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MSK- Pelvis and Lower Limb > Knee- Soft Tissue Injuries > Flashcards

Knee- Soft Tissue Injuries Flashcards

1
Q

Where do the menisci have a blood supply? What is the significance of this?

A

Only at their periphery- tears aren’t particularly painful and also won’t heal well

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2
Q

Knees pivot through what compartment during flexion and extension? What is the significance of this (regarding meniscal tears)?

A

Medial compartment, medial meniscus is more likely to tear

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3
Q

What way does the tibia rotate on flexion?

A

Internally

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4
Q

Which has a better blood supply, MCL or LCL?

A

MCL

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5
Q

What will be seen on clinical examination of a patient with a meniscal tear?

A

Effusion (following day), joint line tenderness, + Steinmann’s test (tibial rotation)

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6
Q

Where is a longitudinal meniscal tear?

A

Near the periphery

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7
Q

What is a bucket handle meniscal tear?

A

An extensive longitudinal tear, causing locking

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8
Q

What type of meniscal tear will cause the knee to click painfully?

A

Parrot beak

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9
Q

Why are medial meniscal tears more common?

A

The medial meniscus is more fixed and less mobile, force from pivoting movements is centred there

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10
Q

What will a locked knee in a displaced bucket handle meniscal tear present like?

A

15 degree springy block to extension

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11
Q

What is the mechanism of injury for a meniscal tear?

A

Usually as a sporting injury in young patients, or getting up from a squatting position (twisting force on a loaded knee)

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12
Q

Can meniscal tears occur spontaneously?

A

Yes, degenerate tears in older patients can (>40)

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13
Q

Rupture of what ligament is closely associated with meniscal tears?

A

ACL

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14
Q

What is the investigation of choice for a meniscal tear?

A

MRI

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15
Q

What features imply worse healing of a meniscal tear?

A

Radial tears, aged > 25, increased time from injury

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16
Q

What type of meniscal tears should be considered for repair?

A

Reasonably fresh bucket handle tears involving the outer 1/33rd of the meniscus in a younger patient

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17
Q

What happens in a meniscal repair?

A

The meniscus is sutured to its bed

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18
Q

What is the failure rate of meniscal tear repairs?

A

25%

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19
Q

When should an arthroscopic meniscectomy be considered?

A

In patients who still have pain or mechanical problems after 3 months

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20
Q

If meniscal repair surgery fails, what happens next?

A

Remove it (you only get one shot at repair)

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21
Q

An acute locked knee signifies what?

A

Displaced bucket handle meniscal tear

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22
Q

How soon must arthroscopic repair be done following a bucket handle meniscal tear?

A

6 weeks

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23
Q

If the knee remains locked following a meniscal tear, what may this result in?

A

Fixed flexion deformity

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24
Q

What do degenerate meniscal tears signify?

A

The first stage of knee OA

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25
Q

Will the Steinmann’s test be positive in degenerate meniscal tears? What other signs and symptoms will be associated with this?

A

No, Steinmann’s will be negative. There will be signs and symptoms of OA

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26
Q

What should you not treat degenerate meniscal tears with?

A

Arthroscopy

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27
Q

What may help control the symptoms in the early period of a degenerate meniscal tear?

A

Steroid injections

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28
Q

What is a grade 1 ligament injury?

A

Sprain- tearing of some fibres but macroscopically intact

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29
Q

What is a grade 2 ligament injury?

A

Partial tear, some fascicles disrupted

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30
Q

What is a grade 3 ligament injury?

A

Complete tear

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31
Q

Does the MCL heal well?

A

Yes

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32
Q

When would the MCL not heal well?

A

If associated with ACL or PCL rupture

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33
Q

How do you treat MCL rupture?

A

Bracing, early motion and physio

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34
Q

How long can it take for pain from an MCL rupture to settle?

A

Several months

35
Q

What treatment can be used in chronic MCL instability?

A

Tightening or reconstruction with a tendon graft

36
Q

Where may patients with an MCL rupture have laxity and pain?

A

On valgus stress, over the origin/insertion of the MCL

37
Q

Do LCL ruptures happen alone?

A

Not often, they are usually part of multiple ligament injuries

38
Q

What motions can cause LCL rupture?

A

Hyperextension or varus

39
Q

Does the LCL heal well? What problems can you be left with?

A

It does not heal well- can be left with varus and rotatory instability (especially external)

40
Q

Excessive stretch from varus/hyperextension in LCL ruptures can cause what nerve injury? What can this result in?

A

Damage to the common fibular nerve which can cause a permanent foot drop

41
Q

LCL rupture is often found in combination with what other ligament ruptures?

A

PCL/ACL

42
Q

If found within 2 weeks, how is an LCL rupture treated? What happens if it presents later than this?

A

Urgent repair. If late then reconstruction.

43
Q

The ACL is the main stabiliser against what movement?

A

Internal rotation of the tibia

44
Q

What is the principle complaint of ACL deficiency?

A

Rotatory instability which gives way on turning

45
Q

How are ACL ruptures usually acquired?

A

Sports injury- football/rugby/skiing turning the upper body laterally on a planted foot

46
Q

How are ACL ruptures treated?

A

Reconstruction

47
Q

What will examination of an ACL rupture reveal?

A

Knee swelling with excessive anterior translation of the tibia on anterior drawer test and Lachmann’s test

48
Q

To give stability, the ACL can be stuck to which other ligament?

A

PCL

49
Q

Recovery from ACL rupture comes under the rule of thirds, what is this?

A

1/3rd compensate and function well, 1/3rd avoid instability by avoiding certain movements, 1/3rd have frequent instability

50
Q

When should surgery be considered for an ACL rupture?

A

Rotatory instability, no response to physio, protect a meniscal repair, return to professional sport, multi-ligament damage

51
Q

After surgery for ACL repair, what is the recovery like?

A

Can be up to 1 year of intense rehab, some never get back to sport, often have arthritis within 10 years

52
Q

What is the mechanism of injury of a PCL rupture?

A

Direct blow to the anterior tibia or hyperextension

53
Q

How will a PCL rupture occur?

A

Popliteal pain and bruising

54
Q

Is isolated PCL rupture common?

A

No

55
Q

When is reconstruction used for PCL rupture?

A

If part of multi-ligament injury or if severe instability

56
Q

What can PCL ruptures cause long term?

A

Instability, recurrent hyperextension, feeling unstable going downstairs

57
Q

How would you describe a knee dislocation?

A

High impact injury with a high incidence of complications

58
Q

What are some complications of knee dislocation?

A

Popliteal artery injury, nerve injury, compartment syndrome

59
Q

What is the treatment for a knee dislocation?

A

Emergency reduction with possible external fixation, multiple ligament reconstruction

60
Q

The patella will almost always dislocate in what direction?

A

Laterally

61
Q

When the patella dislocates, what ligament is torn?

A

Medial patellofemoral ligament

62
Q

As well as the torn ligament, what else may happen alongside patellar dislocations?

A

Osteochondral fracture (small opacification on x-ray)

63
Q

What movements can cause a patellar dislocation?

A

Rapid turn or direct blow

64
Q

What are some factors which predispose to patellar dislocations?

A

Female, adolescent, ligamentous laxity, values knees, high patella, femoral neck ante version, shallow trochlear groove

65
Q

What % of people will have a recurrent patellar dislocation?

A

10%

66
Q

What is the treatment for recurrent patellar dislocations?

A

Surgical stabilisation

67
Q

What occurs following a patellar dislocation which causes a characteristic x-ray appearance?

A

Lipo-haemarthrosis

68
Q

After a patellar dislocation, physiotherapy to strengthen which muscles may help?

A

Quadriceps

69
Q

What components make up the extensor mechanism of the knee?

A

Tibial tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscles

70
Q

What is the mechanism of injury for an extensor mechanism rupture?

A

Fall onto a flexed knee with quadriceps contracted

71
Q

What are some risk factors for extensor mechanism rupture?

A

Previous tendonitis (quinolones), steroids, chronic renal failure, diabetic, RA

72
Q

What are the clinical signs of an extensor mechanism rupture?

A

Unable to straight leg raise and a palpable gap

73
Q

What treatment should be avoided in an extensor mechanism rupture?

A

Steroid injections

74
Q

At what ages are a) patellar tendon ruptures and b) quadriceps tendon ruptures more common?

A

a) < 40 b) > 40

75
Q

On an x-ray, where will the patella lie in a) patellar tendon ruptures and b) quadriceps tendon ruptures?

A

a) high lying patella b) low lying patella

76
Q

If a patient is obese and there is no palpable gap, what test can be used to assess for extensor mechanism rupture?

A

Ultrasound

77
Q

What is the treatment for an extensor mechanism rupture?

A

Tendon to tendon repair or reattachment of the tendon to the patella

78
Q

If there is a loose mechanical fragment in a meniscal tear, how may this present?

A

Feeling like the knee is going to give way

79
Q

Is it possible to have a meniscal tear without locking?

A

Yes

80
Q

Is pseudo-locking a sign of meniscal injury?

A

No

81
Q

How soon after an ACL rupture will a haemarthrosis develop?

A

An hour

82
Q

Valgus stress injuries usually tear which ligament? What other injuries may occur?

A

MCL - can also cause ACL damage and lateral tibial plateau fracture

83
Q

A varus stress injury will usually damage what ligament? What other ligament may or may not be involved?

A

LCL +/- PCL

84
Q

If a knee injury is though to be significant, what is the best test to do?

A

MRI

MSK- Pelvis and Lower Limb (5 decks)

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