Orthopaedic Knee Conditions Flashcards
What is the aetiology of meniscal tear?
- Acute
- Twisting especially during flexion
- Degenerative
- Osteoarthritis
Is medial or lateral meniscal tear more common?
Medial
What is the presentation of meniscal tear?
- Symptoms
- Pain
- Clocking
- Locking
- Intermittent swelling
- Signs
- Effusion
- Tender joint
- McMurrays test positive
- Fail deep squat
- Thassaly’s test position
What investigations are done for meniscal tear?
- X-ray
- To exclude arthritis, fracture
- MRI
- Most sensitive test
- High false positive rate
What is the treatment for meniscal tear?
- Unlikely to heal due to poor blood supply
- Non-operative
- Rest
- NSAIDs
- Physiotherapy
- Hamstring and quadriceps strengthening
- Operative
- Arthroscopy
- Repair
- Resection
- Arthroscopy
Describe the pathophysiology of OA of the knee?
- Degenerative change of synovial joints
- Progressive loss of articular cartilage
- Secondary bony changes
What is the presentation of OA of the knee?
- Pain and stiffness of joint is characteristic
What is the mangement for OA of the knee?
- Conservative
- Weight loss
- Analgesia
- Activity modification
- Braces
- Walking aids
- Steroid injection
- Operative
- Total knee replacement
- Cruciate retaining
- Cruciate sacrificing
- Uni-compartmental knee replacement
- Medial (most common)
- Lateral
- Patello-femoral
- Total knee replacement
What is the aetiology of ACL injury?
- Non-contact pivot injury
Describe the epidemiology of ACL injury in terms of sex?
- F:M 4.5:1
What is the presentation of ACL injury?
- Heard a pop or crack
- Immediate swelling (70%)
- Unable to continue playing
- Deep pain
- Signs
- Effusion
- Anterior draw test positive
- Lachmann’s test positive
- Pivot shift test positive
What investigations are done for ACT injury?
- X-ray
- Secondary fracture
- MRI
- Look at ACL
- Look at menisci
- Lateral tear simultaneous with ACL tear half the time
- Medial tear occurs secondary to chronic instability
What is the treatment for ACT injury?
- Non-operative
- Focused quadriceps programme
- Operative
- ACL reconstruction
What are the functions of the superficial and deep MCL?
- Superficial
- Primary restrain to vulgus stress
- Deep
- Contributes in full knee extension
- Attaches to medial meniscus, continuous with joint capsule
What is the presentation of MCL injury?
- Heard a pop or crack
- Pain
- Medial side
- Unable to continue playing
- Bruising medial knee
- Localised swelling
What investigations are done for MCL injury?
- X-ray
- MRI
- Modality of choice
- Assess location and severity of injury
What is the treatment for MCL injury?
- Non-operative
- Majority of treatment
- Rest
- NSAIDs
- Analgesia
- Physiotherapy
- Brace
- Operative
- For severe tears when non-operative management has failed
- Repair or reconstruction
- Repair – avulstions
- Reconstruction – damaged tissue
What is osteochondritis dissecans?
Pathological lesion affecting articular cartilage and subchondral bone due to disruption of blood supply
What are the 2 forms of osteochondritis dissecans?
- Juvenile
- 10-15 years while growth plates still open
- Adult
What is the aetiology of osteochondritis dissecans?
- Hereditary
- Traumatic
- Vascular
- Adult form
What is the most common location of osteochondritis dissecans?
- Knee most common location
- Posteriolateral aspect of medial femoral condyle
What is the presentation of osteochondritis dissecans?
- Activity related pain
- Poorly localised
- Recurrent effusions
- Mechanical symptoms
- Locking
- Block to full movement
What investigations are done for osteochondritis dissecans?
- X-ray
- Add in tunnel view (flexed 30-50o)
- MRI
- Lesion size
- Status of cartilage and subchondral bone
What is the treatment of osteochonditis dissecans?
- Non-operative
- Restricted weight-bearing
- ROM brace
- Operative
- Arthroscopy
- Subchondral drilling
- Fixation of loose fragments
- Open fixation
- Arthroscopy
