Ortho: Knee

Question 1

Knee pain can be broadly categorized as due to one or more of the following

Answer 1

• An intraarticular process such as a meniscal or ligamentous injury (internal derangement) or fracture
• Patellar malalignment or dysfunction
• Cartilage loss due to osteoarthritis or synovitis
• Periarticular bursitis or tendinopathy
• Referred pain from the hip, femur, or spine
• Inflammatory arthritides (synovitis)

Question 2

Symptoms that are most important in arriving at a specific anatomical diagnosis

Answer 2

localized pain, focal swelling, inflammatory changes, and abnormal noise (clicking, popping, grinding).

Question 3

Symptoms that suggest the presence of a joint effusion

Answer 3

generalized swelling and the mechanical consequence of the effusion, namely impaired bending

Question 4

Symptoms that reflect a change in overall knee function

Answer 4

complaints of loss of muscular or ligamentous support (weakness, giving out, collapsing), loss of smooth movement (catching, “something is wrong inside”), and difficulty with ambulation (limping, fatigue, favoring).

Question 5

Common causes of medial knee pain include

Answer 5

osteoarthritis, pes anserinus pain syndrome (formerly anserine bursitis), medial collateral ligament injury, and medial meniscal tear

Question 6

Causes of anterior knee pain include

Answer 6

injuries to the quadriceps muscles or tendon, patellofemoral pain syndrome, advanced osteoarthritis, prepatellar bursitis, patellar tendinopathy, patella injury, and inflammatory or septic arthritis

Question 7

Causes of lateral knee pain include

Answer 7

osteoarthritis, iliotibial band syndrome, lateral collateral ligament injury, and lateral meniscal tear

Question 8

Posterior, or popliteal, knee pain

Answer 8

muscle or neurovascular injury, including deep vein thrombosis

Question 9

Ultrasonography of knee to pick up

Answer 9

Baker’s cyst, meniscal cyst or synovitis

Question 10

MRI knee

Answer 10

soft tissue pathology is suspected (eg, chronic tendon or meniscal tears, focal articular cartilage damage, or plica syndrome) osteomyelitis, osteonecrosis, and stress fractures

Question 11

CT knee

Answer 11

assess for fractures that are clinically suspected but are not apparent on plain radiographs and to further assess and aid in preoperative planning for complex fractures

Question 12

osteoarthritis

Answer 12

joint pain, stiffness, and locomotor restriction. They usually present in just one or a few joints in a middle-aged or older person. knees, hips, interphalangeal joints, first carpometacarpal (CMC) joints, first metatarsophalangeal (MTP) joints, and apophyseal (facet) joints of the lower cervical and lower lumbar spine

Question 13

Generalized OA

Answer 13

polyarticular subset of OA involving the distal interphalangeal (DIP) joints, thumb bases (first CMC joints and trapezioscaphoid joints), first MTP joints, lower cervical and lumbar facet joints, knees, and hips.

Question 14

Peripheral joint OA

Answer 14

-Persistent usage-related joint pain in one or few joints

• Age ≥45 years
• Morning stiffness ≤30 minutes

Question 15

patellofemoral pain syndrome

Answer 15

anterior knee pain common in those < 40 and those with advanced osteoarthritis can be unilateral or bilateral “runners knee”

Question 16

prepatellar bursitis

Answer 16

anterior knee pain with swelling and inflammatory changes anterior to the patella

Question 17

patellar tendinopathy

Answer 17

“jumpers knee”, focal knee pain at the patellar tendon usually involves a minor tear at the patellar tendon seen commonly in athletes, Often the tendon feels very stiff first thing in the morning

Question 18

septic arthritis knee

Answer 18

diffuse anterior knee pain, swelling and impaired flexion prefer to keep the knee slightly flexed

Question 19

Lateral knee pain

Answer 19

lateral osteoarthritis, injured lateral collateral ligament, lateral meniscus tears

Question 20

IT band syndrome knee pain

Answer 20

focal lateral pain at the femoral condyl showing inflammation of the IT band. Can be from worn shoes, excessive running, or running on uneven terrain. Aching or burning pain over the lateral femoral condyl and can radiate toward the hip.

Question 21

Clicking, popping, snapping knee

Answer 21

patellofemoral syndrome, IT band syndrome, meniscus tear

Question 22

Classic critera for knee osteoarthritis

Answer 22

greater than 50 years of age, morning stiffness less than 30 minutes, crepitus, bony tenderness, bony enlargement, no palpable warmth. XRay shows a decrease in cartilage space and adjacent osteophyte formation

Question 23

Synovial effussion

Answer 23

Intraarticular pathology can be septic arthritis, IBD – gout, RA, tumor, infection.s/s knee swelling, knee tightness, restricted ROM.

Question 24

Hemarthrosis

Answer 24

immediate rapid within 2-4 swelling. -ACL tear most common, can also be MCL or meninscal tear. If no trauma think blood coag disorder

Question 25

Popliteal cyst

Answer 25

aka Bakers cyst fluid filled mass in popliteal fossa. Popliteal tightness, fullness, impaired bending, medial popliteal mass prominent when standing and goes away when flex 45 degrees

Question 26

Bursitis

Answer 26

exquisite local tenderness, pain on motion and at rest, occassional loss of active movement, swelling and warmth with prepatellar bursitis

Question 27

Pes anserinus pain syndrome

Answer 27

Pain when rising from a seated position and goes up or down stairs, between the tibia and sartorius. Pain when on medial region at night. No swelling or warmth. Does have focal tenderness. Common in swimmers.

Question 28

Prepatellar bursitis

Answer 28

Localized swelling and tenderness anterior to the patella from trauma or kneeling too much due to direct pressure, localized redness swelling and tenderness. Knee motion is unimpaired.

Question 29

ACL

Answer 29

Trauma, feels loose or giving out, swelling begins shortly after, laxity on Lachman, pivot shift or drawer tests. Noncontact deceleration, cutting movement or hyperextension, w a ‘pop’ and unable to continue sports

Question 30

Medial collateral ligament

Answer 30

Knee pain along the medial aspect of the joint, difficulty walking, pivoting and twisting. can be inflammed, torn partially or completely.

Question 31

Lateral collateral ligament

Answer 31

tender along lateral joint line, very uncommon, laxisity or pain during varus stress test

Question 32

Posterior cruciate ligament

Answer 32

Foot is planter flexed and fall forward or from direct blow during contact sport or MVA striking dashboard. Posterior drawer sign + to diagnose

Question 33

Meninscal tear

Answer 33

Loss of smooth motion (locking) knee effusion and premature osteoarthritis. Twisting knee w foot fixed on the ground. Need MRI or diagnostic arthroscopy.

Question 34

Anterior drawer test

Answer 34

subluxating the tibia anteriorly with the knee 90 degree flexion. Any gross movement is abnormal. posterior drawer is done if there is PCL tear.

Question 35

Lachman test

Answer 35

knee in 30 degree flexion stabilize femur and apply anterior force to the tibia any laxity is abnormal

Question 36

Pivot shift test

Answer 36

knee is extended hold tibia in internal rotation positive if there is a clunk or a glide of 20-40 degrees
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Question 37

McMurray test to assess for

Answer 37

menincus tear