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My2 MSK > orthopaedics: knee > Flashcards

orthopaedics: knee Flashcards

1
Q

what does the knee joint consist of

A

medial and lateral compartments of tibiofemoral joint, patellofemoral joint

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2
Q

what type of hyaline is inside the synovial knee joint

A

hyaline

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3
Q

what part of the body has the thickest hyaline cartilage

A

retropatellar surface

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4
Q

what are menisci

A

fibrocartilaginous cartilage inbetween tibiofemoral joint (x2), they are shock absorbers

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5
Q

which meniscus is more mobile

A

lateral more mobile, medial fixed

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6
Q

what is the function of the anterior cruciate ligament (ACL)

A

prevents tibia rotating

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7
Q

what is the function of the posterior cruciate ligament (PCL)

A

prevents hyperextension and translation of the femur

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8
Q

what do the medial and lateral collateral ligaments (MCL and LCL) do

A

MCL resist valgus forces, LCL resists varus forces

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9
Q

what are early OA risk factors for the knee (5)

A

meniscal tears, ligament injuries (esp ACL), abnormal alignment, inflam arthritis, hobbies/ occupation

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10
Q

what are the criteria for a knee replacement from OA

A

substantial pain and disability with no conservative treatment working

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11
Q

what are risks of knee replacement

A

infection, thrombosis, unexplained pain after TKR

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12
Q

who gets and what causes meniscal tears

A

young people playing sport - twisting force on loaded knee

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13
Q

what are symptoms of meniscal tears

A

localised pain in medial or lateral joint line, effusion that develops NEXT day, pain, locking (cant straighten knee), positive steinmanns test

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14
Q

what is more common medial or lateral meniscal tears

A

medial 10x more common

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15
Q

what type of meniscal tears can occur

A

longitudinal, radial, oblique, horizontal, flap, degenerative

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16
Q

what are bucket handle tears

A

large longitudinal tears where meniscal fragment flips out and is displaced

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17
Q

what is a key feature of bucket handle tears

A

knee locks and cannot fully extend from mechanical obstruction - 15 degree extension

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18
Q

how do you manage bucket handle tears

A

urgent arthroscopic repair

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19
Q

what are degenerate meniscal tears

A

complex patterns

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20
Q

who gets degenerate meniscal tears

A

elderly, common first stage of OA, spontaneous or mild injury

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21
Q

how do you manage degenerate meniscal tears

A

steroid injection

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22
Q

what feature of menisci leads to poor healing and what else contributes to poor healing

A

poor blood supply - elderly and older injuries

23
Q

what is gold standard investigations of meniscal tears

A

MRI

24
Q

what is the criteria for a meniscal repair

A

longitudinal repair in outer 1/3, recent, young patient (need 3/3)

25
Q

what is involved in a meniscal repair

A

stitching meniscus to it’s bed, extensive rehab (90% not suitable)

26
Q

when would an arthroscopic partial meniscectomy be done

A

mechanical and acute tears

27
Q

what causes ACL ruptures

A

high rotational force: rotating body landing on planted foot - skiing, rugby, football

28
Q

what are symptoms and signs of ACL ruptures

A

pop usually heard/ felt, haemoarthrisis within an hour, deep pain in knee

29
Q

what is a symptom of chronic ACL rupture

A

when turning on planted foot gives way, tibia translocated forward

30
Q

what is favoured in ACL management

A

reconstruction > repair

31
Q

who are general ACL reconstruction candidates

A

professional sportsmen, failed phsyio, if injury from low impact injury

32
Q

what is involved in ACL reconstruction surgery

A

tendon graft passed through tibial and femoral tunnel, attached to normal ACL attachment sites on bone. then intense rehab

33
Q

describe PCL ruptures (4 points)

A

not common by itself, direct blow to ant tibia, bruising and knee pain, tibia translocated ant

34
Q

what are symptoms of MCL tears

A

laxity, pain on valgus stress, tenderness on origin and insertion of ligaments

35
Q

how do you manage acute MCL tears

A

normally good healing, hinged knee brace

36
Q

how do you manage chronic MCL tears

A

MCL tightening and reconstruction with a tendon graft

37
Q

when do LCL ruptures occur

A

uncommon alone - combo with PCL and ACL

38
Q

what is commonly injured in LCL ruptures

A

peroneal nerve

39
Q

what management is done in complete LCL tears

A

urgent surgery –> later reconstruction

40
Q

what causes a complete knee dislocation

A

high degree of forces can rupture all 4 ligaments (ACL, PCL, MCL, LCL)

41
Q

what are risks of total knee dislocation

A

thrombosis, popliteal artery damage, compartment syndrome

42
Q

how do you manage a total knee dislocation

A

emergency, X ray, vascular surgery assessment, stent or bypass, multi-ligament reconstruction

43
Q

what does the extensor knee mechanism consist of (5)

A

tibial tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscles

44
Q

how to extensor mechanism ruptures occur

A

fast contractile forces eg weightlifting, fall, degenerative tendon

45
Q

which age group get patella tendon ruptures vs quadriceps tendon ruptures

A 
patella = young < 40
quadriceps = old
46
Q

what are risk factors for extensor mechanism ruptures (5)

A

tendonitis, chronic steroid use, diabetes, RA, CKD

47
Q

what drugs can cause tendonitis

A

quinolone ABs eg ciprofloxacin

48
Q

how do you diagnose extensor mechanism ruptures

A

strait leg test, obvious gap, USS in overweight patient

49
Q

how do you manage extensor mechanism ruptures

A

surgery for complete/ large tears, reattachment of tendon to patella

50
Q

what is patellofemoral dysfunction

A

disorder of patellofemoral articulation

51
Q

what is patellofemoral dysfunction associated with (3)

A

chondromalacia patellae, adolescent ant knee pain, lateral patellar compression syndrome

52
Q

what are signs and symptoms of patellofemoral dysfunction

A

ant knee pain, worse downhill, grinding sensation, pseudo-locking after prolonged sitting

53
Q

how do you manage patellofemoral dysfunction

A

PHYSIO, taping, surgery as a last resort

54
Q

what can predispose patellar dislocations

A

ligament laxity, female, shallow groove, genu valum, femoral neck anteverion, high riding patella

My2 MSK (29 decks)

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