Ligamentous and Cartilagenous Knee Lesions

Question 1

What does locking of the knee indicate

Answer 1

Meniscal, cruciate or osteochondral injury

Question 2

What are some causes of haemarthrosis of the knee

Answer 2

Primary spontaneous haemarthrosis:-
Occurs without trauma
May be secondary to disorders of coagulation or vascular malformations

Secondary haemarthrosis:-
Secondary to trauma
80% due to ACL injuries
10% secondary to patellar dislocation
10% follow tears in the peripheral third of the menisci, capsular tears and osteochondral or osteophyte fractures

Question 3

Where is the meniscus vascularized

Answer 3

In the peripheral third

Question 4

What factors in the history point to an ACL injury

Answer 4

Most commonly associated with valgus/external rotation, hyperextension, deceleration and rotational movements
Patients hear a ‘pop’ or feel something tear - 50% cases
Inability to continue sport or activity
Effusion developing within 4-6 hours

Question 5

What are the problems associated with ACL rupture

Answer 5

Abnormal knee movements occur which lead to:-
Meniscal tears
Collateral ligament injury
Progressive premature osteoarthritis

Question 6

How do you surgically treat a meniscal tear

Answer 6

Arthroscopic or open
Partial meniscectomy
Meniscal repair

Question 7

What is the outcome of physiotherapy in patients with ACL tears

Answer 7

Noyes’ rule of thirds

1/3 will compensate and pursue normal recreational sports
1/3 will reduce sporting activities with avoidance of jumping and pivoting exercises
1/3 will do poorly and develop instability, requiring early surgery

Question 8

What are the options for surgical management of ACL tears

Answer 8

Intra-articular reconstruction
Extra-articular reconstruction
Combination of the above

Question 9

What tendons are used in an intra-articular reconstruction of the ACL

Answer 9

Autologous hamstring tendon

Autologous patellar tendon

Question 10

What are the causes of a locked knee

Answer 10

Classified by age

In childhood:- POD
Pathology in hip
Osteochondritis dissecans
Discoid meniscus

Adolescence:- SCOM
Synovial chondromatosis
Cruciate ligament injury
Osteochondritis dissecans
Meniscal tear

Adult:- CLOMS
Cruciate ligament injury
Loose body
Osteochondral fracture
Meniscal tear
Synovial chondromatosis

Elderly:- LIM
Loose body
Intraarticular tumour (rare)
Meniscal tears