Orthopaedic Knee Conditions Flashcards by Sophie Pitcairn

What are the main ligaments of the knee?

Cruciate ligaments - Anterior and posterior
Collateral ligaments - medial and lateral
Transverse and ligament of Wristberg

How well did you know this?

Not at all

Perfectly

Describe the meniscii

Specialised C-shaped cartilages - triangular in cross section
Medial is attached to deep MCL
Function is aid force transmission and increase stability

How well did you know this?

Not at all

Perfectly

How can meniscal tear occur?

Acute - twisting esp. in deep flexion
Degenerative - OA
Medial meniscal tears are most common

How well did you know this?

Not at all

Perfectly

What are some types of meniscal tear?

Flap (horizontal cleavage), radial, degenerative, Parrot’s beak and bucket handle

How well did you know this?

Not at all

Perfectly

What is the presentation of acute meniscal tear?

Pain, clicking, locking and intermittent swelling
Mainly in people under 40

How well did you know this?

Not at all

Perfectly

What is done in examination of meniscal tear?

Look for effusion of knee
Feel tender joint line at point at tear
Move - mechanical block to movement, McMurray’s test positive, fail deep squat and Thassaly’s test positive

How well did you know this?

Not at all

Perfectly

What is the McMurray’s test?

Examiner places middle finer over lateral joint line and thumb over medial joint line
Patient knee is flexed and load is applied then rotate tibia on knee and under fingers there is clicking

How well did you know this?

Not at all

Perfectly

What is the Thassaly’s test?

Patient stands and knees slightly flexed
Patient rotated and if lateral aspect of knee then lateral meniscal tear on external rotation

How well did you know this?

Not at all

Perfectly

What investigations are done for meniscal tear?

X-ray - excludes arthritis and fractures
MRI - most sensitive test. Used for more unsure cases

How well did you know this?

Not at all

Perfectly

What are the zones of the meniscus?

White zone - gain from synovial fluid so if tear then won’t heal
Red zone - if tears peripherally then can be repaired

How well did you know this?

Not at all

Perfectly

What is the non-operative management for meniscal tears?

Rest
NSAIDs
Physio - hamstring and quadriceps strengthening

How well did you know this?

Not at all

Perfectly

What is the operative treatment of meniscal tear?

Arthroscopy - repair and resection

How well did you know this?

Not at all

Perfectly

Describe osteoarthritis

Degenerative change of synovial joints - progressive loss of articular cartilage and secondary body changes
Worsening pain and stiffness

How well did you know this?

Not at all

Perfectly

What is the conservative management for OA?

Weight loss, analgesia, activity modification, braces, walking aids, visco-supplementation, and steroid injections

How well did you know this?

Not at all

Perfectly

What is the operative management for OA?

Total knee replacement (most common) - cruciate retaining (keep PCL)and sacrificing
Uni-compartmental - medial (more common) and lateral
Medial can be mobile or fixed bearing

How well did you know this?

Not at all

Perfectly

Describe the anterior cruciate ligament

32mm length x 7-12mm width
Runs from between tibial eminences to lateral wall of intercondylar notch of femur
Middle geniculate artery and posterior articular nerve

What is the function of the ACL?

Primary restraint to anterior translation of tibia relation to femur
Secondary restraint to tibial rotation and varus/ valgus stress

How does an ACL tear occur?

Non-contact pivot injury
More females to males - landing biomechanical and quad strength

How does an ACL tear present?

Heard a pop or crack
Immediate swelling - hemarthrosis
Unable to continue playing but can walk in straight line
Deep pain

What causes an ACL tear?

Bones of leg twist in opposite directions under full weight bearing - cruciate ligament tears

What is done during examination of ACL tear?

Look for effusion
Feel for tenderness
Move - Anterior draw (can see tibia translating on femur), Lachman’s test and pivot shift

What investigations are done for ACL tears?

X-ray - segond fracture (avulsion of anteriolateral ligament)
MRI - ACL, menisci and MCL

What is the non-operative treatment of ACL?

Focussed quadricep programme

What is the operative treatment for ACL tear?

ACL reconstruction
Possible partial menisctomy, ligament repair or augmentation
Hamstring graft

Describe the MCL

Superficial and deep medial collateral ligament Superficial is primary restraint to valgus stress Deep contributes in full knee extension

Describe MCL tear

Most common ligament injury Severe valgus stress - usually contact related Associated injuries - ACL tear and meniscal tear

What is the presentation of MCL tear?

heard a pop or crack Pain on medial side Unable to continue playing Bruising medial knee Localised swelling

What is done in examination for MCL tear?

Look for medial swelling and bruising Feel tender medial joint line and femoral insertion of MCL Move - painful in full extension and opening in valgus stress

What imaging is done for MCL tear?

X-ray - may be normal. Can have calcification at femoral insertion if taken after a long time MRI - modality of choice. Assess severity and injury

What is the non-operative treatment of MCL tear?

Majority treated this way Rest, NSAIDs, physio and brace for comfort

What is the operative treatment for MCL tear?

For severe tears and failed non-operative management Repair or reconstruction Repair avulsions and reconstruct damaged tissue

What is osteochondritis dissecans

Pathological lesion affecting articular cartilage and subchondral bone 2 forms - juvenile (10-15 yrs as growth plates still open) and adult

What is the cause of osteochondritis dissecans?

Hereditary, traumatic and vascular - adult form

What is the most common location of osteochondritis dissecans?

Knee - most common Posterolateral aspect of medial femoral condyle

What is the presentation of osteochondritis dissecans?

Activity related pain - poorly localised Recurrent effusions Mechanical symptoms - locking and block to full movement if fragment breaks

What examination is done for osteochondritis dissecans?

May be normal Look for effusion Feel for localised tenderness Move - stiffness, block to movement and Wilson's test (flex knee over bed then extend and internally rotate then pain)

What investigations are done for osteochondritis dissecans?

X-ray - add in tunnel view MRI - lesion size, status of cartilage and subchondral bone, and signal intensity (oedema suggests fragment)

What is the treatment for osteochondritis dissecans?

Restricted weight bearing and rom brace Arthroscopy (subchondral drilling and fixation of loose fragment) and open fixation