Leg Injuries Flashcards
What parts of the extensor mechanism can rupture?
patella tendon rupture - <40yrs
quads tendon rupture - >40yrs
rectus femoris rupture
patella fracture
How is the extensor mechanism commonly injured?
fall onto a flexed knee with quads contraction
How would an extensor mechanism injury present?
unable to straight leg raise, palpable gap
What risk factors can predispose to extensor mechanism injury?
patellofemoral OA
previous tendonitis
chronic renal failure
steroid injections into tendons
How are extensor mechanism ruptures investigated and treated?
Xray or ultrasound
patella low lying on xray: qauds rupture
patella high lying on xray: patella tendon rupture
surgical repair
What would be the problem if there was no trauma and the patient could not straight leg raise?
femoral nerve problem
How are meniscal tears investigated?
MRI
What do radial tears lead to?
parrot beak tears
What do longitudinal tears lead to?
bucket handle tears
What is the risk with bucket handle tears?
part of the knee can displace anteriorly or into the intercondylar notch meaning the KNEE LOCKS
What do horizontal tears lead to?
flap tears
What does an acute locked knee show?
displaced bucket handle tear
patient will still have a 15 degree springy block
requires URGENT SURGERY
What are more common: medial or lateral meniscal tears?
medialx10
What is the treatment for meniscal tears?
limited due to there only being a blood supply to the outer third
longitudinal tears involving the outer third in young patients should get surgical repair
What is the unhappy triad?
damage to MCL, ACL and medial meniscus
- due to lateral impact and valgus stress
What way would a patella commonly dislocate: laterally or medially?
laterally
What is the treatment for a patella dislocation?
may spontaneously reduce when the knee is straightened or may need to be manually manipulated back into position
What may patella dislocation result in?
patellafemoral ligament tears
osteochondral fracture of the lateral femoral epicondyle
Which people are more at risk of a patella dislocation?
females
increased laxity
shallow trochlear groove
genu valgum
When would an ACL rupture take place?
due to rotatory instability
knee giving way on turning
What is the classic presentation of an ACL rupture?
knee swelling
haemarthrosis and effusion
excessive anterior translation of the tibia on the anterior drawer test/Lachmanns test
What is the ACL rule of 1/3rd?
1/3rd will compensate and do whatever they want
1/3rd will compensate but wont be able to do sports
1/3rd will not compensate and will need to have surgery
What is the treatment for ACL ruptures?
physiotherapy to strenghten muscles surgical reconstruction (tendon transfer) for those who cant compensate
When would a PCL rupture happen?
motorbikes
RTA
What is the common presentation of an MCL tear?
laxity and pain on valgus stress
tenderness over the origin/insertion of the MCL
What is the treatment for MCL tears?
Acute: knee hinge brace
Chronic: MCL reconstruction or tightening
What is the common presentation of LCL tears?
instability on rotating
look varus and hyperextended
What nerve can commonly be damaged due to LCL tears?
peroneal nerve - due to excessive stretch
What is myositis ossificans?
abnormal calcification of the muscle haematoma forming a hardness over a previously injured area
How is myositis ossificans diagnosed?
Xray
MRI
