O: Adult Knee Disorders

Question 1

purpose of menisci?

Answer 1

fibrocartilages that stabilise round femoral condyles on flat tibial plateaux

Question 2

aetiology of meniscal tear?

Answer 2

young: trauma, sports/squatting
older: spontaneous due to degeneration

Question 3

mechanisms of injury for meniscal tears?

Answer 3

twisting on loaded knee, hyper-flexion of knee jt

Question 4

what are the 4 meniscal tears?

Answer 4

longitudinal, bucket-handle, radial tear, parrot beak tear

Question 5

s/s of a meniscal tear?

Answer 5

general pain, swelling, popping and giving way sensation, possible effusion

Question 6

which tear poses a risk for acute locked knee syndrome?

Answer 6

bucket handle tear

Question 7

ix of choice for meniscal tear?

Answer 7

MRI

Question 8

mx for meniscal tears?

Answer 8

non-surgical: physio, knee strengthening

surgery: arthroscopic meniscal repair, arthroscopic meniscectomy

Question 9

when is meniscal repair indicated?

Answer 9

in acute peripheral meniscal tear or in young

Question 10

when is meniscectomy indicated?

Answer 10

irreplaceable tears, chronic pain, and mechanical symptoms e.g. clicking

Question 11

why must an acute locked knee be immediately unlocked in theatre?

Answer 11

may cause fixed flexion deformity (FFD)

Question 12

what are the 4 knee ligaments?

Answer 12

medial collateral ligament (MCL), LCL, Anterior cruciate ligament (ACL), PCL

Question 13

MCL injury causes _____ instability

Answer 13

valgus

Question 14

ACL & LCL causes ____ instability

Answer 14

rotatory

Question 15

PCL injury causes _____ or ___

Answer 15

recurrent hyperextension or instability

Question 16

cause of ACL tear?

Answer 16

sports- commonly football, rugby, skiing

Question 17

causes of PCL?

Answer 17

direct blow to anterior tibia or hyperextension injury

Question 18

cause of MCL?

Answer 18

high force from side

Question 19

cause of LCL?

Answer 19

varus stress injury

Question 20

s/s of ACL injury?

Answer 20

‘pop’, giving way on turning, deep knee pain, ahemoarthrosis common

Question 21

PCL s/s?

Answer 21

popliteal knee pain, bruising

Question 22

ix for ligamental damage?

Answer 22

MRI, exam & special tests

Question 23

what is a special test for ACL tear?

Answer 23

Lachman’s Test

Question 24

tx for MCL damage?

Answer 24

brace, early motion, physio, surgical tendon graft reconstruction

Question 25

ACL damage mx?

Answer 25

physio, surgery if physio not effective

Question 26

T/F: surgery for ACL improves pain

Answer 26

F: improves stability but not necessarily pain

Question 27

PCL mx?

Answer 27

conservative or surgical reconstruction

Question 28

which of the 4 ligament injuries always has surgical tendon graft mx as 1st line?

Answer 28

LCL injury

Question 29

what is a complication of ligament injury?

Answer 29

haemoarthrosis (bleeding into jt cavity), premature osteoarthritis, perineal nerve injury with LCL damage

Question 30

T/F: complete knee dislocations are impossible

Answer 30

F: may occur and high risk of NV injury, surgery is tx

Question 31

what is patellofemoral pain syndrome?

Answer 31

problem with the patellofemoral articulation resulting in anterior knee pain

Question 32

aetiology of patellofemoral pain syndrome

Answer 32

muscle imbalance, tightness of lateral tissues, bony malalignment, often synonymous with chondromalacia (softening of cartilage)

Question 33

s/s of patellofemoral pain syndrome?

Answer 33

anterior knee pain worse on going downhill, grinding or clicking at anterior knee, stiffness

Question 34

mx for patellofemoral pain syndrome

Answer 34

physio

Question 35

rupture of patellar and/or quadricep tendon is called...

Answer 35

extensor mechanism rupture

Question 36

what makes up the extensor mechanism?

Answer 36

tibial tuberosity, patella, patellar tendon, quadricep muscles, quadricep tendon

Question 37

T/F: <40yo usually have quadricep tendon rupture

Answer 37

F: <40 usually patellar tendon rupture, >40 quadricep tendon rupture

Question 38

aetiology of extensor mechanism rupture?

Answer 38

rapid quadricep contraction

Question 39

which abx predisposes to tendon rupture?

Answer 39

ciprofloxacin- quinolone

Question 40

signs on exam of extensor mechanism rupture?

Answer 40

unable to do straight leg test, palpable gap

Question 41

on MRI, how do you differentiate between patellar tendon and quadricep tendon rupture?

Answer 41

Patellar: high patella Quadricep: low patella

Question 42

mx for extensor mechanism rupture?

Answer 42

surgery

Question 43

what is osteochondritis dissecans?

Answer 43

area of knee loses blood supply and cartilage/ bone may fragment off

Question 44

T/F: loose bodies often break off at lateral femoral condyle in osteochondritis dissecans

Answer 44

F: usually break off at lateral aspect of medial femoral condyle

Question 45

epi of osteochondritis dissecans?

Answer 45

M>F, 7-17yo

Question 46

aetiology of osteochondrtitis dissecans?

Answer 46

traumatic + hereditary factors

Question 47

ix for OD?

Answer 47

MRI

Question 48

mx for OD?

Answer 48

un-displaced: spontaneous resolution | displaced: if detached= pin surgery + cartilage regeneration therapy

Question 49

what is bone bruising?

Answer 49

common complication of previous trauma- micros coping fracture of trabecular bone with bleeding

Question 50

mx for bone bruising?

Answer 50

self-resolves in 3/12- 12/12

Question 51

why do loose bodies keep growing?

Answer 51

nutrition from synovial fluid

Question 52

s/s of loose bodies?

Answer 52

clicking/ locking, mobile lump

Question 53

mx for loose bodies?

Answer 53

arthroscopic removal