Orthopaedic knee problems

Question 1

What bones surround the knee joint?

Answer 1

Distal end of femur - epicondyles
Tibia
Patella

Question 2

What are the extensor muscles of the knee?

Answer 2

Quadriceps

Question 3

What are the flexor muscles of the knee?

Answer 3

Hamstrings

Question 4

What are the ligaments supporting the knee joint?

Answer 4

Anterior cruciate ligamnet
Posterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament

Question 5

What are the meniscii?

Answer 5

C shaped cartilage within the knee joint, which helps to absorb force and increase stability

Question 6

What are the 2 meniscii?

Answer 6

Medial meniscus

Lateral meniscus

Question 7

What causes meniscal tear?

Answer 7

Twisting in deep flexion

Osteoarthritis

Question 8

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

Answer 8

Medial

Question 9

How does meniscal tear present?

Answer 9

Pain
Clicking
Locking
Intermittent swelling

Question 10

What can be seen on examination of meniscal tear?

Answer 10

LOOK - effusion
FEEL - tender joint line at point of tear
MOVE - mechanical block to movement
McMurrays test positive
Fail deep squat
Thassalys test positive

Question 11

What investigations can be done for meniscal tear?

Answer 11

X-ray to detect arthritis or fracture

MRI - see soft tissue but high false positive rate

Question 12

What is prognosis for meniscal tear?

Answer 12

Poor due to poor blood supply

Question 13

What are non-operative treatment options for meniscal tear?

Answer 13

Rest
NSAIDs
Physio - hamstring and quadriceps strengthening

Question 14

What are operative treatment options for meniscal tear?

Answer 14

Arthroscopy

Question 15

What is the course of the anterior cruciate ligament?

Answer 15

From between the tibial eminences to the lateral wall of intercondylar notch of femur

Question 16

What is the blood supply of the ACL?

Answer 16

Middle geniculate artery

Question 17

What is the function of the ACL?

Answer 17

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

Question 18

What is the most common cause of acl tear?

Answer 18

Non-contact pivot injury

Question 19

How does acl tear present?

Answer 19

Heard a pop or crack
Immediate swelling
Unable to continue playing sport
Deep pain

Question 20

What can be found on examination of ACL tear?

Answer 20

LOOK - effusion
MOVE - anterior draw positive
Lachmann’s test
Pivot shift

Question 21

What investigations can be done for ACL tear?

Answer 21

X-ray

MRI - ACL and meniscii

Question 22

How is ACL tear treated?

Answer 22

Non-operative - Focused quadricep programme

Operative - ACL reconstruction

Question 23

What is the role of the superficial medial collateral ligament?

Answer 23

Primary restraint to valgus stress

Question 24

What is the role of the deep medial collateral ligament?

Answer 24

Contributes in full knee extension

Question 25

What causes MCL tear?

Answer 25

Severe valgus stress - contact related

Question 26

How does MCL tear present?

Answer 26

``` Heard a pop or crack Pain++ on medial side of knee Unable to continue playing sport Bruising on medial knee Localised swelling ```

Question 27

What will be found on examination of MCL tear?

Answer 27

LOOK - medial swelling, bruising FEEL - tender medial joint line and femoral insertion of MCL MOVE - painful in full extension, opening on valgus stress

Question 28

What investigations can be done for MCL tear?

Answer 28

X-ray - may be normal, calcification at femoral insertion | MRI helps assess location and severity

Question 29

What are non-operative treatments for MCL tear?

Answer 29

Rest/NSAIDs Physiotherapy Brace for comfort

Question 30

What are indications for surgery in MCL tear?

Answer 30

Severe tears | Failed non-operative management

Question 31

What are operative treatments for MCL tear?

Answer 31

Repair - avulsions | Reconstruction - damaged tissue

Question 32

What is osteochondritis dissecans?

Answer 32

Pathological lesions affecting articular cartilage and subchondral bone causing cracks to appear

Question 33

What are causes of osteochondritis dissecans?

Answer 33

Hereditary Traumatic Vascular

Question 34

How does osteochondritis dissecans present?

Answer 34

Activity related pain - poorly localised Recurrent effusions Mechanical symptoms - locking and block to full movement

Question 35

What is found on examination of osteochondritis dissecans?

Answer 35

LOOK - effusion FEEL - localised tenderness MOVE - stiffness, block to movement, wilsons test

Question 36

What investigations can be done into osteochondritis dissecans?

Answer 36

X-ray | MRI

Question 37

What are treatment options for osteochondritis dissecans?

Answer 37

Non-operative - restricted weight bearing and range of movement brace Operative - Arthroscopy, open fixation