Orthopaedic Knee Problems Flashcards
What are the possible causes of meniscal tears?
Acute due to twisting, especially in deep flexion
Degenerative in osteoarthritis
Which meniscus tears most commonly and why?
Medial meniscus tears more common than lateral
Medial meniscus is a more fixed structure
How do meniscal tears present?
- Pain
- Clicking
- Locking
- Intermittent swelling
How is a meniscal tear examined?
Look
- Effusion
Feel
- Tender joint line at point of tear
Move
- Mechanical block to movement
- McMurrays test positive (flex and rotate knee, apply axial pressure and extend the knee again. Positive test involves an audible click)
- Fail deep squat (useful in younger patients, asymmetric squat)
- Thassaly’s test positive (patient holds hand on chair, bend knee to 20 degrees with one leg raised and get patient to twist, recreate injury pattern)
How are meniscal tears investigated?
Investigations involve x-ray, primarily to exclude arthritis and fracture. MRI is the most sensitive test but has a high false positive rate.
What is the treatment of a meniscal tear?
- Rest
- NSAIDs
- Physiotherapy (hamstring/quadriceps strengthening)
Operative treatment is an arthroscopy, which can be either a repair or resection.
What type of injuries most commonly causes ACL tears?
Non-contact pivot injuries
More common in females (5:1)
How does an ACL tear present?
- Heard a pop or crack
- Immediate swelling due to bleeding
- Unable to continue playing sport
- Deep pain
How is an ACL tear examined?
Look - Effusion Feel - Not much to feel asides from if there is an associated meniscal tear Move - Anterior draw - Lachmann’s test - Pivot shift (usually under anaesthetic)
How are ACL tears investigated?
Investigations can include an X-ray to check for secondary fracture and an MRI (most important) to assess the ACL and the menisci
What injury is commonly associated with an ACL tear?
Lateral meniscal tears occur in ~50% of ACL tears
How is an ACL tear treated?
Surgery is not always required in ACL tears, if the ACL flips back and attaches to the PCL and maintains a blood supply from there then a focused quadricep programme can be sufficient. Operatively, an ACL reconstruction can have associated partial menisectomy, ligament repair or a hamstring graft.
What injuries cause MCL tears?
Severe valgus stress
Usually contact related
What are the possible related injuries to MCL tears?
ACL and meniscal tears
How does a MCL tear present?
- Heard a ‘pop’ or ‘crack’
- Pain ++ (medial side)
- Unable to continue playing
- Bruising medial knee
- Localised swelling
How is an MCL tear examined?
Look - Medial swelling - Bruising Feel - Tender medial joint line - Tender femoral insertion of MCL Move - Painful in full extension - Opening on valgus stress
How is an MCL tear investigated?
X-ray
MRI
How is an MCL tear treated?
Non-operative treatment is sufficient in the majority of MCL tears and involves:
- Rest
- NSAIDs
- Physiotherapy
- Brace for comfort
Operative treatment may be required in severe tears and in cases of failed non-operative management. Repair or reconstructions can be helpful.
What are the two classes of osteochondrosis dissecans?
Juvenile
Adult
What bone does osteochondrosis dissecans usually affect?
The femur
What are the causes of osteochondrosis dissecans?
- Hereditary
- Traumatic
- Vascular (adult form)
How does osteochondrosis dissecans present?
- Activity-related pain (poorly localised)
- Recurrent effusions
- Mechanical symptoms (locking, block to full movement)
How is osteochondrosis dissecans examined?
Look - Effusion Feel - Localised tenderness Move - Stiffness - Block to movement - Wilsons test (rarely done in practice)
How is osteochondrosis dissecans investigated?
Investigations are X-ray and MRI. MRI is useful in assessing lesion size and status of cartilage. Tunnel view x-rays can be much more helpful than AP views
How is osteochondrosis dissecans treated?
Non-operative treatment involves restricted weight-bearing and a range of movement brace. Operatively, arthroscopy can be done to perform subchondral drilling or fixation of loose fragment or open fixation can be done.
