Soft Tissue Knee Injuries

Question 1

Which meniscus is more flexible?

Answer 1

Lateral (the medial one is more fixed)

Question 2

Purpose of menisci?

Answer 2

Distribute load from the convex femoral condyles to the relatively flat tibial articular surfaces

Question 3

A valgus stress on the knee will damage…

Answer 3

MCL

Question 4

A varus stress on the knee will damage…

Answer 4

LCL

Question 5

What are the function(s) of the ACL?

Answer 5

1) Prevent anterior subluxation of tibia

2) Prevent internal rotation of tibia in knee extension

Question 6

What are the function(s) of the PCL?

Answer 6

1) Prevent posterior subluxation of the tibia

2) Prevent knee hyperextension

Question 7

Instability descending stairs and recurrent hyperextension suggest damage to which ligament?

Answer 7

PCL

Question 8

Rotatory instability of the tibia suggests damage to which ligament?

Answer 8

ACL

Question 9

In young patients, meniscal tears tend to be traumatic/atruamatic?

Answer 9

Traumatic

Question 10

50% of ACL ruptures will also have what injury

Answer 10

Meniscal tear

Question 11

What’s the imaging modality of choice for meniscal tears?

Answer 11

MRI

Question 12

Most common area of meniscal tear

Answer 12

Medial

Question 13

T/F: The meniscus generally has good healing potential.

Answer 13

False - only the peripheral 1/3rd of it has a blood supply. Radial tears will not heal at all.

Question 14

Which surgery is useful in acute peripheral meniscal tears in young patients?

Answer 14

Arthroscopic repair

Question 15

An arthroscopic menisectomy should be considered if what is present with meniscal tear?

Answer 15

Symptoms of locking or failed repair

Question 16

An acute locked knee signifies what type of meniscal tear?

Answer 16

Bucket-handle tear

Question 17

Degenerate tears are common in which group of patients?

Answer 17

> 50 (grey hair - meniscal tear)

Question 18

Degenerate tears of the meniscus usually are the 1st indicator of which other disease

Answer 18

OA

Question 19

What are the 3 grades of knee ligament injury?

Answer 19

Grade 1 = sprain
Grade 2 = partial tear
Grade 3 = complete tear

Question 20

MCL tear treatment options

Answer 20

Brace, early motion and physio.

Most resolve very well without surgery.

Question 21

T/F: ACL repairs are more common than reconstruction.

Answer 21

False - repairs usually don’t work, reconstruction is the mainstay

Question 22

What tendons can be used in an ACL reconstruction?

Answer 22

Patellar or semitendinosus tendon. 
Achilles tendon (less similar).

Question 23

What is the “rule of 1/3rds” in reference to ACL?

Answer 23

1/3rd do well, 1/3rd can avoid instability, 1/3rd get frequent instability

(younger patients more likely to have poorer outcomes)

Question 24

What % of ACL injuries have to have surgery?

Answer 24

40%

Question 25

What is the main indication for surgery in ACL rupture?

Answer 25

Rotatory instability not responding to therapy.

Question 26

ACL reconstruction means how long in rehab?

Answer 26

3 months to 1 year

Question 27

LCL injury commonly gives damage to which nerve?

Answer 27

Common fibular nerve

Question 28

LCL tends to heal well by itself, T/F?

Answer 28

False - doesn't heal well and often leads to varus and rotatory instability if not corrected

Question 29

A direct blow to the anterior tibia OR a hyperextension injury is likely to damage which structure?

Answer 29

PCL

Question 30

How is complete knee dislocation treated?

Answer 30

ORIF (emergency due to risk of compartment syndrome and common fibular nerve injury)

Question 31

Risk factors for patellar dislocation (4)

Answer 31

1) Female sex 2) Adolescent age 3) Ligamentous laxity 4) Valgus knee

Question 32

A fall onto the flexed knee with quadriceps contracted is likely to cause which type of injury

Answer 32

Extensor mechanism rupture

Question 33

What are the risk factors for extensor mechanism rupture?

Answer 33

Tendonitis, steroids, chronic renal failure, fluroquinolones (ciprofloxacin)

Question 34

Extensor mechanism rupture can be managed conservatively, T/F?

Answer 34

False - needs surgery to correct

Question 35

Which ligament damage: valgus force?

Answer 35

MCL

Question 36

Which ligament damage: twisting?

Answer 36

ACL or meniscal injury

Question 37

Which ligament damage: varus?

Answer 37

LCL

Question 38

Dashboard or hyperextension injury will damage which ligament?

Answer 38

PCL

Question 39

Getting up from squatting will damage which structure?

Answer 39

Meniscus

Question 40

Spot diagnosis: football injury, twist and pop, haemarthrosis, generalised knee pain, pain settles after a few days but rotatory instability present.

Answer 40

ACL rupture

Question 41

Spot diagnosis: getting up from squatting, sudden sharp pain in medial joint line, effusion, recurrent medial pain & locking?

Answer 41

Meniscal tear (bucket handle-possible)

Question 42

Which cartilage covers the surface of the bones in synovial joints?

Answer 42

Hyaline cartilage

Question 43

T/F: Partial articular cartilage injuries will heal quickly.

Answer 43

False - only full thickness injuries tend to heal.

Question 44

What is the underyling pathology of osteochondritis dessecans?

Answer 44

An area of the surface of the knee loses it blood supply and cartilage (plus bone sometimes) can fragment off.

Question 45

Treatment of choice for osteochondritis dessecans?

Answer 45

Pinning if detaching

Question 46

Will osteochondritis dessecans continue to progress to further injury?

Answer 46

Sometimes - can also heal or resolve spontaneously.

Question 47

All cartilage regeneration techniques will heal with what

Answer 47

Fibrocartillage

Question 48

Most common cartilage regeneration technique

Answer 48

Drilling

Question 49

Contraindications to cartillage regeneration

Answer 49

Radiographic signs of OA, inflammatory arthritis, joint instability.

Question 50

What's a surgical treatment option for early knee OA?

Answer 50

Osteotomy - only if varus knee with pure medial OA.

Question 51

Knee replacements should be given as early as possible in OA, T/F?

Answer 51

False - wait for end-stage arthritis.

Question 52

What has a better success rate: partial or total knee replacement?

Answer 52

TKR

Question 53

How long should a TKR usually last?

Answer 53

15-20 years

Question 54

T/F: ACL reconstruction surgery involves drilling into the femur.

Answer 54

True