Musc - Knee Flashcards
Differentials for knee pain and stiffness
- Knee OA
- Patellofemoral OA
- Patellar fracture
- Ligament injury
- Meniscal injury
- Crystal arthropathy
Risk factors for knee OA
Constitutional
- Age
- Female gender
- Obesity
Local
- Prev. joint injury
- Occupational/recreational joint stresses
- Joint laxity/malalignement
Mx of knee OA
Conservative
- Weight loss
- Stop smoking
- Physio/exercise programmes
Medical
- analgesia (paracetamol, topical NSAIDs)
Surgery
- Total knee replacement
- Partial knee replacement (done in 10% - when disease is localised to either medial or lateral compartment)
Presentation of patellofemoral OA
Anterior knee pain (worse when doing things that pressurise the patella e.g. climbing stairs)
joint stiffness/swelling
Differentials for ACL injury
Collateral ligament tear
Meniscal tear
Tibial plateau fracture
Differentials for ACL injury
Collateral ligament tear
Meniscal tear
Tibial plateau fracture
Ix for ACL tear
MRI knee
Mx of ACL tear
Conservative
Quadricep strength training to stabilise joint
Surgical
ACL repair - performed using an artificial graft after months of physio
Most common knee ligament injury and mechanism
MCL - blow to the lateral aspect of the knee
Presentation of MCL injury
‘Pop’ sound + immediate medial knee pain
Swelling after a few hours
Grading of MCL injury
Grade I – mild injury, with minimally torn fibres and no loss of MCL integrity
Grade II – moderate injury, with an incomplete tear and increased laxity of the MCL
Grade III – severe injury, with a complete tear and gross laxity of the MCL
Mx of MCL injury
Conservative
- Analgesia and physio
For Grade 2 or 3
- Knee brace + weight bearing/strength training as tolerated
Types of meniscus tear and most common
Vertical
Longitudinal (Bucket handle - most common)
Transverse
Degeneration
Presentation of meniscus tear
Tearing sensation
Sudden onset knee pain
‘Locking’ (if free body within the knee, most commonly in bucket handle tears)
Joint effusion
Mx of meniscus tears
For small tears: RICE
For larger tears: Arthroscopic meniscus removal or repair
What is Iliotibial band syndrome
Inflammation of the iliotibial band aponeurosis of gluteus maximus and tensor fasciae latae. The most common cause of lateral knee pain in young athletes. Thought to be caused by repeated flexion and extension of the knee
Mx of Iliotibial band syndrome
Analgesia
Physiotherapy
Potentially corticosteroid injections
Surgery - release of iliotibial band - indicated if symptomatic after 6 months of maximal Tx
Presentation of patellar fracture
Anterior knee pain
Hx of direct patellar trauma
Unable to straight leg raise
Swelling and bruising
Mx of open fractures
- Resuscitate in ED ○ Fluids ○ Analgesia ○ Blood ○ Tetanus booster and vaccination ○ Remove any obvious debris ○ Photograph wound
- Transfer to theatre ○ Debridement of wound and fracture site ○ Reduction
What is a Baker’s cyst
A Popliteal expansion of synovial fluid
Differentials for popliteal cystic mass
Popliteal artery aneurysm
Soft tissue tumour
Baker’s cyst
Haematoma
RFs for Baker’s cyst
Osteoarthritis
Idiopathic
Past knee injuries/trauma
Inflammatory diseases e.g. RA
Ottawa knee rules (5 things)
Age >55 Isolated patellar tenderness Unable to flex knee to 90 degrees Fibular head tenderness Unable to weight bear >4 steps immediately and in ED
If any present, requires imaging
Ottawa ankle rules
Tenderness at:
- Malleolar (posterior tip or lateral or medial malleolus)
- Midfoot (Navicular, base of 5th metatarsal)
Unable to weight bear 4 steps
