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MSK > Orthopaedic Knee Conditions > Flashcards

Orthopaedic Knee Conditions Flashcards

1
Q

What are the bony structures that form the knee?

A

Femur: medial and lateral condyles

Tibia: tibial plateau

Patella: sesamoid bone

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2
Q

What are the collateral ligaments of the knee? Where does each attach?

A

lateral collateral ligament: tip of fibula to the lateral condyle of the femur

Medial collateral ligament: originates from tibia and inserts on proximal portion of the medial condyle of the femur

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3
Q

Which of the collateral ligaments is attached to its corresponding meniscus?

A

The medial collateral ligament is attached to the medial meniscus

The LCL and lateral meniscus aren’t attached

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4
Q

What are the cruciate ligaments of the knee? Where does each attach?

A

ACL: originates at intercondylar eminence of the tibia and inserts on the medial aspect of the lateral femoral condyle

PCL: originates on the medial femoral condyle and inserts onto the posterior tibia

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5
Q

Describe the structure of the meniscii

A

C-shaped cartilage

  • Triangular in cross-section: medial side thin, lateral edge wide. Results in more stability on flat tibial plateau

coronary ligaments on both meniscii (attach meniscii to joint capsule of the knee)

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6
Q

What are the common causes of meniscal tears? Which meniscii is more vulnerable to being torn?

A

Acute: twisting of knee esp. during flexion (< 40yrs)
Degenerative: osteoarthritis (60+)

Medial meniscus tears more common, probably due to more fixed shape / position

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7
Q

What are the symptoms of a meniscal tear?

A
  • Pain
  • Clicking
  • Locking
  • Intermittent swelling
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8
Q

What are some clinical signs on examination that are suggestive of a meniscal tear?

A
  • Mechanical block to movement
  • McMurrays test positive: bend knee and rotate foot, clicking / pain?
  • Thassaly’s test positive: partially bent knee standing on that leg, rotate knee internally & externally. Pain should be on rotation to side of injured meniscus
  • Patient fails to deep squat
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9
Q

Investigations for suspected meniscal tear?

A
  • X-Ray: exclude arthritis / fracture

- MRI: white line within meniscus indicates tearing, high false positive rate but good sensitivity

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10
Q

How does the location of a meniscal tear influence its ability to heal?

A

The meniscus is separated into a lateral 1/3 (red zone) that is quite well perfused, and a medial 2/3 (white zone) that has limited blood supply

If the tear is more lateral, it is more likely to heal due to better perfusion

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11
Q

Non-operative options for meniscal tear treatment?

A
  • Rest
  • NSAIDs
  • Physiotherapy (quad & hamstrings strengthening)
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12
Q

What type of surgery is done to repair meniscal tears?

A

Arthroscopy (repair / resection)

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13
Q

How does osteoarthritis of the knee tend to present?

A

Progressive pain and stiffness of the affected joint

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14
Q

What are some non-operative treatment options for osteoarthritis of the knee?

A
  • Weight loss
  • Analgesics
  • Activity modification
  • Braces / walking aids
  • Visco-supplementation (hyaluronic acid)
  • Steroid injections
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15
Q

Types of knee surgery that can be used to treat osteoarthritis?

A

Total Knee Replacement: (90%)

  • cruciate retaining total knee replacement (retains the PCL)
  • Cruciate sacrificing TKR

Uni-compartmental surgery:

  • medial condyle (most common)
  • Lateral
  • Patello-femoral
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16
Q

Describe the anatomy (attachments / blood supply / innervation) of the ACL

A
  • Originates between tibial eminences, inserts on lateral wall of intercondylar notch of femur
  • Middle geniculate artery
  • Posterior articular nerve (branch of tibial n.)
17
Q

What movements does the ACL protect against? (function of ACL?)

A
  • Restrains anterior movement of tibia relative to femur

- Restrains tibial rotation & varus/valgus stress

18
Q

Which gender gets more ACL injuries? What type of action usually produces an ACL injury?

A

Females (4.5 : 1 )

  • Non-contact pivot injury
19
Q

How does an ACL injury tend to present?

A
  • Patient heard a “pop” or “crack”
  • Immediate swelling of joint (haemarthrosis)
  • Unable to continue playing the sport. Rest for a few months then can walk normally. Movements involving twisting / turning of knee cause instability / pain
20
Q

What signs should be looked for on clinical examination of a ACL tear?

A
  • Looks for effusion
  • Positive anterior draw test
  • Positive Lachmann’s test
  • Positive pivot shift test
21
Q

Investigations for suspected ACL tear?

A
  • X-Ray: secondary fractures

MRI:

  • ACL
  • Meniscii (lateral meniscal injury common)
  • MCL
22
Q

What are the treatment options for ACL tears?

A

Non-operative:
- Focused quadriceps programme

Operative:
- ACL reconstruction (usually via hamstring / patella tendon graft)

23
Q

Describe the structure and function of the MCL

A

2 layers: superficial and deep MCL

  • Superficial: primary restraint to valgus stress
  • Deep: contributes to full knee extension. Attaches to medial meniscus & is continuous with the joint capsule
24
Q

Presentation of MCL tear?

A
  • Patient heard a pop / crack
  • Pain (esp on medial side)
  • Unable to continue playing
  • Brusing of medial knee and localized sweeling
  • No haemarthrosis (bleeding in joint capsule)
25
Q

Signs of MCL tear on clinical examination?

A
  • Medial swelling / bruising
  • Tenderness at femoral insertion of MCL
  • Painful movement in full extension
  • Opening on valgus stress
26
Q

Investigations for suspected MCL tear?

A

X-ray

  • Exclude other bony injury
  • Pellegrini-Stieda: calcification at femoral insertion after injury can indicate chronic damage to MCL

MRI
- gold standard, info about severity and location of injury

27
Q

How are most MCL tears treated?

A

Conservatively:

  • Rest / NSAIDs
  • Physiotherapy
  • Braces

In severe tears or tears that resist treatment there can be operative management

28
Q

What is osteochondritis dissecans? Where does it most commonly occur?

A

Lesion affecting articular cartilage and the subchondral bone. Necrosis of the cartilage and bone, bone may break off

  • Due to interruption of vascular supply to cartilage and bone
  • Most commonly seen on posterolateral aspect of the medial femoral condyle
29
Q

Presentation of osteochondritis dissecans?

A
  • Activity related pain (poorly localized)
  • Recurrent effusions
  • May have localized tenderness
  • Mechanical symptoms if affected bone breaks off into the joint space: locking / block to full movement
30
Q

Investigations for osteochondritis dissecans?

A

X-Ray
- Loose bone fragment?

MRI

  • lesion size, status of bone & cartilage
  • Oedema? may suggest instability of bone fragment
31
Q

Treatment options for osteochondritis dissecans?

A

Non-operative:
- Restricted weight bearing & ROM brace

Operative:

  • Arthroscopy: subchondral drilling & loose fragment fixation
  • Open fixation

MSK (43 decks)

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