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
