Meniscal injuries. Injuries of the knee ligaments. Knee instability.

Question 1

what is meniscus ?

Answer 1

it is a fibrocartilage structure containing collagen one which is above the cartilage of the lateral and medial condyle of tibia

Question 2

what is the function of the meniscus ?

Answer 2

shock absorbing

act to disperse the weight of the body and reduce friction during movement

and joint stability

Question 3

which meniscus has more probability in tear ?

Answer 3

medial meniscus - in the posterioir horn for degenerative tear in older patients occur with arthritis

Question 4

latera meniscus tear is more common with what ?

Answer 4

acute anterior cruciate lig tear

Question 5

what causes meniscal tear ?

Answer 5

twisting or jumping

Question 6

what are the mechanical symptoms of meniscal injury /

Answer 6

locking of the knee joint with a lack of full extension - especially of bucket handle tear

clicking sounds of the knee joint
swelling of knee joint

Question 7

how do we diagnose the meniscal injury ?

Answer 7

Mc murray test
a painful pop or click when knee is brought from flexion to extension with either internal (lateral meniscus tear) or external rotation (medial meniscus tear )

arthroscopy

MRI is usually done to confirm

Question 8

tear in the peripheral 1/3 of the meniscus heals why ?

Answer 8

peripheral 1/3 is highly vascularised - from the vehicular arteries

middle third - may or may not heal

and inner 1/3 is avascular - tear will not heal

Question 9

what is the treatment of meniscal injury ?

Answer 9

indicated as first line of 
rest , 
NSAIDS  
 physical therapy 
removing weight of the meniscus 

partial meniscectomy
with degenerative
radial tear patterns
usually do minimal removal because the arthritis is risk is proportional to the amount removed

repair of meniscal tear
suturing the torn edges back into place and allowing the meniscus to heal on its own
usually done for peripheral tear because it will heal

meniscal transplant
usually done in young patient who had total menisectomy esp the lateral meniscus
not done in rheumatoid , chondromalacia , anterior cruciate ligament instability

Question 10

what are the ligaments of the knee ?

Answer 10

anterior cruciate lig
posterioir cruciate lig
medial collateral lig
lateral collateral lig

Question 11

what are the primary ligaments which leads t instability in the knee

Answer 11

anterior cruciate lig

Question 12

what causes anterior cruciate lig ?

Answer 12

during sports that involve sudden stops or changes in direction, jumping and landin

Question 13

what are the signs and symptoms of ALL ligament injuries?

Answer 13

A loud “pop” or a “popping” sensation in the knee
Severe pain
Rapid swelling
Loss of range of motion

Question 14

what is the treatment of anterior cruciate lig tearing ?

Answer 14

A torn ACL will not heal without surgery . However, if the knee remains stable enough to allow for walking and the individual does not plan to participate in high level of activity, doctors will recommend hinged knee bracing and physical therapy rather than surgery

ACL reconstruction surgery involves replacing the torn ACL with a “graft,” Grafts can be taken from the patellar tendon, hamstring tendon can be allograft or autograft
graft serves as scaffolding upon which new ligament tissue will grow

Question 15

what is the complications of anterior cruciate lig injury tear

Answer 15

early onset knee arthritis

Question 16

what is the function of the anterior cruciate lig injury ?

Answer 16

ACL is to resist the motions of anterior tibial translation and internal tibial rotation

Question 17

how can we diagnose ACL injury

Answer 17

lachman test
bring the knee to 30 degree flexion in supine portion
bring the tibia into slight external rotation
stabilise the femur with one hand
and grasp the upper tibia and draw it forward
considered positive if there is excessive anterior translation

pivot shift test
patient in supine postion
take the heel of the patient and put the leg into internal rotation of the tibia
apply valgus stress taking the knee from full extension up into extension
mimics a giving away feeling for positive t test

Question 18

what is the role of the posterioir cruciate ligamnent

Answer 18

prevent the tibia from displacing posterior to the femur.

Question 19

what causes posterior cruciate lig injury ?

Answer 19

direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee,

Question 20

how do we diagnose posterior cruciate lig injury ?

Answer 20

posterioir drawer test

flex the knee to 9 degrees in supine position
sit on the feet to fixate the knee
push the tibia posteriorly in a serious of explosive energy attempts
CHECK FOR POSTERIOIR TRANSLATION

arthroscopy and MRI

Question 21

what is the treatment for posterior cruciate ligament injury

Answer 21

It is possible for the PCL to heal on its own.
Nonoperative treatment is recommended for most grade I and grade II PCL tears.
grade 1 - partial tear
grade 2 - complete tear

quadriceps rehabilitation with a focus on knee extensor strengthening

Surgery is usually required in complete tears of the ligament or grade 3 - sprain of the ACL and/or collateral ligaments
ligament reconstruction is used to replace the torn PCL with a new ligament, which is usually a graft taken from the hamstring or Achilles tendon

Question 22

what causes MCL injury ?

Answer 22

valgus stress is the most common mechanism of injury

or direct blo to the knee

Question 23

what is the role of MCL

Answer 23

resists valgus stress

Question 24

MCL injury is usually associated with ?

Answer 24

ACL TEAR

Question 25

what is the grade of MCL ?

Answer 25

grade 1 - sprain stretch
grade 2 - partial tear of MCL
grade 3 - complete tear of the ligament , no end point with valgus stress at 30 degree flexion
no end point to valgus stress with 0 degrees flexion of the knee indicated anterior cruciate lig

Question 26

how is MCL treated ?

Answer 26

grade 1 - NSAIDs rest and therapy

grade 2/3 -if stable to valgus stress in full extension(no cruciate lig injury)
hinged knee bracing

grade 3 with anterior create lig injury - there needs to be lig repair - hamstring tendon or Achilles tendon allograft