Regional Peri-Atricular Pain - Knee

Question 1

What are the causes of peri-atricular knee pain?

Answer 1

Osgood-Schlatter's disease
Meniscal tears
Ligament injuries
Bursitis
Popliteal swellings

Question 2

What are the main types of ligament injury?

Answer 2

Ant Cruciate tear (most common)
Medial Collat tear
Mixed

Question 3

What are the main types of bursitis?

Answer 3

Pre-patellar
Infra-patellar
Anserine

Question 4

What are the main types of popliteal swelling?

Answer 4

Semimebranosus bursa

Popliteal/baker’s cyst

Question 5

What is Osgood-Schlatter’s disease?

Answer 5

Traction injury of patellar ligament leading to prominent/tender tibial tuberosity
-common in adolescents

Question 6

What is the management of Osgood-Schlatter’s disease?

Answer 6

Spontaneous recovery takes time

Restricting sporting activity

Question 7

What causes meniscal tears?

Answer 7

Twisting strain on flexed, weight bearing knee

• degenerative tears seen in knee OA
• little force req in older adults (fibrosis)

Question 8

Which meniscus tears most commonly?

Answer 8

Medial

• less mobile
• associated w/ ACL tears

Question 9

What is the prognosis for meniscus tears?

Answer 9

Mainly avascular (apart from lat 25%)
Will not heal spontaneously after tear OR heal after surgical repair

Question 10

How do meniscal tears present?

Answer 10

Initial pain (intermittent)
Variable swelling hrs later
Locking of knee/spontaneous giving way of knee

Question 11

What are the signs on examination of meniscal tears?

Answer 11

Effusion
Fixed flexion deformity
Medial joint line tenderness

Question 12

What investigations may be appropriate in meniscal tears?

Answer 12

X-ray (AP/lat/skyline) - normal, exclude fractures/OA

MRI - mainstay of dx

Question 13

What is the management of meniscal tears?

Answer 13

Arthroscopic repair
-tears in vascular zone amenable to repair
-partial meniscetomy reduces mechanical sx
-total meniscetomy avoided due to risk of 2o OA
Conservative management
-in degenerative tears 2o to OA

Question 14

What is the main complication of untreated meniscal tears?

Answer 14

Propagation to 2o arthritis

Question 15

What causes ligament injuries?

Answer 15

When a force greater than the tensile strength of the ligament occurs e.g. sporting injuries/trauma

Question 16

In which groups are ligament injuries most common?

Answer 16

Women more susceptible

Men more commonly injured

Question 17

In what position are the collateral ligaments most susceptible to injury?

Answer 17

When knee is extended

-ligaments tight in extension, loose in flexion

Question 18

How do ligament injuries present?

Answer 18

Pop at time of injury
Pts cannot bear weight bear after injury/knee feels very unstable
Swelling in 1st hour indicates complete rupture

Question 19

What are the signs on examination of ligament injuries?

Answer 19

Soft end point as surrounding soft tissues stop the force
Pain when testing
Lachman’s +ve (ant/post drawer_

Question 20

What is the Lachman’s test? (ant/post drawer)

Answer 20

Detects ACL tear
Knee flexed at 20-30o
Examiner places one hand behind tibia & one on thigh
Intact ACL prevents forward translational movement

Question 21

What investigations may be appropriate in ligament injuries?

Answer 21

X-ray (AP/lat/skyline) - shows displacements, exclude OA, show fractures
MRI (90% of ligament injuries)
Diagnostic arthroscopy

Question 22

What is the conservative management of ligament injuries?

Answer 22

Patient education
Physiotherapy
Active movement w/ a brace

Question 23

What is the surgical management of ACL injuries?

Answer 23

Arthroscopic tendon graft repair

-hamstring/semitendinosus as donor tendon

Question 24

What is the surgical management of PCL injuries?

Answer 24

Optimal management not known

-bony avulsion most common indication

Question 25

What is the time limit for surgical management of collateral ligament injuries?

Answer 25

If fixed surgically should be performed w/i 2wks of injury

Question 26

What causes Pre-patellar bursitis?

Answer 26

Housemaid’s knee

Caused by unaccustomed kneeling

Question 27

What causes Infra-patellar bursitis?

Answer 27

Clergyman’s bursitis

Caused by unaccustomed kneeling

Question 28

How do pre-patellar/infra-patellar bursitis present?

Answer 28

Ant knee pain

Fluctuant swelling

Question 29

How are pre-patellar/infra-patellar bursitis managed?

Answer 29

Avoidance of kneeling

Corticosteroid injection

Question 30

What is anserine bursitis?

Answer 30

Pain/bursa in insertion of MCL into upper tibia

Question 31

How does anserine bursitis present?

Answer 31

Pain

-worse on standing/stressing the MCL

Question 32

In which groups is anserine bursitis more common?

Answer 32

Obese women

Breast stroke swimmers

Question 33

How is anserine bursitis managed?

Answer 33

Physiotherapy

Local corticosteroid injections

Question 34

What is a semimembranosus bursa?

Answer 34

Bursa b/w semimembranosus & medial head of gastrocnemius becomes enlarged

Question 35

How does a semimembranosus bursa present?

Answer 35

Painless lump behind knee

Question 36

What is a popliteal/Bakers cyst?

Answer 36

Bulging of post capsule of knee w/ synovial herniation leading to a swelling in popliteal fossa

Question 37

What are the causes of popliteal/Bakers cyst?

Answer 37

RA

OA

Question 38

How do popliteal/Bakers cyst present?

Answer 38

Bulging of post capsule of knee

Swelling/pain in calf

Question 39

What is the management of popliteal/Bakers cysts?

Answer 39

Aspiration (if non-ruptured)

Hydrocortisone injection