Knee Trauma Flashcards

1
Q

Examples of knee trauma

A

-ACL injury
-Meniscal injuries
-Quadriceps
-Patellar tendon rupture
-Tibial fractures (fibula)
-Soft tissue knee

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2
Q

General principles of knee injury

A

-The knee has complex bony and soft tissue anatomy that must be appreciated in order to understand the conditions that affect it.
-Injuries to the knee are exceptionally common.
-Two symptoms are more common in knee pathology that at other sites:
=Locking - an inability to extend the knee.
=Instability – subjective or objective

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3
Q

Describe ACL injuries

A

-50% injuries in women, lateral blow to knee (sudden twisting or awkward landing)
-Typically due to pivoting
-Associated with
=Meniscal injuries: usually posterior horn of lateral meniscus acutely
=Collateral ligament injuries

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4
Q

Presentation of ACL injuries

A

-Acute
=Pain
=Sudden popping sound/ loud crack
=Swelling (haemarthrosis over minutes- hours)
-Late
=Instability, feeling that knee will give way
-High twisting force applied to bent knee

-Swelling
-Mild calor, effusion
-Anterior Drawer (should prevent forward translation movement)/ Lachmann (more reliable), pivotal shift

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5
Q

ACL injury diagnosis

A

-XR – usually done acutely
=Second Fracture = pathognomic
-MRI – can also identify associated injuries (ie. lateral meniscus)

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6
Q

Management of ACL injury

A

-ACL reconstruction with hamstring autograft (<40y/o and / or high functional demand =most patients)
-Conservative for patients with a low functional demand, poor healing intense PT

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7
Q

Describe the meniscus

A

-Fibrocartilaginous C-shaped discs that:
=Deepen the tibiofemoral articulation -> stability
=Dissipate the forces across the tibial plateau
=Move synovial fluid

-Avascular, relying on diffusion from the para-meniscal plexus (PMCP) -> poor ability to heal
-Several different morphologies, which influence management

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8
Q

Types of meniscal injuries

A

-Longitudinal tear
-Bucket handle tear
-Horizontal tear
-Radial tear
-Flap tear
-Degenerative tear

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9
Q

Presentation of meniscal injuries

A

-Pain
+/- locking
+/- intermittent swelling (delayed)
Recurrent episodes of pain and effusions are common, often following minor trauma

-Rotational sporting injuries (twisting), delayed knee swelling, recurrent episodes of pain and effusions common following minor trauma

-Swelling (mild)
-Joint line tenderness
-?locked knee when displaced/ give way
-Thessaly’s test (weight bearing at 20 degrees of knee flexion, patient supported by doctor, positive if pain on twisting knee)

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10
Q

Investigation and management of meniscal injury

A

-MRI

-Degenerative tears= conservative
-Arthroscopic (keyhole) surgery
=Partial meniscectomy (tears that cannot be repaired)
=Meniscal repair (peripheral tears, longitudinal or root)

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11
Q

Describe quadriceps/ patellar tendon tear (including risk factors)

A

-Collectively referred to as the ‘extensor mechanism’
=Mid energy fall on flexed knee for quad rupture

-Classical age distribution:
< 40 y/o = patellar tendon
> 40 y/o = quadriceps tendon

-Risk factors:
=Steroids
=DM
=CKD
=RA

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12
Q

Presentation of quadriceps/ patellar tendon tear

A

-Boggy swelling at site of tear
-Palpable ‘step’ in the continuity of the extensor
-Unable to extend the knee

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13
Q

Investigation and Management of quadriceps/ patellar tendon tear

A

-X/R +/- USS:
=Patella alta (patellar tendon tear)Or
=Patella baja (quadriceps tendon tear)

-Rx = Surgical repair

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14
Q

Describe tibial fractures (plateau)

A

-The tibial plateau is intra-articular; therefore, if fractured, blood and lipid (bone marrow) will leak from the bone into the knee.
-This may be the only sign that there is a fracture
-Lateral plateau is far more commonly fractured that the medial side
-Knee forced into valgus or varus but knee fractures before ligaments rupture
=Varus: medial
=Valgus: lateral depressed (more common)
-Lipohaemarthrosis (fluid level visible on X ray)

=Look for lipohaemarthrosis

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15
Q

Describe tibial fractures (diaphysis)

A

-Common, significant trauma in young
-Most common open fracture
-High risk of compartment syndrome
-Rx: Tibial nail

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16
Q

Describe tibial fractures (pilon)

A

-High energy fractures of the distal tibial, which involve the articular surface of the tibiotalar joint
-Not the same as an ‘ankle’ fracture
-Malignant group of injuries

17
Q

Investigation and management of tibial Pilon fracture

A
  • X/R
    -CT -> all complex, intra-articular fractures benefit from a CT to aide surgical planning

-Strict elevation -> swelling +++ -> high rate of wound complications
-Ex-Fix (temporary; if there will be delay to definitive surgery)
=ORIF is definitive

-Complications: Post-traumatic osteoarthritis is common

18
Q

Other ligament injuries

A

-Posterior cruciate: caused by anterior force applied to proximal tibia (knee hitting dashboard, hyperextension), tibia lies back on femur, paradoxical anterior draw test
-Collateral: tenderness over the affected ligament, knee effusion may be seen (medial following valgus stress, causes abnormal passive abduction of knee)
=medial: leg forced into valgus via force outside the leg. Knee unstable when put into valgus position