Orthopaedic Knee Conditions Flashcards

1
Q

What is the aetiology of meniscal tear?

A
  • Acute
    • Twisting especially during flexion
  • Degenerative
    • Osteoarthritis
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2
Q

Is medial or lateral meniscal tear more common?

A

Medial

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3
Q

What is the presentation of meniscal tear?

A
  • Symptoms
    • Pain
    • Clocking
    • Locking
    • Intermittent swelling
  • Signs
    • Effusion
    • Tender joint
    • McMurrays test positive
    • Fail deep squat
    • Thassaly’s test position
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4
Q

What investigations are done for meniscal tear?

A
  • X-ray
    • To exclude arthritis, fracture
  • MRI
    • Most sensitive test
    • High false positive rate
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5
Q

What is the treatment for meniscal tear?

A
  • Unlikely to heal due to poor blood supply
  • Non-operative
    • Rest
    • NSAIDs
    • Physiotherapy
      • Hamstring and quadriceps strengthening
  • Operative
    • Arthroscopy
      • Repair
      • Resection
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6
Q

Describe the pathophysiology of OA of the knee?

A
  • Degenerative change of synovial joints
    • Progressive loss of articular cartilage
    • Secondary bony changes
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7
Q

What is the presentation of OA of the knee?

A
  • Pain and stiffness of joint is characteristic
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8
Q

What is the mangement for OA of the knee?

A
  • 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
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9
Q

What is the aetiology of ACL injury?

A
  • Non-contact pivot injury
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10
Q

Describe the epidemiology of ACL injury in terms of sex?

A
  • F:M 4.5:1
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11
Q

What is the presentation of ACL injury?

A
  • 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
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12
Q

What investigations are done for ACT injury?

A
  • 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
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13
Q

What is the treatment for ACT injury?

A
  • Non-operative
    • Focused quadriceps programme
  • Operative
    • ACL reconstruction
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14
Q

What are the functions of the superficial and deep MCL?

A
  • Superficial
    • Primary restrain to vulgus stress
  • Deep
    • Contributes in full knee extension
    • Attaches to medial meniscus, continuous with joint capsule
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15
Q

What is the presentation of MCL injury?

A
  • Heard a pop or crack
  • Pain
    • Medial side
  • Unable to continue playing
  • Bruising medial knee
  • Localised swelling
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16
Q

What investigations are done for MCL injury?

A
  • X-ray
  • MRI
    • Modality of choice
    • Assess location and severity of injury
17
Q

What is the treatment for MCL injury?

A
  • 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
18
Q

What is osteochondritis dissecans?

A

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

19
Q

What are the 2 forms of osteochondritis dissecans?

A
  • Juvenile
    • 10-15 years while growth plates still open
  • Adult
20
Q

What is the aetiology of osteochondritis dissecans?

A
  • Hereditary
  • Traumatic
  • Vascular
    • Adult form
21
Q

What is the most common location of osteochondritis dissecans?

A
  • Knee most common location
    • Posteriolateral aspect of medial femoral condyle
22
Q

What is the presentation of osteochondritis dissecans?

A
  • Activity related pain
    • Poorly localised
  • Recurrent effusions
  • Mechanical symptoms
    • Locking
    • Block to full movement
23
Q

What investigations are done for osteochondritis dissecans?

A
  • X-ray
    • Add in tunnel view (flexed 30-50o)
  • MRI
    • Lesion size
    • Status of cartilage and subchondral bone
24
Q

What is the treatment of osteochonditis dissecans?

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