soft tissue knee injuries Flashcards
how do meniscal tears usually occur
- usually sporting injury in younger patients or getting up from squatting position
- atraumatic spontaneous degenerate tears in old patients
symptoms of meniscal tear
pain and tenderness localized to joint line
what are the four types of meniscal tears
- longitudinal tears
- radial tears
- bucket handle tear
- parrot beak tear
which type of tear wont heal
radial
what should you consider for acute traumatic peripheral meniscal tears in young people
arthroscopic meniscal repair
when would you consider arthroscopic meniscectomy
for irreparable tears with recurrent pain, effusion or mechanical symptoms which fail to settle
what type of tear does an acute locked knee signify
displaced bucket handle meniscal tear
urgent surgery required
what causes degenerate tears
meniscus weakens with age and can tear spontaneously
what type of stress does MCL resist
valgus stress
what type of stress does LCL resist
varus stress
what does ACL resist
anterior subluxation of the tibia and internal rotation of the tibia in extension
what does PCL resist
posterior subluxation of the tibia
what are the three grades of knee ligament injuries
grade 1 - sprain - tear some fibres but macroscopic structure intact
grade 2 - partial tear
grade 3 - complete tear
what can MCL rupture lead to
valgus instability
what can ACL rupture lead to
rotatory instability
what can PCL rupture lead to
recurrent hyperextension or instability descending stairs
treatment for MCL injury
- brace
- early motion
- physio
requirement for ACL rupture stabilization
time and physio
when is surgery considered in ACL rupture
rotatory instability not responding to physio
how long is the recovery for ACL reconstruction
3/12 to 1 year rehab
how does LCL injury usually happen
varus and hyperextension
how do PCL ruptures happen
direct blow to anterior tibia or hyperextension injury
cause of patellar dislocation
rapid turn or direct blow
causes of patellofemoral pain syndrome
- muscle imbalance
- tightness of lateral tissues
- bony malalignment
- flat feet
cause of extensor mechanism rupture
fall onto flexed knee with quads contraction - rupture quads or patellar tendon
what is osteochondritis dissecans
an area of the surface of the knee loses its blood supply and cartilage +/- bone can fragment off
cause of bone bruising/bone marrow oedema
impaction to articular surface leads to microscopic fracture of trabecular bone with bleeding and inflammation
cause of loose bodies
- trauma
- OCD
- joint degeneration
what can happen to loose bodies in the joint
they can grow overtime getting nutrition from synovial fluid and may cause painful locking or catching
some can stick to synovium or fat pad
which bone is commonly misdiagnosed as a loose body
the fabella
what do you do when the pain or swelling is worse than examination and x-rays
MRI to look for unusual pathology
what do you do when the pain or swelling is worse than examination and x-rays
MRI to look for unusual pathology
whats the diagnosis:
football injury, twist, pop, haemarthrosis, generalised pain, pain settles after a few days, rotatory instability
ACL rupture
diagnosis?:
getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain and catching +/- locking
meniscal tear
