Orthopaedic Knee Conditions

Question 1

What is the aetiology of meniscal tear?

Answer 1

• Acute
  
  • Twisting especially during flexion
• Degenerative
  
  • Osteoarthritis

Question 2

Is medial or lateral meniscal tear more common?

Answer 2

Medial

Question 3

What is the presentation of meniscal tear?

Answer 3

• Symptoms
  
  • Pain
  • Clocking
  • Locking
  • Intermittent swelling
• Signs
  
  • Effusion
  • Tender joint
  • McMurrays test positive
  • Fail deep squat
  • Thassaly’s test position

Question 4

What investigations are done for meniscal tear?

Answer 4

• X-ray
  
  • To exclude arthritis, fracture
• MRI
  
  • Most sensitive test
  • High false positive rate

Question 5

What is the treatment for meniscal tear?

Answer 5

• Unlikely to heal due to poor blood supply
• Non-operative
  
  • Rest
  • NSAIDs
  • Physiotherapy
    
    • Hamstring and quadriceps strengthening
• Operative
  
  • Arthroscopy
    
    • Repair
    • Resection

Question 6

Describe the pathophysiology of OA of the knee?

Answer 6

• Degenerative change of synovial joints
  
  • Progressive loss of articular cartilage
  • Secondary bony changes

Question 7

What is the presentation of OA of the knee?

Answer 7

• Pain and stiffness of joint is characteristic

Question 8

What is the mangement for OA of the knee?

Answer 8

• 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

Question 9

What is the aetiology of ACL injury?

Answer 9

• Non-contact pivot injury

Question 10

Describe the epidemiology of ACL injury in terms of sex?

Answer 10

• F:M 4.5:1

Question 11

What is the presentation of ACL injury?

Answer 11

• 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

Question 12

What investigations are done for ACT injury?

Answer 12

• 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

Question 13

What is the treatment for ACT injury?

Answer 13

• Non-operative
  
  • Focused quadriceps programme
• Operative
  
  • ACL reconstruction

Question 14

What are the functions of the superficial and deep MCL?

Answer 14

• Superficial
  
  • Primary restrain to vulgus stress
• Deep
  
  • Contributes in full knee extension
  • Attaches to medial meniscus, continuous with joint capsule

Question 15

What is the presentation of MCL injury?

Answer 15

• Heard a pop or crack
• Pain
  
  • Medial side
• Unable to continue playing
• Bruising medial knee
• Localised swelling

Question 16

What investigations are done for MCL injury?

Answer 16

• X-ray
• MRI
  
  • Modality of choice
  • Assess location and severity of injury

Question 17

What is the treatment for MCL injury?

Answer 17

• 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

Question 18

What is osteochondritis dissecans?

Answer 18

Pathological lesion affecting articular cartilage and subchondral bone due to disruption of blood supply

Question 19

What are the 2 forms of osteochondritis dissecans?

Answer 19

• Juvenile
  
  • 10-15 years while growth plates still open
• Adult

Question 20

What is the aetiology of osteochondritis dissecans?

Answer 20

• Hereditary
• Traumatic
• Vascular
  
  • Adult form

Question 21

What is the most common location of osteochondritis dissecans?

Answer 21

• Knee most common location
  
  • Posteriolateral aspect of medial femoral condyle

Question 22

What is the presentation of osteochondritis dissecans?

Answer 22

• Activity related pain
  
  • Poorly localised
• Recurrent effusions
• Mechanical symptoms
  
  • Locking
  • Block to full movement

Question 23

What investigations are done for osteochondritis dissecans?

Answer 23

• X-ray
  
  • Add in tunnel view (flexed 30-50^o)
• MRI
  
  • Lesion size
  • Status of cartilage and subchondral bone

Question 24

What is the treatment of osteochonditis dissecans?

Answer 24

• Non-operative
  
  • Restricted weight-bearing
  • ROM brace
• Operative
  
  • Arthroscopy
    
    • Subchondral drilling
    • Fixation of loose fragments
  • Open fixation