Soft tissue knee injuries Flashcards
Which meniscal tears are most common?
Medial meniscal tears
Why are medial meniscal tears most common?
Medial is more fixed, less mobile
Pivoting force centred on medial
When do meniscal injuries classically occur?
Twisting force on loaded knee
Where is pain in meniscal tears?
Localized to medial (majority) or lateral joint line with effusion the following day
Clinical features of meniscal tears?
Effusion Joint line tenderness & pain Pain on tibial rotation (Steinmann's test) Locked knee \+ve meniscal provocation test
Variations of meniscal tears?
Longitdunal Radial Oblique Horizontal Bucket handle
“Bucket handle tear”?
Large meniscal fragment is able to flip out normal position and displace anteriorly or into intercondylar notch where knee locks
Unable to fully extend
Investigations for meniscal tears?
MRI
Management of meniscal tears?
Arthroscopic meniscal repair (only in acute, longitudinal (peripheral) tears involving outer 1/3)
When is arthroscopic meniscectomy considered?
For irreparable tears with recurrent pain, effusion or mechanical symptoms (clicking, locking etc) if doesn’t settle for 3 months or if degenerate changes on radiology
Treatment for acute locked knee from displaced bucket handle meniscal tear?
Urgent surgery
If irreparable -> partial meniscectomy
Has the meniscus got good healing potential and why?
No
Only has blood supply in outer 1/3
Degenerate meniscal tears?
As meniscus weakens with age
Spontaneous to innocuous injury
Steinmann negative
Treatment for degenerate meniscal tears?
No improvement with resection and not treated with arthroscopy
History for ACL rupture?
High rotational force leading to internal rotation force on tibia in high impact sport
“Pop” heard
ACL?
Main stabiliser against internal rotation of tibia
Clinical features of ACL rupture?
Haemarthrosis within hour of injury
Deep pain in knee
Chronic rotatory instability (knee goes way when turning on planted foot)
Clinical examination in ACL rupture?
Knee swelling (haemarthrosis or effusion) Excessive anterior translation of tibia on anterior drawer test & Lachman test
Management of ACL rupture?
Primary repair not effective
Reconstruction
When is ACL reconstruction considered?
Straight away for sports people who need to get back asap
If knee gives way on sedentary activity
Strong desire to get back to high impact sport but cannot despite physio
PCL rupture?
Direct blow to anterior tibia or hyperextension injury Isolated rare (usually with another injury)
Clinical features of PCL rupture?
Popilteal knee pain & bruising
Recurrent hyperextension or feeling unstable going down stairs
Management of PCL rupture?
Most isolated ones do not need reconstruction
If part of multiple- ligament knee injury -> reconstruction
MCL injuries?
Uncommon, MCL is a forgiving knee ligament
Healing is expected
Clinical features of MCL tears?
Laxity
Pain on valgus stress with tenderness over origin or insertion of MCL
Treatment of acute MCL tears?
Hinged knee brace
Treatment of chronic MCL instability?
MCL tightening (advancement) or reconstruction with tendon graft
LCL tears common or uncommon?
Uncommon
Clinical features of LCL tears?
Marked instability on rotational movement
Peroneal nerve injury
Often part of multilligament injuries
Vascular injury (popliteal artery. intimal or complete tear)
Does LCL teat heel well?
Doesn’t heal
Can cause virus and rotator instability
Treatment for LCL tears?
Usually surgical with early repair or late reconstruction with tendon graft
Combined knee ligament ruptures & dislocation?
Often require surgical reconstruction
Management of complete knee dislocations?
Reduced as emergency
External fixation for temporary stabilization
Check for neurovascular injury
Check feet
If concern with distal circulation after complete combined knee ligament rupture and dislocation?
Vascular surgery assessment & vascular stenting or bypass may be required
What can reperfusion cause?
Compartment syndrome
What do combined knee ligament and dislocations usually require?
Multiple ligament reconstruction
Complications of knee dislocation?
Popliteal artery injury (tear, intimal tera, thrombosis)
Nerve injury - common perineal nerve
Compartment syndrome
Management of knee dislocation?
Emergency reduction
Recheck neuromuscular status
May need ex-fix for temporary stabilisation
Multiligament reconstruction after
