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MSK clinical > Orthopaedic knee conditions > Flashcards

Orthopaedic knee conditions Flashcards

1
Q

what is a classic manoeuvre which can cause a meniscal tear?

A

deep flexion with a twist

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2
Q

what investigations would you carry out to diagnose a meniscal tear?

A

history and examination
x-ray
MRI - most sensitive but a lot of false positives

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3
Q

what tests can be carried out on examination if you suspect meniscal tear?

A

McMurrays test
Fail deep squat - asymmetric
Thassaly’s test

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4
Q

what is the treatment for meniscal tears?

A

non-operative:

  • rest
  • NSAIDS
  • physiotherapy

operative:
- arthroscopy

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5
Q

what is the presentation of a meniscal tear?

A

pain (localised)
clicking
locking
intermittent swelling

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6
Q

what are the 2 types of meniscal tear?

A

acute:
- twisting in deep flexion

degenerative:
- osteoarthritis

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7
Q

what meniscal tear is more common?

A

medial because it is a more fixed structure compared to the lateral menisci

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8
Q

what is the function of the menisci?

A

shock absorption
aid in force transmission
stability
load distribution

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9
Q

what its he blood and nerve supply of the ACL?

A

blood:
- middle geniculate artery

nerve:
- posterior articular nerve (branch of tibial nerve)

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10
Q

how does ACL tears occur?

A

bad landing mechanics

non-contact pivot injury

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11
Q

what is the presentation of an ACL tear?

A

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

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12
Q

what tests are carried out during clinical examination if you suspect an ACL tear?

A

anterior draw
lachmann’s test
pivot shift (under anaesthetic)

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13
Q

what accompanying pathologies usually occur with an ACL tear?

A

lateral meniscal tear (50%) - acute ACL tear

medial meniscal secondary to shear from chronic instability

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14
Q

what is the treatment for ACL tear?

A

non-operative :
- focused quadricep programme to strengthen quads for compensation

operative:
- ACL reconstruction

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15
Q

what investigations would you carry out to help with diagnosis of ACL tear and why?

A

x-ray:
- segond fracture (avulsion fracture of anterolateral ligament)
MRI; view the ACL and menisci

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16
Q

how does a MCL tear occur?

A

severe valgus stress

usually contact related

17
Q

what are associated injuries with a MCL tear?

A

meniscal

ACL

18
Q

what is the presentation of a MCL tear?

A 
heard a "pop" or a "crack"
extreme pain in medial side- very localised 
bruising of medial knee
localised swelling 
unable to continue playing
19
Q

what are the signs on examination of a patient with a MCL tear?

A

look:
- medial rotation
- bruising

feel:

  • tender medial joint line
  • tender femoral insertion MCL

move:

  • painful in full extension
  • opening on valgus stress
20
Q

what is Pellegrini-Stieda?

A

calcification at femoral insertion of the middle collateral ligament
it is found on x-ray which suggests chronic injury to the MCL

21
Q

what are the treatments for a MCL tear?

A

non operative:

  • rest
  • NSAIDS
  • physiotherapy
  • brace

operative:
- reapir or reconstruction

22
Q

what is osteochondritis dissecans?

A

pathological lesion affecting articular cartilage and subchondral bone

23
Q

what are the causes of osteochondritis dissecans?

A

hereditary
traumatic
vascular (adult form)

24
Q

what is the presentation of osteochondritis dissecans?

A

activity related pain - poorly localised
recurrent effusions
mechanical symptoms: locking, block to full movement

25
Q

what are the clinical features during examination of a patient with osteochondritis dissecans?

A

look:
- effusion

feel:
- localised tenderness

move:

  • stiffness
  • block to movement
  • wilsons test
26
Q

what type of view on x-ray do you require to view osteochondritis dissecans?

A

tunnel view

27
Q

what is the treatment for osteochondritis dissecans?

A

non-operative:

  • restricted weight bearing
  • range of motion brace

operative:

  • arthroscopy
  • open fixation
28
Q

where does osteochondritis dissecans commonly affect?

A

knee is most common

- posterior aspect of femoral medial condyle

29
Q

what are the functions of the superficial and deep MCL’s?

A

superficial: restrains from valgus stress
deep: contributed to full extension

30
Q

what are the functions of the ACL?

A

primary restraint to anterior translation of the tibia relative to the femur
secondary restraint to tibial rotation and various/valgus stress

MSK clinical (25 decks)

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