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MSK > Orthopaedic Knee Conditions > Flashcards

Orthopaedic Knee Conditions Flashcards

1
Q

Meniscal tear causes

A
  • Acute
    • Twisting especially in deep flexion
  • Degenerative
    • Osteoarthritis
  • Medial meniscal tears more common
    • More fixed structure
  • Unlikely to heal
    • Poor blood supply
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2
Q

Meniscal Tear Presentation

A
  • Pain
  • Clicking
  • Locking
  • Intermittent swelling
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3
Q

Meniscal tear examination look

A

effusion

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4
Q

Meniscal tear examination feel

A

tender joint line at point of tear

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5
Q

Meniscal tear examination move

A
  • mechanical block to movement
  • McMurrays test positive
  • fail deep squat
  • Thessalays test positive
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6
Q

Meniscal tear investigations

A
  • X-Ray
    • arthritis
    • fractures
  • MRI
    • more sensitive test
    • high false positive rate
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7
Q

Meniscal tear non-operative treatment

A
  • Rest
  • NSAIDs
  • Physiotherapy
  • Hamstring and Quadriceps strengthening
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8
Q

Meniscal tear operative treatment

A
  • arthroscopy
    • repair
    • resection
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9
Q

ACL position

A

runs from between tibial eminences to lateral wall of intercondylar notch of femur

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10
Q

ACL blood supply

A

middle geniculate artery

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11
Q

ACL innervation

A
  • posterior articulate nerve
    • branch of tibial nerve
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12
Q

ACL function

A

primary restraint to anterior translation of the tibia relative to femur

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13
Q

ACL tear cause and female:male ratio

A
  • non-contact pivot injury
  • females:male 4.5:1
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14
Q

ACL tear presentation

A
  • heard a ‘pop’
  • immediate swelling
    • haemarthrosis
  • unable to continue playing
    • can walk in a straight line
  • deep pain
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15
Q

ACL tear examination look

A

effusion (if recent injury)

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16
Q

ACL tear examination move

A
  • Anterior draw
  • Lachmann’s test
  • Pivot shift
    • Best done under anaesthetic
17
Q

ACL tear investigations

A
  • X-ray
    • Segond fracture
    • Avulsion # of anterolateral ligament
  • MRI
    • ACL
    • Meniscii
      • Lateral – simultaneous with acl tear (48%)
      • Medial – secondary to shear from chronic instability
    • MCL
18
Q

ACL tear non-operative treatment

A

focussed quadriceps programme

19
Q

ACL tear operative treatment

A
  • ACL reconstruction
    • +/- partial menisectomy +/- ligament repair or augmentation
    • hamstring graft
20
Q

Superficial and deep MCL function

A
  • superficial - primary restraint to valgus stress
  • deep - contributes to full knee extension
21
Q

MCL tear pathology and associated injuries

A
  • severe valgus stress
    • usually contact related
  • associated injuries
    • ACL tear
    • Meniscal tear
22
Q

MCL tear examination look

A
  • medial swelling
  • bruising
23
Q

MCL tear examination feel

A
  • tender medial joint line
  • tender femoral insertion of MCL
24
Q

MCL tear examination move

A
  • painful in full extension
  • opening on valgus stress
25
Q

MCL tear investigations

A
  • X-Ray
    • may be normal
    • calcification at femoral insertion - chronic injury
  • MRI
    • modality of choice
    • assess location and severity of injury
    • identify other pathologies
26
Q

MCL tear non-operative treatment

A
  • Majority
  • Rest, NSAIDs
  • Physiotherapy
  • Brace for comfort
27
Q

MCL tear operative treatment

A
  • severe tears
  • failed non-operative management
  • repair or reconstruction
    • repair: avulsions
    • reconstruction: damaged tissue
28
Q

Osteochondritis dissicans

A
  • pathological lesion affecting articular cartilage and subchondral bone
  • 2 forms
    • juvenile -10-15 years - while growth plates still open
    • adult
29
Q

Osteochondritis dissicans cause

A
  • hereditary
  • traumatic
  • vascular
    • adult form
30
Q

Osteochondritis dissicans presentation

A
  • Activity-related Pain
    • Poorly localised
  • Recurrent effusions
  • Mechanical symptoms
    • Locking
    • block to full movement
31
Q

Osteochondritis dissicans examination look

A

effusion

32
Q

Osteochondritis dissicans examination feel

A

localised tenderness

33
Q

Osteochondritis dissicans examination move

A
  • stiffness
  • block to movement
  • Wilson’s test
34
Q

Osteochondritis dissicans investigations

A
  • X-Ray
    • Add in tunnel view (flexed 30-50 deg)
  • MRI
    • Lesion size
    • Status of cartilage and subchondral bone
    • Signal intensity
      • Oedema suggests instability of fragment
35
Q

Osteochondritis dissicans non-operative treatment

A
  • restricted weight bearing
  • rom brace
36
Q

Osteochondritis dissicans operative treatment

A
  • Arthroscopy
    • Subchondral drilling
    • Fixation of loose fragment
  • Open fixation

MSK (24 decks)

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