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