Soft Tissue Knee Injuries

Question 1

is meniscus vascular or avascular?

Answer 1

only blood supply outer third, so largely avascular

Question 2

where are nerves in meniscus?

Answer 2

peripheral attachment

Question 3

how is meniscus usually injured?

Answer 3

usually sporting or getting up from squatting position in younger patients

Question 4

what meniscal damage do middle aged patients tend to get?

Answer 4

atraumatic degenerative tears

Question 5

how do meniscal tears typically present?

Answer 5

pain and tenderness localised to joint line (can have inflammatory involvement)

Question 6

how do you investigate meniscal tears?

Answer 6

MRI

Question 7

how much more common are medial meniscal tears to lateral meniscal tears?

Answer 7

9-10 times

Question 8

what is the healing potential of meniscal tears?

Answer 8

limited. only peripheral 1/3 has blood supply, radial tears don’t heal. pain from the injury might settle

Question 9

what treatment method for acute traumatic peripheral meniscal tears in younger patients?

Answer 9

arthroscopic meniscal repair

Question 10

what treatment method for people with irreparable tears with recurrent pain, effusion or mechanical symptoms?

Answer 10

arthroscopic meniscectomy

Question 11

what tear usually signifies acute locked knee syndrome

Answer 11

displaced bucket handle meniscal tear

Question 12

what is a locked knee

Answer 12

inability to fully extend knee

Question 13

what happens if the knee remains locked

Answer 13

patient may develop fixed flexion contracture

Question 14

what happens in degenerate tears of the meniscus

Answer 14

meniscus weakens over time and can tear spontaneously

Question 15

what do degenerate tears tend to signify

Answer 15

first stage of OA (loss of shock absorbers lead to increased pressure)

Question 16

what does the pain usually originate from in degenerate tears

Answer 16

bone marrow oedema and synovitis

Question 17

what can help degenerative tears

Answer 17

injection of corticosteroids or antiinflammatories

Question 18

why is arthroscopic meniscectomy ineffective for degenerative tears

Answer 18

ineffective for pain, only for unstable tears with mechanical symptoms

Question 19

what ligament tears heal very well

Answer 19

MCL due to high vascularisation

Question 20

what can be used to treat MCL tears

Answer 20

brace, physio, early motion (rarely surgery)

Question 21

what does ACL rupture usually come from

Answer 21

sports injuries

Question 22

what is characteristic of ACL tear

Answer 22

‘pop’, swelling within hour and giving way on turning

Question 23

treatment for ACL tears

Answer 23

time and physio

Question 24

how good is survival rate

Answer 24

1/3 compensate well, 1/3 avoid instability by behaviour avoidance and 1/3 don’t compensate and have frequent instability

Question 25

what is the percentage of ACL tears that need reconstruction

Answer 25

50%

Question 26

what does reconstruction involve

Answer 26

surgical stabilisation with graft (hamstrings and patellar tendon) repair doesn’t work

Question 27

what is involved in the diagnosis of ACL tears

Answer 27

positive lachman and anterior drawer test

Question 28

which ligament injury is uncommon

Answer 28

LCL

Question 29

which mechanism of injury occurs for LCL injuries

Answer 29

varus and hyperextension

Question 30

do LCL injuries heal

Answer 30

no

Question 31

what do LCL injuries normally result in

Answer 31

varus and rotatory instability, perineal nerve palsy

Question 32

what ligament injuries commonly occur with LCL injuries

Answer 32

ACL and PCL