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Musculoskeletal > Soft tissue knee injuries > Flashcards

Soft tissue knee injuries Flashcards

1
Q

Which meniscal tears are most common?

A

Medial meniscal tears

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2
Q

Why are medial meniscal tears most common?

A

Medial is more fixed, less mobile

Pivoting force centred on medial

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3
Q

When do meniscal injuries classically occur?

A

Twisting force on loaded knee

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4
Q

Where is pain in meniscal tears?

A

Localized to medial (majority) or lateral joint line with effusion the following day

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5
Q

Clinical features of meniscal tears?

A 
Effusion
Joint line tenderness & pain
Pain on tibial rotation (Steinmann's test)
Locked knee 
\+ve meniscal provocation test
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6
Q

Variations of meniscal tears?

A 
Longitdunal
Radial
Oblique
Horizontal
Bucket handle
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7
Q

“Bucket handle tear”?

A

Large meniscal fragment is able to flip out normal position and displace anteriorly or into intercondylar notch where knee locks
Unable to fully extend

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8
Q

Investigations for meniscal tears?

A

MRI

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9
Q

Management of meniscal tears?

A

Arthroscopic meniscal repair (only in acute, longitudinal (peripheral) tears involving outer 1/3)

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10
Q

When is arthroscopic meniscectomy considered?

A

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

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11
Q

Treatment for acute locked knee from displaced bucket handle meniscal tear?

A

Urgent surgery

If irreparable -> partial meniscectomy

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12
Q

Has the meniscus got good healing potential and why?

A

No

Only has blood supply in outer 1/3

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13
Q

Degenerate meniscal tears?

A

As meniscus weakens with age
Spontaneous to innocuous injury
Steinmann negative

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14
Q

Treatment for degenerate meniscal tears?

A

No improvement with resection and not treated with arthroscopy

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15
Q

History for ACL rupture?

A

High rotational force leading to internal rotation force on tibia in high impact sport
“Pop” heard

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16
Q

ACL?

A

Main stabiliser against internal rotation of tibia

17
Q

Clinical features of ACL rupture?

A

Haemarthrosis within hour of injury
Deep pain in knee
Chronic rotatory instability (knee goes way when turning on planted foot)

18
Q

Clinical examination in ACL rupture?

A 
Knee swelling (haemarthrosis or effusion) 
Excessive anterior translation of tibia on anterior drawer test & Lachman test
19
Q

Management of ACL rupture?

A

Primary repair not effective

Reconstruction

20
Q

When is ACL reconstruction considered?

A

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

21
Q

PCL rupture?

A 
Direct blow to anterior tibia or hyperextension injury
Isolated rare (usually with another injury)
22
Q

Clinical features of PCL rupture?

A

Popilteal knee pain & bruising

Recurrent hyperextension or feeling unstable going down stairs

23
Q

Management of PCL rupture?

A

Most isolated ones do not need reconstruction

If part of multiple- ligament knee injury -> reconstruction

24
Q

MCL injuries?

A

Uncommon, MCL is a forgiving knee ligament

Healing is expected

25
Q

Clinical features of MCL tears?

A

Laxity

Pain on valgus stress with tenderness over origin or insertion of MCL

26
Q

Treatment of acute MCL tears?

A

Hinged knee brace

27
Q

Treatment of chronic MCL instability?

A

MCL tightening (advancement) or reconstruction with tendon graft

28
Q

LCL tears common or uncommon?

A

Uncommon

29
Q

Clinical features of LCL tears?

A

Marked instability on rotational movement
Peroneal nerve injury
Often part of multilligament injuries
Vascular injury (popliteal artery. intimal or complete tear)

30
Q

Does LCL teat heel well?

A

Doesn’t heal

Can cause virus and rotator instability

31
Q

Treatment for LCL tears?

A

Usually surgical with early repair or late reconstruction with tendon graft

32
Q

Combined knee ligament ruptures & dislocation?

A

Often require surgical reconstruction

33
Q

Management of complete knee dislocations?

A

Reduced as emergency
External fixation for temporary stabilization
Check for neurovascular injury
Check feet

34
Q

If concern with distal circulation after complete combined knee ligament rupture and dislocation?

A

Vascular surgery assessment & vascular stenting or bypass may be required

35
Q

What can reperfusion cause?

A

Compartment syndrome

36
Q

What do combined knee ligament and dislocations usually require?

A

Multiple ligament reconstruction

37
Q

Complications of knee dislocation?

A

Popliteal artery injury (tear, intimal tera, thrombosis)
Nerve injury - common perineal nerve
Compartment syndrome

38
Q

Management of knee dislocation?

A

Emergency reduction
Recheck neuromuscular status
May need ex-fix for temporary stabilisation
Multiligament reconstruction after

Musculoskeletal (12 decks)

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