Orthopaedic Knee Conditions Flashcards
Where does the lateral collateral ligament attach to and from?
From lateral epicondyle of femur to the tip of the fibula
Where does the medial collateral ligament attach to and from?
Originates from tibia
Inserts of proximal femur (not quite median epicondyle)
->has a deep and superficial layer
What are knee meniscii?
Specialised C-shaped cartilages which increase stability and spreads load on femur
What are the two instances in which the meniscus can tear?
Acute injury
Degenerative .g. osteoarthritis
What kind of motion injures the menisci in an acute injury?
Twisting motion, particularly when knee is in deep flexion
Which tears are more common; lateral or medial meniscal tears?
Medial meniscal tears
Presentation of meniscal tears?
Pain
Clicking
Locking
Intermittent swelling
Which people tend to get meniscal tears?
Younger people, usually under 40yrs for acute injuries
Older people for degenerative related tears
On MSK examination of someone with a meniscal tear, what will be seen in LOOK?
Effusion of knee (fluid accumulation in the intra-articular space and bursae of a joint)
Potentially wasting of the quadriceps
At which point in the FEEL part of the MSK examination would it be most tender in a meniscal tear?
Medial joint line at point of tear
Which two movement tests will be positive in a meniscal tear?
McMurrays test
Thassaly’s test
Investigations for a meniscal tear are not always necessary. However, which investigations may be done?
X-ray- exclude arthritis and fractures
MRI- more sensitive but high false positive rates
Meniscal tear location can be divided into red and white zones.
White zone?
No blood supply and unlikely to heal
Meniscal tear location can be divided into red and white zones.
Red zone?
Blood supply, more easily treated
Can be treated operatively to stitch the area and oppose tissues
->slow rehabilitation after with limited weight bearing
Not all meniscal tears require operations. What are some of the non-operative measures?
Rest
NSAIDs
Physiotherapy
What kind of operation takes place for meniscal tears?
Arthroscopy- repair and resection
->pretty specialised area of surgery, many don’t get operated on
Osteoarthritis?
Degenerative change to synovial joints, progressive loss of the articular cartilage with secondary bone changes
What is osteoarthritis characterised by?
Worsening pain and stiffness of affected joint limiting everyday life
Conservative treatment for osteoarthritis of the knee??
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
What is the problem with steroid injections and operations?
If operating after steroid injections in the last few months, much higher risk of infection
If a patient has OA in all three compartments of the knee; the medial, lateral and patella-femoral, what is the operative management?
Total knee replacement
->used in about 90% of patient (can be cruciate retaining or sacrificing)
Uni compartmental knee replacements come and go with popularity.
However, which compartment replacement is most common?
Medial knee replacement
Blood supply of the anterior cruciate ligament?
Middle geniculate artery
Innevertaion of anterior cruciate ligament?
Posterior articular nerve, a branch of the posterior articular nerve
Function of the anterior cruciate ligament?
Primary restraint to anterior translation of the tibia relative to the femur
Secondary restraint to tibial rotation
How does an ACL tear usually occur?
Non-contact pivot injury
More common in females
Presentation of ACL tear?
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
In an MSK examination, what is seen on the LOOK part in an ACL tear?
Effusion (/swelling) if recent injury
What test is positive in MOVE of an ACL tear?
Anterior draw test
Lachmann’s test
Investigations for ACL tear?
X-ray- looks for a segmond fracture and avulsion # of anterolateral ligament
MRI- to identify any associated injuries
Conservative management of an ACL tear?
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
Operative management of ACL tear?
ACL reconstruction
What is the most common knee ligament injury?
Medial collateral ligament
What type of injury is a MCL tear usually?
Usually contact related, severe valgus stress
What are some of the associated injuries of a MCL tear?
ACL tear
Meniscal tear
What would be seen on a MSK examination of a MCL tear?
Medial swelling
Bruising
Where would feel tender on an MSK examination of a MCL tear?
Medial joint line
Femoral insertion of the MCL
When would be painful during the MOVE section of an MSK examination for a MCL tear?
Painful in full extension
Investigations for MCL tear?
X-ray- to exclude bony injuries
MRI- modality of choice, assess location and severity
Non-operative treatment of MCL tear is the usual treatment for the majority. What is involved?
Rest
NSAIDs
Physio
Brace for comfort
Small number of MCL tear cases require operations, in severe cases or when they have not responded to alternative management. What is involved~?
Repair (avulsion) or reconstruction (damaged tissue)
Osteochondritis dissecans?
Pathological lesion affecting the articular cartilage and subchondral bone
Two forms of osteochondiritis dissecans?
Juvenile; 10-15yrs while the growth plates are still open
Adult
Cause of osteochondiritis dissecans?
`Not really known- hereditary, traumatic, vascular
Where is the most common location of osteochondiritis dissecans?
Knee (posterolateral aspect of medial femoral condyle)
Presentation of osteochondiritis dissecans?
Activity related pain, poorly localised
Recurrent effusions
Mechanical symptoms e.g. locking
Examination of osteochondiritis dissecans might be normal but what may be seen on LOOK?
Effusion
Investigations for osteochondiritis dissecans?
X-ray
MRI- lesion size, status or cartilage and subchondral bone
Non-operative treatment of osteochondiritis dissecans?
Restricted weight-bearing
ROM brace
Operative management of osteochondiritis dissecans?
Arthroscopy- subchondral drilling and fixation of the loose fragment
Open fixation
Girl, what actually is arthroscopy?
Keyhole surgery for checking and repairing joints x
