Orthopaedic knee conditions Flashcards
What do MCL and LCL stand for?
Middle Collateral and Lateral Collateral Ligament
What do ACL and PCL stand for?
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Which ligament is the meniscus attached to?
Deep MCL
What do meniscii do?
Aid force transmission
Increase stability
What is the usual cause of acute meniscal tears?
Twisting
Especially in deep flexion
What causes degenerative meniscal tears?
Osteoarthritis
Is it more common for the medial or lateral meniscus to tear?
Medial
More fixed structure
How do meniscal tears present?
Pain
Clicking
Locking
Intermittent swelling
What is a symptom of meniscal tear which may be visible on inspection?
Effusion
What are some possible examination findings for meniscal tears?
Tender joint line at tear
Mechanical block
McMurray and Thessaly tests positive
Fail deep squat
What is the most sensitive test meniscal tear?
MRI
What is a drawback of MRI for meniscal tear imaging?
High false positive rate
Which imaging technique is better for arthritis and fracture?
X-ray
How are meniscal tears managed?
Unlikely to heal due to poor blood supply
Rest
NSAIDs
Physio
What are the main aims for physio in meniscal tears?
Hamstring and quadriceps strengthening
Where does the ACL run?
From tibial eminences to lateral wall of intercondylar notch of femur
What is the blood supply of the ACL?
Middle geniculate artery
What is the innervation of the ACL?
Posterior articular nerve
Branch of tibial nerve
What are the functions of the ACL?
Primary restraint to anterior translation of the tibia relative to femur
Secondary restraint to tibial rotation and varus/valgus stress
Do ACL tears have immediate swelling?
Yes
What test is useful for diagnosing ACL tear?
Lachman’s
What are some treatment options for ACL tear?
Focussed quadricep programme
ACL reconstruction
What is the function of the superficial MCL?
Primary restraint to valgus stress
What are the functions of the deep MCL?
Contributes in full knee extension
Why does the MCL usually tear?
Severe valgus stress
What is the most common ligament injury of the knee?
MCL tear
How does an MCl tear present?
Heard a pop or crack
Pain and bruising medially, tender
Localised swelling
Painful on full extension
What is the modality of choice for MCL tear?
MRI
What is a possible x-ray finding in mcl tears?
Calcification at femoral insertion
How do we treat MCL tears?
Rest
NSAIDs
Physio
Brace
What is osteochondritis dissecans?
Pathological lesion affecting articular cartilage and subchondral bone
How does osteochondritis dissecans present?
Poorly localised pain with activity
Recurrent effusions
Locking
Block to full movement
What is a good test for Osteochondritis dissecans?
Internal rotation causes impingement of the tibial eminence on the OCD lesion
