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MSK > S4L2 - Disorders Of The Knee > Flashcards

S4L2 - Disorders Of The Knee Flashcards

1
Q

What are the standard x-ray series for the knee?

A

AP view, lateral view, patella axial (skyline) view

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2
Q

Who are prone to femoral shaft fractures and how do they occur?

A

Children and young adults as result of high velocity trauma.

Low velocity injury in elderly with osteoporotic bones.

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3
Q

Why is the proximal segment in a femoral shaft fracture often abducted and flexed?

A

Because the musculature acts as a deforming force. Abducted by gluteus medius and minimus and flexed by iliopsoas pulling on the lesser trochanter.

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4
Q

Why is the distal segment of the femur after a fracture adducted into varus deformity and extended?

A

The musculature acts as a deforming force. Adducted by the adductor muscles (gracilis, adductor Magnus). Extended due to the pull of gastrocneumius on the posterior femur.

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5
Q

What are signs of a femoral shaft fracture?

A

Tense swollen thigh, possible drowsiness from hypovolaemic shock.

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6
Q

What is a common complication of a femoral shaft fracture?

A

Hypovolaemic shock as blood loss in closed femoral shaft fractures is 1L-1.5L. Rarely have neuromuscular complications.

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7
Q

How are femoral shaft fractures treated?

A

Surgical fixation.

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8
Q

What complications can occur in a distal fracture of the femur?

A

Popliteal artery may become involved if there is significant displacement of the fracture.

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9
Q

How is a fracture of the distal femur treated?

A

Assessment of the nerurovasculature status of the limb before and after reduction of the fracture.

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10
Q

How do tibial plateau fractures usually occur?

A

High energy injuries. Axial loading with varus or valgus angulation of the knee.

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11
Q

What are tibial plateau fractures?

A

Fractures affecting the articulating surface of the tibia within the knee joint. Can be unicondylar or bicondylar.

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12
Q

What are complications of tibial plateau fractures?

A

Articular cartilage is always damaged. Most patients develop a degree of post-traumatic osteoarthritis in the affected joint. Also associated with meniscus tears and anterior cruciate ligament injuries.

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13
Q

How do patellar fractures occur?

A

Direct impact injury
Eccentric con ration of the quadriceps
20-50yrs

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14
Q

What can often be found on presentation of a patellar fracture?

A

Palpable defect in the patella
Haemarthrosis
Patient unable to perform a straight leg raise (extensor mechanism disrupted as fracture is distal to the insertion of the quadriceps tendon)

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15
Q

How are displaced patellar fractures treated?

A

Reduction

Surgical fixation

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16
Q

How are undisplaced patellar fractures treated?

A

Protected whilst healing by splints and crutches

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17
Q

Wha can often be mistaken for a patellar fracture?

A

Bipartite patella (failure of union of a secondary ossification centre within the main body of the patella)

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18
Q

What is patellar subluxation?

A

Partial displacement of the patella

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19
Q

What is the most common direction for the patella to dislocate?

A

Laterally

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20
Q

How is the patella usually dislocated?

A

Trauma, often a twisting injury with slight flexion. Usually with internal rotation of the femur on a planted foot
Direct blow to the knee.

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21
Q

What people commonly suffer from patella dislocation?

A

Athletic teenagers

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22
Q

What are predisposing factors to a patella dislocation?

A

Generalised ligamentous laxity
Weakness of the quadriceps muscles (especially the vastus medialis obliquus)
Shallow trochlear groove with a flat lateral lip
Long patellar ligament
Previous dislocations

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23
Q

How are patellar dislocations treated?

A

By extending the knee and then manually reducing the patella. Immobilise when healing. Physiotherapy to strengthen the vastus medialis obliquus after healing.

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24
Q

How do menisci life injuries typically occur?

A

Sudden twisting motion of a weight-bearing knee in a high degree of flexion.

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25
Q

What are the signs and symptoms of a meniscus injury?

A

Intermittent pain localised to the joint line. Knee may click, catch or lock, unable to extend full due to intra-Articular foreign body os a sensation of giving way. Swelling may or may not occur. If haemarthrosis present it indicates a tear in the peripheral vascular aspect of the meniscus or an associated ACL injury.
Joint line tenderness, restricted motion due to pain or swelling.

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26
Q

What can a chronic effusion of the knee joint indicate?

A

Synovitis

Meniscus injury

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27
Q

What can be the cause of a mechanical block or locking of the knee joint?

A

A displaced meniscal tear resulting in fragments becoming trapped between articular surfaces.

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28
Q

How are acute traumatic meniscal tears usually treated?

A

Conservative management
Meniscectomy
Meniscal repair

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29
Q

How does collateral ligament injury occur?

A

Acute varus or valgus angulation of the knee

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30
Q

What do the collateral ligaments usually do?

A

Brace the knee against unusually varus or valgus deformation

Prevent excessive posterior deformation of the tibia on the femur (alongside the PCL)

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31
Q

What is a varus deformation of the knee?

A

There is a medial angulation of the leg/distal segment.

Bow-legged.

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32
Q

What is valgus deformation of the knee?

A

Lateral angulation of the leg/distal fragment. Knock knees.

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33
Q

When is there strain on the lateral collateral ligament?

A

When there is varus deformation at the knee.

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34
Q

When is there strain of the medial collateral ligament?

A

In acute valgus strain at the knee.

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35
Q

Why does an injury to the lateral collateral ligament have a higher chance of causing knee instability than a MCL injury?

A

The lateral tibial plateau forms a shallower and more unstable socket for the medial condyle of the femur. Hence the lateral collateral ligament plays a larger role in maintaining the stability of the knee.

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36
Q

What are the presenting symptoms of a collateral ligament injury?

A

Pain and swelling of the knee. Stiffness. Joint felling unstable, giving way and not supporting body weight.

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37
Q

What are the unhappy triad?

A

Injury to the:
anterior cruciate ligament
Medial meniscus
Medial collateral ligament

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38
Q

How does an unhappy triad injury occur?

A

When a strong force is applied to the lateral aspect of the knee. Medial meniscus is strongly adhered to the medial collateral ligament which is why it is also injured.

39
Q

Which cruciate ligament is most commonly injured?

A

The anterior cruciate ligament

40
Q

What usually causes a torn ACL?

A

Sporting injuries - quick deceleration, hyperextension or rotational injury. Usually non-contact.

41
Q

What are the presenting symptoms of a patient with a torn ACL?

A

Knee pain. Popping sensation in the knee. Immediate swelling. Instability of the knee/ giving way as the tibia slides anteriorly under the femur. Anterolateral rotary instability.

42
Q

How is a torn ACL treated?

A

Surgical reconstruction if musculature isn’t enough to stabilise joints (necessary in athletic people)

43
Q

How does a posterior cruciate ligament injury usually occur?

A

Knee is flexed and a large degree of force is applied to the upper tibia, displacing it posteriorly. Fall onto flexed knee, road traffic collisions where proximal leg collides with dashboard. Severe hyperextension.

44
Q

How are anterior and posterior cruciate ligament injuries detected?

A

Anterior and posterior drawer tests. Lachmans test can also be used to detect an ACL injury.

45
Q

How does a knee dislocation injury occur?

A

High energy trauma

46
Q

How many ligaments must be ruptured to dislocate the knee?

A

Three of the four ligaments (MCL, LCL, ACL, PCL) must be ruptured

47
Q

What arterial injury is commonly associated with a dislocated knee.

A

Popliteal artery. It is very immobile and tethered at the adductor hiatus and under the tendinitis arch of the soleus muscle. May be torn (Haematoma) or crushed or suffer a traction injury (endothelial damage leading to thrombotic occlusion)

48
Q

How is dislocation of the knee joint treated?

A

Reduction of the knee joint. Assess vascularity of the leg with MRA

49
Q

What swellings can occur around the knee?

A

Bony
Soft tissue
Fluid

50
Q

What causes bony swellings around the knee?

A

Osgood-schlatters disease

51
Q

What causes soft tissue swelling at the knee?

A

An enlarged popliteal lymph node, a popliteal artery aneurysm, Lymphoedema of the lower leg.

52
Q

What causes fluid swelling around the knee?

A

Effusion ( inside the joint )

Soft tissue Haematoma

53
Q

What is a knee effusion?

A

Accumulation of fluid inside the knee joint

54
Q

What is the difference between an acute and delayed effusion?

A 
Acute effusion (< 6 hrs after injury)
Delayed effusion (>6hrs after injury)
55
Q

What is haemarthrosis? When does it occur?

A

Bleeding inside the joint. In an ACL rupture.

56
Q

What usually causes acute effusions of the knee joint?

A

ACL rupture

57
Q

What usually cause delayed effusion of the knee joint?

A

Synovitis

58
Q

What is synovitis?

A

Inflammation of the synovitis in response to injury that leads to the production of an increased volume of synovial fluid.

59
Q

What are the 2 types of acute knee effusions?

A

Haemarthrosis

Lipo-haemarthrosis

60
Q

What is lipo-haemarthrosis?

A

Blood and fat in the joint. Usually due to a fracture at the fat has been released from the bone marrow

61
Q

What can be seen on an x-ray of a knee joint with lipoprotein-haemarthrosis?

A

A fat-fluid interface in the joint. Fat appears darker than blood as less dense. Likely to see an intracapsular fracture such as a tibial plateau fracture

62
Q

What is bursitis?

A

Inflammation of a bursa

63
Q

What bursa of the knee are most commonly inflammed?

A
  1. Subcutaneous prepatellar bursa
  2. Deep infrapatellar bursa
  3. Pes anserinus bursa (subsartorial bursa)
  4. Suprapatellar bursa.
64
Q

Where is the prepatellar bursa located?

A

Between the skin and the patella.

65
Q

How does pre-patellar bursitis present?

A

Knee pain and swelling. Erythema overlying the inflamed bursa.

66
Q

What usually causes pre-patellar bursitis?

A

Repetitive trauma such as scrubbing the floor.

Can be fall or blunt trauma to the front of the knee.

67
Q

What condition is also known as housemaids knee?

A

Pre-patellar bursitis.

68
Q

What is infrapatellar bursitis?

A

Inflammation of the the infrapatellar bursae (superficial and deep). Usually affects the superficial infrapatellar bursa.

69
Q

How does infrapatellar bursitis usually occur?

A

Repeated micro trauma caused by activities involving kneeling.

70
Q

What condition is also known as clergyman knee?

A

Infrapatellar bursitis.

71
Q

As well as localised irritation, what can suprapatellar bursitis be a sign of?

A

Knee effusion. The suprapatellar bursa is an extension of the synovial cavity of the knee joint, therefore swelling in the knee joint (caused by a knee effusion) often represents with swelling into the suprapatellar pouch.

72
Q

What are possible causes for a knee effusion?

A 
Osteoarthritis
Rheumatoid arthritis
Infection
Gout and pseudo gout
Repetitive micro trauma of a joint.
73
Q

Where is the semimembranosus bursa located?

A

Under the skin overlying the posterior of the knee joint. Beneath the deep fascia of the popliteal fossa in the interval between the semimembranosus muscle and the medial head of the gastrocneumius muscle.

74
Q

What usually causes semimembranosus bursitis?

A

Indirect consequence of swelling of the knee joint. Fluid from the knee effusion forces its way through the narrow communication into the semimembranous bursa.

75
Q

What condition is also known as a popliteal cyst/bakers cyst?

A

Semimembranosus bursitis

76
Q

What is Osgood-Schlatter’s disease?

A

Inflammation of the apophysis (site of insertion) of the patellar ligament into the tibial tuberosity.

77
Q

When does Osgood-Schlatter’s disease commonly occur?

A

In teenagers that play sport

78
Q

What are the presenting symptoms of Osgood-Schlatter’s disease?

A

Inflammation anteriorly below the knee joint. Localised pain and swelling. Intense knee pain during active movements and when kneeling.

79
Q

How does Osgoods-Schlatters disease resolve?

A

With ice and rest. Pain and swelling resolve at the age of skeletal maturity when the apophysis fuses.

80
Q

What are typical symptoms and signs of osteaoarthritis of the knee?

A

Knee pain
Stiffness
Swelling
Deformity (varus/valgus/flexed flexion of the knee)
Crepitus
Effusion
Knee giving way (muscle weakness of quads)

81
Q

What may induce pain in a patient with osteoarthritis of the knee?

A

Flare ups, when the chronic low level pain increases in severity
Activities such as bending,kneeling, squatting, or climbing stairs.
Pain and stiffness that is wore after prolonged periods of rest.

82
Q

What causes crepitus during osteoarthritis of the knee?

A

Loss of articular cartilage leading to increased friction as bone rubs on bone during movement, causing crepitus.

83
Q

In tri compartmental osteoarthritis of the knee, which compartments are affected?

A

Medial femorotibial
Lateral femorotibial
Patellofemoral

84
Q

What are the risk factors for osteoarthritis?

A 
Age
Female sex
Previous trauma to the joint
Obesity
Family history of OA
Having another condition that affects the joint.
85
Q

How is osteoarthritis of the knee treated?

A
  1. Taught strengthening exercises to strengthen the VM to reduce instability
  2. Analgesia
  3. Weight loss if overweight
  4. Activity modification
  5. Surgery - total knee replacement
86
Q

What is septic arthritis?

A

Invasion of the joint space by microorganisms, usually bacteria.

87
Q

How is septic arthritis different from reactive arthritis?

A

Reactive arthritis is a sterile inflammatory process, septic arthritis isn’t.

88
Q

How does reactive arthritis occur?

A

From an extra-articular infection (gastroenteritis)

89
Q

What is the most common pathogen to cause septic arthritis?

A

Staphylococcus aureus.

Can be caused by staph. Epidermis is, neissseria gonorrhoeae, strep.viridans, strep. Pneumonia and group B streptococci.

90
Q

What are risk factors for septic arthritis?

A 
Extremes of age
Diabetes mellitus
Rheumatoid arthritis
Immunosuppression
Intravenous drug abuse
Prosthetic joints (intraoperative contamination)
91
Q

Why are joint replacements prone to causing septic arthritis?

A

Delayed wound healing
Biofilm produced by staph. Epidermidis protects pathogen from hosts defence and antibiotics.
Polymethacrylate cement inhibits white blood cell and complement function.

92
Q

What consequences are there from a bacterium causing septic arthritis in a joint?

A

Damage to articular cartilage due to organisms pathological properties or hosts immune response.

93
Q

What symptom triad do patients with septic arthritis usually present with?

A

Fever
Pain
Reduced range of motion

Also experience erythema, swelling, warmth of joint, tenderness

94
Q

How should septic arthritis be treated?

A

Aspiration of joint, aspirate should be sent for urgent microscopy, culture and sensitivities.
Septic arthritis carries a high morbidity.

MSK (17 decks)

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