Orthopaedic knee conditions Flashcards
what is a classic manoeuvre which can cause a meniscal tear?
deep flexion with a twist
what investigations would you carry out to diagnose a meniscal tear?
history and examination
x-ray
MRI - most sensitive but a lot of false positives
what tests can be carried out on examination if you suspect meniscal tear?
McMurrays test
Fail deep squat - asymmetric
Thassaly’s test
what is the treatment for meniscal tears?
non-operative:
- rest
- NSAIDS
- physiotherapy
operative:
- arthroscopy
what is the presentation of a meniscal tear?
pain (localised)
clicking
locking
intermittent swelling
what are the 2 types of meniscal tear?
acute:
- twisting in deep flexion
degenerative:
- osteoarthritis
what meniscal tear is more common?
medial because it is a more fixed structure compared to the lateral menisci
what is the function of the menisci?
shock absorption
aid in force transmission
stability
load distribution
what its he blood and nerve supply of the ACL?
blood:
- middle geniculate artery
nerve:
- posterior articular nerve (branch of tibial nerve)
how does ACL tears occur?
bad landing mechanics
non-contact pivot injury
what is the presentation of an ACL tear?
heard a ‘pop’ or a ‘crack’
immediate swelling (haemarthrosis)
continue playing, they are able to walk in a straight line (off the pitch)
deep pain
what tests are carried out during clinical examination if you suspect an ACL tear?
anterior draw
lachmann’s test
pivot shift (under anaesthetic)
what accompanying pathologies usually occur with an ACL tear?
lateral meniscal tear (50%) - acute ACL tear
medial meniscal secondary to shear from chronic instability
what is the treatment for ACL tear?
non-operative :
- focused quadricep programme to strengthen quads for compensation
operative:
- ACL reconstruction
what investigations would you carry out to help with diagnosis of ACL tear and why?
x-ray:
- segond fracture (avulsion fracture of anterolateral ligament)
MRI; view the ACL and menisci
how does a MCL tear occur?
severe valgus stress
usually contact related
what are associated injuries with a MCL tear?
meniscal
ACL
what is the presentation of a MCL tear?
heard a "pop" or a "crack" extreme pain in medial side- very localised bruising of medial knee localised swelling unable to continue playing
what are the signs on examination of a patient with a MCL tear?
look:
- medial rotation
- bruising
feel:
- tender medial joint line
- tender femoral insertion MCL
move:
- painful in full extension
- opening on valgus stress
what is Pellegrini-Stieda?
calcification at femoral insertion of the middle collateral ligament
it is found on x-ray which suggests chronic injury to the MCL
what are the treatments for a MCL tear?
non operative:
- rest
- NSAIDS
- physiotherapy
- brace
operative:
- reapir or reconstruction
what is osteochondritis dissecans?
pathological lesion affecting articular cartilage and subchondral bone
what are the causes of osteochondritis dissecans?
hereditary
traumatic
vascular (adult form)
what is the presentation of osteochondritis dissecans?
activity related pain - poorly localised
recurrent effusions
mechanical symptoms: locking, block to full movement
what are the clinical features during examination of a patient with osteochondritis dissecans?
look:
- effusion
feel:
- localised tenderness
move:
- stiffness
- block to movement
- wilsons test
what type of view on x-ray do you require to view osteochondritis dissecans?
tunnel view
what is the treatment for osteochondritis dissecans?
non-operative:
- restricted weight bearing
- range of motion brace
operative:
- arthroscopy
- open fixation
where does osteochondritis dissecans commonly affect?
knee is most common
- posterior aspect of femoral medial condyle
what are the functions of the superficial and deep MCL’s?
superficial: restrains from valgus stress
deep: contributed to full extension
what are the functions of the ACL?
primary restraint to anterior translation of the tibia relative to the femur
secondary restraint to tibial rotation and various/valgus stress
