Lower Limb Conditions- KNEE Flashcards by Lucy Crichton

Risk factors of extensor mechanism rupture

Previous tendonitis, chronic steroid use/abuse, diabetes, RA, chronic renal failure, quinolone antibiotics

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What makes up the extensor mechanism

Tibial tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscle

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Causes of extensor mechanism rupture

Rupture with rapid contractile force when lifting a heavy weight or falling onto flexed knee

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What age group rupture patellar tendon

Under 40s

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What age group rupture quadriceps tendon

Over 40s

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Diagnosis or extensor mechanism rupture

Straight leg raise test (cannot be completed), palpable gap in the extensor mechanism, XR for high (PT rupture) or low (quads rupture) lying patella, US confirmation

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Treatment of extensor mechanism rupture

Surgical repair, tendon to tendon repair or reattachment of tendon to the patella

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Causes of meniscal tear

Twisting on a loaded knee, more likely to tear on the medial meniscus as it is fixed, lateral more mobile

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Symptoms of meniscal tear

Localised pain along joint line, effusion, pain on tibial rotation, catching, locking

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Types of meniscal tear

Bucket handle, parrot beak, longitudinal, radial

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Treatment of meniscal tear

Blood supply to meniscus is peripheral so it won’t repair itself but pain and inflampmationwill settle, physiotherapy
ACUTE: locking or longitudinal tears in outer 1/3rd in young patients = arthroscopic repair or if mechanical pain/symptoms don’t settle in 6 months
Degenerative= steroid injections

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Function of ACL

To resist anterior subluxation of the tibia

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Function of PCL

To resist anterior subluxation of the femur

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Causes of ACL rupture

Direct blow to anterior tibia or planted foot with lateral upper body turning

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Symptoms of ACL rupture

POP + immediate swelling due to haemarthosis from ACL vascular supply/effusion

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Diagnosis of ACL rupture

Lachman test and anterior drawer test positive

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Treatment of ACL rupture

Physiotherapy + rest, in high demand athletes= reconstruction with autograft or allograft

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Causes of PCL rupture

Injury is rare in isolation, can be caused by direct blow to posterior tibia

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Symptoms of PCL rupture

Instability descending stairs

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Diagnosis of PCL rupture

Positive posterior drawer test

Treatment of PCL rupture

Only with severe laxity, recurrent instability, frequent hyperextension –> surgical reconstruction with allograft

Symptoms of MCL rupture

Laxity, pain on valgus stress with tenderness over the insertion of the MCL

Treatment of MCL rupture

Can heal spontaneously, physiotherapy, pain will take months to settle
ACUTE: hinged knee brace
CHRONIC: MCL tightening or reconstruction with tendon graft

Causes of LCL rupture

Varus and hyperextension stress

Symptoms of LCL rupture

Instability of rotational movement

Complications of LCL rupture

Common fibular nerve palsy

Definition of complete knee dislocation

Rupture to all 4 knee ligaments

Complication of complete knee dislocation

Intimal tear causing thrombosis of popliteal artery causing compartment syndrome after repercussion if prolonged ischaemia

Risk Factors for patellar dislocation

Ligamentous laxity, females, shallow trochlear groove, genuflects valgum, femoral neck anteversion, high riding patella

Causes of patellar dislocation

Direct blow or sudden twist of the knee (almost always lateral dislocation)

Symptoms of patellar dislocation

Pain medially due to torn medial retinaculum, effusion (haemarthrosis)

Diagnosis of patellar dislocation

Positive patella apprehension test

Treatment of patellar dislocation

Can spontaneously reduce when knee is straightened or can require manipulation back into position--> brace + physio

When does patellofemoral dysfunction cause pain

Going downhill, causing grinding, clicking, pseudo locking

What is traction apophysitis/Osgood Schlatter's

Inflammation of the tibial tubercle at the patella tendon insertion

Who suffers from traction apophysitis/Osgood Schlatter's

Adolescent active boys (often during growth spurts)

Symptoms + treatment of traction apophysitis/Osgood Schlatter's

Prominent bony lump treated by rest, physio, analgesia

Symptoms of tibial plateau fractures

Swelling, haemarthrosis, loss of ROM

Diagnosis of tibial plateau fractures

Fracture caused by bending force

Transverse

Fracture caused by rotational force

Spiral

Fracture cased by compressive force

Oblique

Complication of tibial shaft fracture

Compartment syndrome

Non operative treatment of tibial shaft fracture

If up to 50% displacement and 5 degrees angulation then above knee cast

Operative treatment of tibial shaft fracture

Internal fixation

Operative treatment of comminuted tibial shaft fracture

Surgical stabilisation with IMN

Describe a pilon fracture

Intraarticular fracture of the distal tibia caused by from from a height or rapid deceleration, the talus is driven into the distal tibia causing disruption/impaction of the articular surface

Diagnosis of pilon fracture

CT scan

Treatment of pilon fractures

Surgical emergency