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Y2 - MSK > Soft Tissue Knee Injuries > Flashcards

Soft Tissue Knee Injuries Flashcards

1
Q

What are the ligaments of the knee?

A

Lateral collateral
Medial collateral
Anterior cruciate
Posterior cruciate

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2
Q

What is extensor mechanism rupture?

A

Rupture of the quads tendon or patellar tendon, or patellar fracture

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3
Q

What is extensor mechanism rupture caused by?

A

Fall onto flexed knee with quads contraction

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4
Q

What are factors that predispose to extensor mechanism rupture?

A

Previous tendonitis
Steroids
Chronic renal failure
Ciprofloxacin

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5
Q

How does extensor mechanism rupture present?

A

Inability to straight leg raise
Palpable gap proximal or distal to the patella
Marked weakness, disability and lack of function in late presentation

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6
Q

What is the treatment for extensor mechanism rupture?

A

Surgical repair

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7
Q

How much of the menisci have blood supply?

A

Outer third

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8
Q

How much of the menisci have nerves?

A

The peripheral attachment

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9
Q

What is the function of the menisci?

A

They distribute load from femoral condyles to articular surfaces

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10
Q

Are the menisci fixed or mobile?

A

Medial is fixed

Lateral is more mobile

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11
Q

Which meniscus is under more sheer stress?

A

Medial

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12
Q

Who usually get meniscal tears, and how are they caused in the different groups?

A 
Younger patients - sporting injury or getting up from squatting position
Older patients (>40) - atraumatic spontaneous degenerate tears
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13
Q

How do meniscal tears present?

A

Pain and tenderness localised to the joint line

Positive meniscal provocation tests (not always reliable)

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14
Q

Should you do investigation if you suspect meniscal tear?

A

Yes - MRI

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15
Q

Which meniscal tears are more common?

A

Medial (10 times)

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16
Q

What are the different patterns of meniscal tear?

A

Longitudinal tear
Bucket handle tear
Radial tear
Parrot beak tear

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17
Q

What is a longitudinal meniscal tear?

A

One that follows the curve of the meniscus

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18
Q

What can a longitudinal meniscal tear progress to?

A

Can fragment and flick out of position causing a bucket handle meniscal tear

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19
Q

What are the clinical signs of a bucket handle meniscal tear?

A

Acute locked knee

15˚ springy block to extension (can extend it passively but it will spring back to around 15˚)

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20
Q

What is the treatment for a bucket handle meniscal tear?

A

Surgery - arthroscopic repair

Ir irreparable needs partial meniscectomy to unlock knee and prevent further damage

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21
Q

What is the best investigation to show meniscal tears?

A

MRI

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22
Q

What is a radial meniscal tear?

A

A tear from the inside of the knee into the meniscus

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23
Q

Will a radial meniscal tear heal by itself?

A

No - area is avascular

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24
Q

What are the surgical options for radial meniscal tears?

A

Arthroscopic meniscal repair

Arthroscopic meniscectomy

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25
Q

When is arthroscopic meniscal repair considered?

A

Acute traumatic peripheral tears in a younger patient

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26
Q

When is arthroscopic meniscectomy done?

A

Mechanical symptoms
Irreparable tears
Failed meniscal repair

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27
Q

What are degenerate meniscal tears?

A

A tear in the meniscus caused by the meniscus weakening with age and tearing spontaneously
Common, many are asymptomatic

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28
Q

What do degenerate meniscal tears lead to, and how?

A

OA

Loss of shock absorber increases pressure on surfaces, leading to OA

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29
Q

What are the secondary effects of degenerate meniscal tears, and what symptom do they cause?

A

Bone marrow oedema, synovitis

Pain

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30
Q

What is the treatment for degenerate meniscal tears?

A

Surgery not as successful
Steroid injection may help
Analgesia

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31
Q

What is the function of the medial collateral ligament?

A

MCL resists valgus stress

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32
Q

What is the function of the lateral collateral ligament?

A

LCL resists varus stress

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33
Q

What is the function of the anterior cruciate ligament?

A

ACL resists anterior subluxation of the tibia and internal rotation of the tibia in extension

34
Q

What is the function of the posterior cruciate ligament?

A

PCL resists posterior subluxation of the tibia and hyperextension of the knee

35
Q

What is the posterolateral corner?

A

The PCL and LCL with other smaller ligaments

36
Q

What is the function of the posterolateral corner?

A

Resists external rotation of the tibia in flexion

37
Q

What is a grade one ligament injury?

A

Sprain - tears some fibres but macroscopic structure is still intact

38
Q

What is a grade two ligament injury?

A

Partial tear - some fascicles disrupted

39
Q

What is a grade three ligament injury?

A

Complete tear of a ligament

40
Q

Are lateral or medial ligament injuries more likely to heal?

A

Medial

41
Q

What does MCL rupture lead to?

A

Valgus instability

42
Q

What does an ACL rupture lead to?

A

Rotatory instability

43
Q

What does a PCL rupture lead to?

A

Recurrent hyperextension or instability descending stairs

44
Q

What does a posterolateral corner rupture lead to?

A

Varus or rotatory instability

45
Q

What is the treatment for a MCL injury?

A 
Brace,  early motion, physio
Rarely surgery (reconstruction  with tendon graft)
46
Q

What is the presentation of an ACL injury?

A

Usually sports injury
Classic history of ‘pop’, haemarthrosis and giving way on turning
Positive Lachman’s test
Positive anterior draw test

47
Q

How are ligament injuries diagnosed?

A

MRI

48
Q

What is the treatment for ACL injuries?

A

Surgical reconstruction and replacement with graft

Physio

49
Q

What is the prognosis for ACL injuries?

A

1/3 compensate and function well
1/3 avoid instability by avoiding certain activities
1/3 do not compensate, have frequent instability

50
Q

What is the indication for surgery in ACL injury?

A

Rotatory instability or not responding to physio
To protect meniscal repair from failing
Rapid return to professional sport or high demand job
As part of multi-ligament reconstruction

51
Q

What are the downsides of surgery for ACL injury?

A

Does not treat pain
Does not prevent arthritis
Doesn’t always work

52
Q

What can LCL injury lead to?

A

Doesn’t heal

Common perineal nerve palsy

53
Q

What is the treatment for LCL injury?

A

Urgent repair if early

If later will need reconstruction

54
Q

What can cause a PCL rupture?

A

Direct blow to anterior tibia or hyperextension injury

55
Q

How does a PCL injury present?

A

Popliteal knee pain and bruising

May have posterior sag of the tibia and hyperextension of the knee

56
Q

Do PCL injuries usually occur with other ligament injury?

A

Yes - isolates PCL rupture is rare

57
Q

What is the treatment for PCL injury?

A

Surgical reconstruction as it is usually part of multi-ligament injury
But doesn’t need surgery is isolated

58
Q

What are the complications of a knee dislocation?

A

Popliteal artery injury
Nerve injury (common perineal nerve)
Compartment syndrome

59
Q

What is the difference between a knee dislocation and a patellar dislocation, and which is more common?

A

Knee - dislocation of the tibial femoral joint

Patellar - dislocation of the patella (more common)

60
Q

Which way does the patella dislocate?

A

Laterally

61
Q

What is a patellar dislocation caused by?

A

Rapid turn or direct blow

62
Q

What are risk factors for patellar dislocations?

A 
Females
Adolescents
Ligamentous laxity
Valgus knee
Torsional abnormalities
63
Q

What complication can patellar dislocation cause?

A

Chondral or osteochondral injury if there is a dislodged bone fragemnt

64
Q

What treatment can be done for patellar dislocation?

A

Surgical stabilisation (medial patellar femoral ligament reconstruction)

65
Q

What is patellofemoral pain syndrome?

A

Idiopathic adolescent anterior knee pain

66
Q

What can cause patellofemoral pain syndrome?

A

Muscle imbalance
Tightness of lateral tissues
Bony malalignment
Flat feet

67
Q

What is the treatment for patellofemoral pain syndrome?

A

Physio

Invasive bony surgery for most severe but results are unpredictable

68
Q

What is osteochondritis dissecans?

A

Where an area of the surface of the knee loses its blood supply and cartilage and/or bone can fragment off

69
Q

What is bone bruising/bone marrow oedema?

A

Impaction to articular surface leads to microscopic fracture of trabecular bone with bleeding and inflammation

70
Q

What is the treatment for bone bruising/bone marrow oedema?

A

None - will heal with time, typically in 3 months but can take over a year

71
Q

What are loose bodies?

A

Trauma, osteochondral dissecans and joint degeneration can cause a fragment of cartilage to detach, causing a loose body in the joint
They can grow over time, getting nutrition from synovial fluid and may cause painful locking or catching

72
Q

What is the presentation of loose bodies?

A

Mobile lump
Sharp occasionaal pain (should not be constant, generalised or severe)
Knee locking/catching

73
Q

What are Baker’s cysts and bursitis?

A

Common swellings around the knee

74
Q

What is the treatment for baker’s cysts and bursitis?

A

Leave alone - risk of wound problems and recurrence if remove

75
Q

What does haemarthrosis indicate?

A

ACL or fracture

76
Q

What does effusion indicate?

A

Meniscal or chondral injury

77
Q

What injury could be caused by getting up from squatting?

A

Meniscal tear

78
Q

What does pain at the joint line indicate?

A

Meniscal or chondral injury

79
Q

What is the most likely diagnosis in a football injury, twist, pop, haemarthrosis, generalised pain which settles after a few days., rotatory instability?

A

ACL rupture

80
Q

What is the most likely diagnosis in an injury when getting up from squatting, side sharp pain medial joint line, effusion, recurrent medial pain and catching +/- locking?

A

Meniscal tear

Y2 - MSK (9 decks)

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