Orthopaedic knee conditions

Question 1

What do MCL and LCL stand for?

Answer 1

Middle Collateral and Lateral Collateral Ligament

Question 2

What do ACL and PCL stand for?

Answer 2

Anterior Cruciate Ligament

Posterior Cruciate Ligament

Question 3

Which ligament is the meniscus attached to?

Answer 3

Deep MCL

Question 4

What do meniscii do?

Answer 4

Aid force transmission

Increase stability

Question 5

What is the usual cause of acute meniscal tears?

Answer 5

Twisting

Especially in deep flexion

Question 6

What causes degenerative meniscal tears?

Answer 6

Osteoarthritis

Question 7

Is it more common for the medial or lateral meniscus to tear?

Answer 7

Medial

More fixed structure

Question 8

How do meniscal tears present?

Answer 8

Pain
Clicking
Locking
Intermittent swelling

Question 9

What is a symptom of meniscal tear which may be visible on inspection?

Answer 9

Effusion

Question 10

What are some possible examination findings for meniscal tears?

Answer 10

Tender joint line at tear
Mechanical block
McMurray and Thessaly tests positive
Fail deep squat

Question 11

What is the most sensitive test meniscal tear?

Answer 11

MRI

Question 12

What is a drawback of MRI for meniscal tear imaging?

Answer 12

High false positive rate

Question 13

Which imaging technique is better for arthritis and fracture?

Answer 13

X-ray

Question 14

How are meniscal tears managed?

Answer 14

Unlikely to heal due to poor blood supply
Rest
NSAIDs
Physio

Question 15

What are the main aims for physio in meniscal tears?

Answer 15

Hamstring and quadriceps strengthening

Question 16

Where does the ACL run?

Answer 16

From tibial eminences to lateral wall of intercondylar notch of femur

Question 17

What is the blood supply of the ACL?

Answer 17

Middle geniculate artery

Question 18

What is the innervation of the ACL?

Answer 18

Posterior articular nerve

Branch of tibial nerve

Question 19

What are the functions of the ACL?

Answer 19

Primary restraint to anterior translation of the tibia relative to femur
Secondary restraint to tibial rotation and varus/valgus stress

Question 20

Do ACL tears have immediate swelling?

Answer 20

Yes

Question 21

What test is useful for diagnosing ACL tear?

Answer 21

Lachman’s

Question 22

What are some treatment options for ACL tear?

Answer 22

Focussed quadricep programme

ACL reconstruction

Question 23

What is the function of the superficial MCL?

Answer 23

Primary restraint to valgus stress

Question 24

What are the functions of the deep MCL?

Answer 24

Contributes in full knee extension

Question 25

Why does the MCL usually tear?

Answer 25

Severe valgus stress

Question 26

What is the most common ligament injury of the knee?

Answer 26

MCL tear

Question 27

How does an MCl tear present?

Answer 27

Heard a pop or crack
Pain and bruising medially, tender
Localised swelling
Painful on full extension

Question 28

What is the modality of choice for MCL tear?

Answer 28

MRI

Question 29

What is a possible x-ray finding in mcl tears?

Answer 29

Calcification at femoral insertion

Question 30

How do we treat MCL tears?

Answer 30

Rest
NSAIDs
Physio
Brace

Question 31

What is osteochondritis dissecans?

Answer 31

Pathological lesion affecting articular cartilage and subchondral bone

Question 32

How does osteochondritis dissecans present?

Answer 32

Poorly localised pain with activity
Recurrent effusions
Locking
Block to full movement

Question 33

What is a good test for Osteochondritis dissecans?

Answer 33

Internal rotation causes impingement of the tibial eminence on the OCD lesion