Orthopaedic Knee Conditions Flashcards
Meniscal tear causes
- Acute
- Twisting especially in deep flexion
- Degenerative
- Osteoarthritis
- Medial meniscal tears more common
- More fixed structure
- Unlikely to heal
- Poor blood supply
Meniscal Tear Presentation
- Pain
- Clicking
- Locking
- Intermittent swelling
Meniscal tear examination look
effusion
Meniscal tear examination feel
tender joint line at point of tear
Meniscal tear examination move
- mechanical block to movement
- McMurrays test positive
- fail deep squat
- Thessalays test positive
Meniscal tear investigations
- X-Ray
- arthritis
- fractures
- MRI
- more sensitive test
- high false positive rate
Meniscal tear non-operative treatment
- Rest
- NSAIDs
- Physiotherapy
- Hamstring and Quadriceps strengthening
Meniscal tear operative treatment
- arthroscopy
- repair
- resection
ACL position
runs from between tibial eminences to lateral wall of intercondylar notch of femur
ACL blood supply
middle geniculate artery
ACL innervation
- posterior articulate nerve
- branch of tibial nerve
ACL function
primary restraint to anterior translation of the tibia relative to femur
ACL tear cause and female:male ratio
- non-contact pivot injury
- females:male 4.5:1
ACL tear presentation
- heard a ‘pop’
- immediate swelling
- haemarthrosis
- unable to continue playing
- can walk in a straight line
- deep pain
ACL tear examination look
effusion (if recent injury)
ACL tear examination move
- Anterior draw
- Lachmann’s test
- Pivot shift
- Best done under anaesthetic
ACL tear investigations
- 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
ACL tear non-operative treatment
focussed quadriceps programme
ACL tear operative treatment
- ACL reconstruction
- +/- partial menisectomy +/- ligament repair or augmentation
- hamstring graft
Superficial and deep MCL function
- superficial - primary restraint to valgus stress
- deep - contributes to full knee extension
MCL tear pathology and associated injuries
- severe valgus stress
- usually contact related
- associated injuries
- ACL tear
- Meniscal tear
MCL tear examination look
- medial swelling
- bruising
MCL tear examination feel
- tender medial joint line
- tender femoral insertion of MCL
MCL tear examination move
- painful in full extension
- opening on valgus stress
MCL tear investigations
- X-Ray
- may be normal
- calcification at femoral insertion - chronic injury
- MRI
- modality of choice
- assess location and severity of injury
- identify other pathologies
MCL tear non-operative treatment
- Majority
- Rest, NSAIDs
- Physiotherapy
- Brace for comfort
MCL tear operative treatment
- severe tears
- failed non-operative management
- repair or reconstruction
- repair: avulsions
- reconstruction: damaged tissue
Osteochondritis dissicans
- pathological lesion affecting articular cartilage and subchondral bone
- 2 forms
- juvenile -10-15 years - while growth plates still open
- adult
Osteochondritis dissicans cause
- hereditary
- traumatic
- vascular
- adult form
Osteochondritis dissicans presentation
- Activity-related Pain
- Poorly localised
- Recurrent effusions
- Mechanical symptoms
- Locking
- block to full movement
Osteochondritis dissicans examination look
effusion
Osteochondritis dissicans examination feel
localised tenderness
Osteochondritis dissicans examination move
- stiffness
- block to movement
- Wilson’s test
Osteochondritis dissicans investigations
- 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
Osteochondritis dissicans non-operative treatment
- restricted weight bearing
- rom brace
Osteochondritis dissicans operative treatment
- Arthroscopy
- Subchondral drilling
- Fixation of loose fragment
- Open fixation
