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Year 2 > Soft tissue knee injuries > Flashcards

Soft tissue knee injuries Flashcards

1
Q

What are the two collateral ligaments of the knee?

A

Lateral collateral ligament

Medial collateral ligament

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2
Q

What are the two cruciate ligaments of the knee?

A

Anterior cruciate ligament

Posterior cruciate ligament

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3
Q

What are the two meniscus of the knee?

A

Medial meniscus

Lateral meniscus

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4
Q

Which bones are involved in the knee joint?

A

Femur
Tibia
Fibula
Patella

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5
Q

What are the two fibres which compose the meniscus?

A

Longitudinal fibres

Radial fibres

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6
Q

Describe the blood supply to the meniscus

A

Only the most peripheral 1/3 of the meniscus has a direct blood supply

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7
Q

Are medial or lateral meniscal tears more common? Why?

A

Medial. The medial meniscus is under a greater amount of sheer stress

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8
Q

What is the function of the menisci?

A

Distribute load from the convex femoral condyles to the relatively flat tibial plateaus

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9
Q

Why does the medial meniscus undergo a greater amount of sheer stress?

A

Knee pivots on medial compartment of the knee during flexion and extension

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10
Q

Which is more mobile the lateral or medial meniscus?

A

Lateral meniscus (medial is fixed)

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11
Q

How does the tibia move during flexion and extension?

A

Flexion - internal rotation

Extension - external rotation

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12
Q

Which forces do the collateral ligaments resist?

A

Medial - valgus stress

Lateral - varus stress

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13
Q

Which forces do the cruciate ligaments resist?

A

Anterior - anterior subluxation of tibia & internal rotation of the tibial in extension
Posterior - posterior subluxation of the tibia (i.e anterior subluxation of the femur and hyperextension of the knee)

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14
Q

Which structures resist external rotation of the tibia in flexion?

A

Posterolateral corner - posterior cruciate, lateral collateral and popliteus

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15
Q

Describe the anatomy of the medial collateral ligament

A

Broad and thin

Excellent blood supply

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16
Q

Describe the anatomy of the lateral collateral ligament

A

Thick and cord like

Poor blood supply

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17
Q

Which collateral ligament of the knee usually heals on its own?

A

Medial

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18
Q

What type of instability does medial collateral ligament rupture cause?

A

Valgus

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19
Q

What type of instability does anterior cruciate ligament rupture cause?

A

Rotatory instability

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20
Q

What type of instability does posterior cruciate ligament rupture cause?

A

Recurrent hyperextension

Difficulty descending stairs

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21
Q

What type of instability does posterolateral corner rupture cause?

A

Varus

Rotatory

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22
Q

What are the types of meniscal tears?

A

Longitudinal
Radial
Bucket handle
Parrot beak

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23
Q

Which type of meniscal tear can cause knee locking?

A

Bucket handle

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24
Q

Which type of meniscal tear may heal on its own?

A

Longitudinal (if very peripheral)

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25
Q

What is the typical history of meniscal tears in younger patients?

A

Traumatic - sporting injury / getting up from squatting

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26
Q

What is the typical history of meniscal tears in older patients (>40)?

A

Atraumatic degenerative

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27
Q

What are meniscal tears associated with?

A

ACL rupture

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28
Q

How are meniscal tears investigated?

A

MRI

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29
Q

How can peripheral tears be managed?

A

Arthroscopic repair in younger patients with extensive rehab
(often fails)

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30
Q

How does the pain progress with meniscal tears?

A

Initial pain may settle

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31
Q

When is an arthroscopic menisectomy considered for meniscal tears?

A

Mechanical symptoms (painful locking)
Irreparable tears
Failed repair

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32
Q

How do you know which menisci you’re looking at on an MRI?

A

Look for the bones - if tibia then probably medial meniscus

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33
Q

What is the cause of an acute locked knee?

A

Displaced bucket handle meniscal tear

34
Q

How does a displaced bucket handle meniscal tear present?

A

Springy 15 degree block to extension

35
Q

How should a displaced bucket handle meniscal tear be managed? Why?

A

Surgery (arthroscopic repair or partial menisectomy)

Prevent further damage to knee joint and resolve locking

36
Q

What may develop of a displaced bucket handle meniscal tear is not treated?

A

Fixed flexion deformity

37
Q

What can be seen on an MRI that indicates meniscal tear?

A

Double PCL sign

Gap in meniscus

38
Q

How common are degenerative meniscal tears?

A

Common

39
Q

How do degenerative meniscal tears present?

A

Often asymptomatic

40
Q

How should degenerative meniscal tears be managed?

A

Conservatively (pain will settle)
Injection to help pain
Surgery for mechanical symptoms (NOT PAIN)

41
Q

Describe the grading system of ligament tears

A

Grade 1 - Sprain (macroscopic structure intact)
Grade 2 - Fascicles disrupted
Grade 3 - Complete tear

42
Q

What is the typical history of a medial collateral ligament tear?

A

Valgus stress (sport tackles, etc)

43
Q

How are MCL tears managed?

A

Bracing
Early motion
Physiotherapy

Surgery if combined injury/unstable knee

44
Q

What are the surgical options for MCL tears?

A

Advancement

Tendon graft

45
Q

How does the pain progress with MCL tears? Why?

A

Can take several months to settle

MCL has good innervation

46
Q

What is the typical history of an anterior cruciate ligament tear?

A

Sports (rugby, football, skiing)

Twisting injury

47
Q

How are ACL tears managed?

A 
Bracing and/or Physiotherapy (elderly)
Surgical reconstruction (younger)
48
Q

What are the different surgical approaches to ACL tears?

A

Autograft - hamsting or patellar

Allograft - achilles

49
Q

How can the ACL self stabilise?

A

By sticking to the PCL

50
Q

Describe the rule of 1/3rds as it relates to ACL tears

A

1/3 - compensate
1/3 - compensate if avoiding certain activities
1/3 - cannot compensate and cannot return to high impact sport

51
Q

Which type of patient is more likely to compensate following and ACL rupture?

A

Older (+ more likely to avoid impact sport)

52
Q

What are the indications for ACL surgery?

A 
Younger
High impact sport
High demand
Rotatory instability not responding to physiotherapy 
Protect meniscal repair
Part of multi-ligament repair
53
Q

What does ACL surgery not do?

A

Treat pain

Prevent arthritis

54
Q

What are the possible consequences of ACL tear and surgery?

A

Stiffness
Infection
Donor site morbidity
Post traumatic arthritis

55
Q

How common is lateral collateral ligament tear?

A

Uncommon

56
Q

What is the typical history of LCL tear?

A

Varus forces

Hyperextension injury

57
Q

Does the LCL heal?

A

No

58
Q

What are the consequences of a non-healing LCL?

A

Varus and rotatory instability

59
Q

What is associated with LCL tear?

A

Common peroneal nerve injury
ACL rupture
PCL rupture

60
Q

How is LCL tear managed?

A 
Surgical repair (caught early)
Surgical reconstruction (caught late)
61
Q

What is the typical history of a posterior cruciate ligament rupture?

A

Direct blow to anterior tibia (dashboard, motorcycle)

Hyperextension injury

62
Q

How might a PCL tear present?

A

Popliteal pain and bruising

63
Q

How common is a PCL tear?

A

Uncommon in isolation

64
Q

How is PCL tear managed?

A

Conservative if isolated

Surgical reconstruction if marked instability or as part of multi-ligament reconstruction

65
Q

How does PCL instability present?

A

Instability when going down stairs

Recurrent hyperextension

66
Q

Is knee dislocation a high or low energy injury?

A

High

67
Q

Knee dislocation has a high incidence of complications. What are these?

A

Popliteal artery injury (intimal tear, thombosis)
Common peroneal nerve injury
Compartment syndrome

68
Q

How should a knee dislocation be managed?

A

Emergency reduction
Neurovascular status +/- vascular surgery
Ex-fix for temporary stabilisation
Multi-ligament reconstruction

69
Q

What is the typical history of a patellar dislocation?

A

Sudden turn

Direct blow

70
Q

Who is most at risk of patellar dislocation?

A 
Females
Ligament laxity 
Valgus deformity 
Adolescents 
Torsional abnormalities
71
Q

What is the risk of recurrent dislocation of the patella?

A

Low (10%)

72
Q

Patellar dislocation can cause chondral or osteochondral damage. T/F

A

True

73
Q

How is patellar dislocation treated?

A

Conservatively

Rarely surgical stabilisation

74
Q

What is the typical history of a extensor mechanism rupture?

A

Fall onto flexed knee with quadriceps contraction

75
Q

Who is at highest risk of extensor mechanism rupture?

A 
Steroids
Chronic renal failure
Ciprfloxacin 
Previous tendonitis 
Rheumatoid arthritis
76
Q

What should be found on examination of a patient with extensor mechanism rupture?

A

Unable to straight leg raise
Palpable gap
High or low riding patella depending on injury site

77
Q

How is extensor mechanism rupture treated?

A

Surgical repair

78
Q

Which ligament rupture will commonly cause a pop or crack?

A

ACL

79
Q

Which injuries will produce a haemarthrosis?

A

ACL

Fracture

80
Q

Which injuries will produce an effusion?

A

Meniscal

Chondral

81
Q

How will a haemarthrosis be described in the history?

A

Sensation of filling up

Year 2 (72 decks)

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