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Year 2- MSK > Orthopaedic Knee Conditions > Flashcards

Orthopaedic Knee Conditions Flashcards

1
Q

Where does the lateral collateral ligament attach to and from?

A

From lateral epicondyle of femur to the tip of the fibula

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2
Q

Where does the medial collateral ligament attach to and from?

A

Originates from tibia
Inserts of proximal femur (not quite median epicondyle)

->has a deep and superficial layer

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3
Q

What are knee meniscii?

A

Specialised C-shaped cartilages which increase stability and spreads load on femur

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4
Q

What are the two instances in which the meniscus can tear?

A

Acute injury
Degenerative .g. osteoarthritis

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5
Q

What kind of motion injures the menisci in an acute injury?

A

Twisting motion, particularly when knee is in deep flexion

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6
Q

Which tears are more common; lateral or medial meniscal tears?

A

Medial meniscal tears

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7
Q

Presentation of meniscal tears?

A

Pain
Clicking
Locking
Intermittent swelling

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8
Q

Which people tend to get meniscal tears?

A

Younger people, usually under 40yrs for acute injuries
Older people for degenerative related tears

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9
Q

On MSK examination of someone with a meniscal tear, what will be seen in LOOK?

A

Effusion of knee (fluid accumulation in the intra-articular space and bursae of a joint)
Potentially wasting of the quadriceps

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10
Q

At which point in the FEEL part of the MSK examination would it be most tender in a meniscal tear?

A

Medial joint line at point of tear

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11
Q

Which two movement tests will be positive in a meniscal tear?

A

McMurrays test
Thassaly’s test

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12
Q

Investigations for a meniscal tear are not always necessary. However, which investigations may be done?

A

X-ray- exclude arthritis and fractures
MRI- more sensitive but high false positive rates

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13
Q

Meniscal tear location can be divided into red and white zones.
White zone?

A

No blood supply and unlikely to heal

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14
Q

Meniscal tear location can be divided into red and white zones.
Red zone?

A

Blood supply, more easily treated
Can be treated operatively to stitch the area and oppose tissues

->slow rehabilitation after with limited weight bearing

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15
Q

Not all meniscal tears require operations. What are some of the non-operative measures?

A

Rest
NSAIDs
Physiotherapy

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16
Q

What kind of operation takes place for meniscal tears?

A

Arthroscopy- repair and resection

->pretty specialised area of surgery, many don’t get operated on

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17
Q

Osteoarthritis?

A

Degenerative change to synovial joints, progressive loss of the articular cartilage with secondary bone changes

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18
Q

What is osteoarthritis characterised by?

A

Worsening pain and stiffness of affected joint limiting everyday life

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19
Q

Conservative treatment for osteoarthritis of the knee??

A

Weight loss- weight often causes osteoarthritis of knee as increased load
Analgesia
Activity modification
Braces- more active people
Walking aids
Steroid injections
Visco-supplementation- injections of hyaluronic acid, proved helpful in early degeneration of the knee

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20
Q

What is the problem with steroid injections and operations?

A

If operating after steroid injections in the last few months, much higher risk of infection

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21
Q

If a patient has OA in all three compartments of the knee; the medial, lateral and patella-femoral, what is the operative management?

A

Total knee replacement

->used in about 90% of patient (can be cruciate retaining or sacrificing)

22
Q

Uni compartmental knee replacements come and go with popularity.
However, which compartment replacement is most common?

A

Medial knee replacement

23
Q

Blood supply of the anterior cruciate ligament?

A

Middle geniculate artery

24
Q

Innevertaion of anterior cruciate ligament?

A

Posterior articular nerve, a branch of the posterior articular nerve

25
Q

Function of the anterior cruciate ligament?

A

Primary restraint to anterior translation of the tibia relative to the femur
Secondary restraint to tibial rotation

26
Q

How does an ACL tear usually occur?

A

Non-contact pivot injury
More common in females

27
Q

Presentation of ACL tear?

A

Patient heard a ‘pop’ or ‘crack’
Immediate swelling (
++)
Unable to continue playing (if injured during a match) but can walk in a straight line- twisting pain
Deep pain

28
Q

In an MSK examination, what is seen on the LOOK part in an ACL tear?

A

Effusion (/swelling) if recent injury

29
Q

What test is positive in MOVE of an ACL tear?

A

Anterior draw test
Lachmann’s test

30
Q

Investigations for ACL tear?

A

X-ray- looks for a segmond fracture and avulsion # of anterolateral ligament
MRI- to identify any associated injuries

31
Q

Conservative management of an ACL tear?

A

All get focussed quadricep therapy programme to help them to decide what they want to do next e.g. will they continue with contact sports etc

32
Q

Operative management of ACL tear?

A

ACL reconstruction

33
Q

What is the most common knee ligament injury?

A

Medial collateral ligament

34
Q

What type of injury is a MCL tear usually?

A

Usually contact related, severe valgus stress

35
Q

What are some of the associated injuries of a MCL tear?

A

ACL tear
Meniscal tear

36
Q

What would be seen on a MSK examination of a MCL tear?

A

Medial swelling
Bruising

37
Q

Where would feel tender on an MSK examination of a MCL tear?

A

Medial joint line
Femoral insertion of the MCL

38
Q

When would be painful during the MOVE section of an MSK examination for a MCL tear?

A

Painful in full extension

39
Q

Investigations for MCL tear?

A

X-ray- to exclude bony injuries
MRI- modality of choice, assess location and severity

40
Q

Non-operative treatment of MCL tear is the usual treatment for the majority. What is involved?

A

Rest
NSAIDs
Physio
Brace for comfort

41
Q

Small number of MCL tear cases require operations, in severe cases or when they have not responded to alternative management. What is involved~?

A

Repair (avulsion) or reconstruction (damaged tissue)

42
Q

Osteochondritis dissecans?

A

Pathological lesion affecting the articular cartilage and subchondral bone

43
Q

Two forms of osteochondiritis dissecans?

A

Juvenile; 10-15yrs while the growth plates are still open
Adult

44
Q

Cause of osteochondiritis dissecans?

A

`Not really known- hereditary, traumatic, vascular

45
Q

Where is the most common location of osteochondiritis dissecans?

A

Knee (posterolateral aspect of medial femoral condyle)

46
Q

Presentation of osteochondiritis dissecans?

A

Activity related pain, poorly localised
Recurrent effusions
Mechanical symptoms e.g. locking

47
Q

Examination of osteochondiritis dissecans might be normal but what may be seen on LOOK?

A

Effusion

48
Q

Investigations for osteochondiritis dissecans?

A

X-ray
MRI- lesion size, status or cartilage and subchondral bone

49
Q

Non-operative treatment of osteochondiritis dissecans?

A

Restricted weight-bearing
ROM brace

50
Q

Operative management of osteochondiritis dissecans?

A

Arthroscopy- subchondral drilling and fixation of the loose fragment
Open fixation

51
Q

Girl, what actually is arthroscopy?

A

Keyhole surgery for checking and repairing joints x

52
Q
A

Year 2- MSK (36 decks)

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