Orthopaedic Knee Conditions Flashcards
What is the aetiology of meniscal tear?
- Acute
- Twisting especially during flexion
- Degenerative
- Osteoarthritis
Is medial or lateral meniscal tear more common?
Medial
What is the presentation of meniscal tear?
- Symptoms
- Pain
- Clocking
- Locking
- Intermittent swelling
- Signs
- Effusion
- Tender joint
- McMurrays test positive
- Fail deep squat
- Thassaly’s test position
What investigations are done for meniscal tear?
- X-ray
- To exclude arthritis, fracture
- MRI
- Most sensitive test
- High false positive rate
What is the treatment for meniscal tear?
- Unlikely to heal due to poor blood supply
- Non-operative
- Rest
- NSAIDs
- Physiotherapy
- Hamstring and quadriceps strengthening
- Operative
- Arthroscopy
- Repair
- Resection
- Arthroscopy
Describe the pathophysiology of OA of the knee?
- Degenerative change of synovial joints
- Progressive loss of articular cartilage
- Secondary bony changes
What is the presentation of OA of the knee?
- Pain and stiffness of joint is characteristic
What is the mangement for OA of the knee?
- Conservative
- Weight loss
- Analgesia
- Activity modification
- Braces
- Walking aids
- Steroid injection
- Operative
- Total knee replacement
- Cruciate retaining
- Cruciate sacrificing
- Uni-compartmental knee replacement
- Medial (most common)
- Lateral
- Patello-femoral
- Total knee replacement
Describe the anatomy of the ACT in terms of where it runs between, blood supply and innervation?
- Runs between tibial eminences to lateral wall of intercondylar notch of femur
- Blood supply is middle geniculate artery
- Innervation is posterior articular nerve (branch of tibial nerve)
What is the blood supply of the ACT?
Middle genticulate artery
What is the innvervation of the ACT?
Posterior articular nerve (branch of tibial nerve)
What is the function of the ACT?
- Primary restrain to anterior translation of tibia relative to femur
- Secondary restraint to tibial rotation and vargus/valgus stress
What is the aetiology of ACT injury?
- Non-contact pivot injury
Describe the epidemiology of ACT injury in terms of sex?
- F:M 4.5:1
What is the presentation of ACT injury?
- Heard a pop or crack
- Immediate swelling (70%)
- Unable to continue playing
- Deep pain
- Signs
- Effusion
- Anterior draw test positive
- Lachmann’s test positive
- Pivot shift test positive
What investigations are done for ACT injury?
- X-ray
- Secondary fracture
- MRI
- Look at ACL
- Look at menisci
- Lateral tear simultaneous with ACL tear half the time
- Medial tear occurs secondary to chronic instability
What is the treatment for ACT injury?
- Non-operative
- Focused quadriceps programme
- Operative
- ACL reconstruction
What are the functions of the superficial and deep MCL?
- Superficial
- Primary restrain to vulgus stress
- Deep
- Contributes in full knee extension
- Attaches to medial meniscus, continuous with joint capsule
What is the presentation of MCL injury?
- Heard a pop or crack
- Pain
- Medial side
- Unable to continue playing
- Bruising medial knee
- Localised swelling
What investigations are done for MCL injury?
- X-ray
- MRI
- Modality of choice
- Assess location and severity of injury
What is the treatment for MCL injury?
- Non-operative
- Majority of treatment
- Rest
- NSAIDs
- Analgesia
- Physiotherapy
- Brace
- Operative
- For severe tears when non-operative management has failed
- Repair or reconstruction
- Repair – avulstions
- Reconstruction – damaged tissue
What is osteochondritis dissecans?
Pathological lesion affecting articular cartilage and subchondral bone
What are the 2 forms of osteochondritis dissecans?
- Juvenile
- 10-15 years while growth plates still open
- Adult
What is the aetiology of osteochondritis dissecans?
- Hereditary
- Traumatic
- Vascular
- Adult form
What is the most common location of osteochondritis dissecans?
- Knee most common location
- Posteriolateral aspect of medial femoral condyle
What is the presentation of osteochondritis dissecans?
- Activity related pain
- Poorly localised
- Recurrent effusions
- Mechanical symptoms
- Locking
- Block to full movement
What investigations are done for osteochondritis dissecans?
- X-ray
- Add in tunnel view (flexed 30-50o)
- MRI
- Lesion size
- Status of cartilage and subchondral bone
What is the treatment of osteochonditis dissecans?
- Non-operative
- Restricted weight-bearing
- ROM brace
- Operative
- Arthroscopy
- Subchondral drilling
- Fixation of loose fragments
- Open fixation
- Arthroscopy
