

What are the typical symptoms of knee osteoarthiritis? (3)

A
  1. Knee pain
  2. Stiffness
  3. Swelling
61
Q

Are the following x-rays normal or abnormal?

A

Normal

62
Q

Why causes a dislocation of the knee?

A

High energy trauma

63
Q

What are the 2 management options for a torn ACL?

A
  • Conservative- some patients can cope without ACL
  • Sportsmen/active people- need surgical reconstruction
64
Q

What is the mechanism of injury for the ‘unhappy triad’?

A

Strong force applied to knee

65
Q

How does a patient with prepatellar bursitis usually present?

A

Knee pain

Swelling

66
Q

What are the risk factors for OA?

A
  • Age
  • Female sex
  • Previous trauma
  • Obesity
  • Family history of OA
  • Another condition affecting joint
67
Q

What tests are used to detect ACL/PCL injuries?

A
  • Anterior and posterior draw tests
  • Lachman’s test
68
Q

How is the patella held in place?

A

Contraction of inferior fibres of vastus medialis

Stabilises patella within trochlear groove

69
Q

Apart from post-traumatic osteoarthritis, what other complications are associated with tibial plateau fractures? (2)

A
  1. Meniscal tears
  2. ACL injuries
70
Q

How will a patient with OSD present?

A
  • Intense knee pain during:
    • Running
    • Jumping
    • Squatting
    • Ascending/descending stairs
    • Kneeling
71
Q

What are the 4 sites where pulses can be palpated in the lower limb?

A
  1. Femoral
  2. Popliteal
  3. Dorsalis
  4. Posterior tibial
72
Q

What is the triad of symptoms which patients with septic arthritis usually present with?

A
  1. Fever (40-60%)
  2. Pain (75%0
  3. Reduced range of motion

(Symptoms may evolve over few days/weeks)

73
Q

Which artery is likely to be injured as a result of knee dislocation?

A

Popliteal

(V. immobile- so high risk of it being injured)

Will either:

  1. tear: haematoma
  2. crushed: thrombotic occlusion
74
Q

What does this xray show?

A

Distal femoral shaft fracture

75
Q

How are meniscle tears treated?

A
  • Acute: surgically- repair
  • Chronic: conservative management
76
Q

What should be done if septic arthritis is suspected?

A

Aspiration of joint immediately

Aspirate sent- urgent microscopy, culture, sensitivities

77
Q

What age group do patella fractures most commonly occur in?

A

20-50yrs

78
Q

Which bursae of the knee are most commonly inflamed?

A
  • Prepatellar bursa
  • Infrapatellar bursa
  • Pes anserinus bursa
  • Suprapatella bursa
79
Q

How does the msuculature act as a deforming force in a femoral shaft fracture?

A
  • Proximal fragment
    • -abducted
      • -gluteus maximus- greater trochanter
      • -gluteus minimus
    • -flexed
      • ilopsoas- lesser trochanter
  • Distal segment
    • -adducted into varus deformity
      • -adductor magnus
      • -gracilis
    • -extended
      • pull of gastrocnemius
80
Q

What usually causes injuries to the collateral ligaments of the knee?

A

Acute varus/valgus angulation of knee

81
Q

What’s another name for Semimembranosus bursitis?

A

Baker’s cyst

Popliteal cyst

82
Q

What are the mechanisms of injury for the anterior cruciate ligament?

A
  1. Quick deceleration
  2. Hyperextension
  3. Rotational injury
  4. Large force to back of knee with joint partially flexed

(Usually non-contact)

83
Q

What conditions may suprapatellar bursitis be a sign of? (5)

A
  1. Osteoarthiritis
  2. Rheumatoid arthritis
  3. Infection (septic arthritis)
  4. Gout and pseudogout
  5. Repetitive microtrauma to the joint
84
Q

What can cause a mechanical block to motion/locking in a displaced meniscal tear?

A

Loose meniscal fragments=trapped in articular surfaces

85
Q

If a patient has a meniscal tear and they present with acute haemarthrosis, what does this it indicate?

A
  1. Tear in peripheral vascular aspect of meniscus
  2. Injury to ACL (Unhappy triad)
86
Q

What is a major consequence of bacterial invasion (in the joint)?

A

Damages articular cartilage: Hydrolysis of collagen and proteoglycans

87
Q

What’s the prognosis for septic arthritis?

A

High morbidity- even if treated optimally

50% adults have:

Decreased range of motion

Chronic pain

…even after infection is resolved

88
Q

Why might a femoral shaft fracture be caused by a low velocity trauma in elderly patients/patients with bone metastasis?

A

Weaker bones

89
Q

What is the unhappy triad? (‘Blown knee’)

A

Injury to:

  1. ACL
  2. MCL
  3. Medial meniscus (as firmly adhered MCL)
90
Q

Describe the prepatellar bursa?

A

Superficial bursa (between skin and patella)

Thin synovial lining

2 MSK Clinical Conditions (10 decks)

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