Orthopaedics & Rheumatology/ Knee Injuries

Question 1

What are the indications for an x-ray series for a knee injury?

Answer 1

Any one of the following -

• point tenderness over patella
• tenderness at head of fibula
• inability to flex beyond 90°
• inability to bear weight both immediately and at time of visit (4 steps)
• age >55

Question 2

What are the key musculoskeletal differential diagnoses of acute knee pain?

Answer 2

• Anterior cruciate ligament (ACL) tear
• patellar dislocation
• patellar fracture
• lateral cruciate ligament (LCL)
• posterior cruciate ligament (PCL)
• meniscal tear

Question 3

What is the differential diagnosis of chronic anterior knee pain?

Answer 3

• Patellofemoral dysfunction
• OsgoodSchlatter disease
• osteochondritis dessicans
• patellar tendonitis
• bursitis
• patellar stress fracture

Question 4

What direction is the patella most likely to dislocate?

Answer 4

Lateral >> medial

Question 5

A 9-year-old boy presents with pain when squatting down to catch the baseball. He has been playing football 3 days a week and baseball twice a week. He is tender over the tibial tubercle. What is the likely diagnosis?

Answer 5

Osgood-Schlatter disease (OSD)

Question 6

What is Osgoog-Schlatter treatment?

Answer 6

• Decrease activity for 1-2 years (most children will grow out of it).
• Specialized neoprene bracing can provide symptomatic relief.

Question 7

What is the knee injury most typical for each history? Popping sensation initially, followed by sensation of locking and lack of full extension

Answer 7

Meniscus tear (medial > lateral)

Question 8

What is the knee injury most typical for each history? Female soccer player felt a pop in her knee when she rotated on a planted foot while running

Answer 8

ACL

Question 9

What knee injury is likely?

A 17-year-old football player hit on the lateral side of his leg by the helmet of the tackling player, causing valgus stress to knee joint.

Answer 9

MCL

Question 10

What is the likely knee injury?

A basketball player takes a hard, direct fall onto her flexed knee. Or, the driver of a car strikes his tibia into the dashboard during a head-on collision.

Answer 10

PCL

Question 11

The likely knee injury…

Often referred to as the “unhappy triad” from being clipped from the side in football, soccer, or other contact sport

Answer 11

ACL, MCL, medial meniscus tears

Question 12

A 28-year-old runner presents to your office describing lateral knee pain, especially when running downhill, that goes away at rest. He can hear an occasional pop when he is running. On examination, he is tender to palpation over the lateral femoral condyle, and has pain when hopping with a flexed knee. What is the likely diagnosis?

Answer 12

Iliotibial band(ITB) syndrome

Question 13

Name the physical examination test used in the evaluation of ITB syndrome described below.

With the patient lying down and knee flexed to 90°, apply pressure to ITB over lateral femoral condyle while extending the knee.

Answer 13

Noble compression test; pain at 30° is a positive test.

Question 14

Name the physical examination test used in the evaluation of ITB syndrome described below.

Patient lies on unaffected side with knee and hip flexed. Flex the affected knee to 90° and abduct and hyperextend hip while stabilizing the pelvis. Lower the affected leg as far as possible

Answer 14

Ober test; positive if leg remains abducted indicating tight IT band

Question 15

What is the treatment of ITB syndrome?

Answer 15

• Physical therapy to improve hamstring and ITB flexibility
• nonsteroid anti-inflammatory drugs (NSAIDs)
• ice
• modifications to activity

Question 16

What are some risk factors for ITB tightness?

Answer 16

• Repetitive flexion and extension of the knee
• long-distance running or cycling
• genu varum
• excessive foot pronation
• internal tibial rotation

Question 17

Tissue injury commonly associaed with a painful swelling in calf and history of bump on back of knee

Answer 17

Ruptured Baker cyst (popliteal cyst)

Question 18

Tissue injury commonly associated with Pain on repeated kneeling, with palpable area of swelling between patella and tibial tuberosity, often seen in tilers, roofers who work without kneepads

Answer 18

Prepatellar bursitis (Housemaid knee)

Question 19

What is the name for diffuse knee pain associated with abnormal tracking of the patella through normal ROM, often seen in running, basketball, and soccer?

Answer 19

Patellofemoral dysfunction (PFD)

Question 20

What is the treatment for Patellofemoral dysfunction?

Answer 20

• Rest
• NSAIDs
• correct the quadriceps imbalance by strengthening the vastus medialis oblique (VMO)

Question 21

What traction apophysitis of the tibial tubercle is associated with trauma to an unclosed ossification system, and occurs in 9-15-year-old boys > girls?

Answer 21

Osgood-Schlatter disease