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MSK > soft tissue knee injuries lecture > Flashcards

soft tissue knee injuries lecture Flashcards

1
Q

Which menisci is under greater stress and why?

A

Medial meniscus under greater amount of shear stress - Due to shape and soft tissues, knee pivots on medial compartment through flexion and extension.

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2
Q

What is the function of the MCL ?

A

Resists valgus stress

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3
Q

What is the function of LCL?

A

Resists varus stress

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4
Q

Whta is the function of the ACL?

A

Resists anterior subluxation of the tibia and internal rotation of the tibia in extension

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5
Q

What is the function of the PCL?

A

Resists posterior subluxation of the tibia ie anterior subluxation of the femur and hyperextension of the knee

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6
Q

What area resists external rotation of the tibia during flexion and what are the main structures which form this area?

A

The posterolateral corner – the PCL and LCL with popliteus and other smaller ligaments resist external rotation of the tibia in flexion

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7
Q

What may MCL rupture lead too?

A

vlagus instability

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8
Q

What may posterolateral corner rupture lead too?

A

Recurrent hyperextension or instability descending stairs

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9
Q

What vwould be seen if multiple ligaments are ruptured?

A

gross instability

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10
Q

Why can a longitudinal cartilage tear be repaired but a bucket handle tear cannot ?

A

Because the peripheral 1/3rd of cartilage has a blood supply hence longitudinal tears can be repaired and bucket handle ones cannot

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11
Q

Which menisci is more commonly torn?

A

the medial (10X’s more likely)

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12
Q

What do people who rupture their ACL commonly also injure?

A

approx 50% also have menisci tears

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13
Q

What is the common mechanism for meniscal injury?

A

Usually sporting injury in younger patients or getting up from squatting position in younger patients

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14
Q

In older patients (over 40) what type of meniscal injury are they also at risk of ?

A

Atraumatic spontaneous degenerate tears

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15
Q

What test is done to confirm the diagnosis of a meniscal injury?

A

MRI

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16
Q

Will radial catilage tears repair ?

A

No

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17
Q

In an acute peripheral cartilage tear in a younger patient what could be considered ?

A

Arthroscopic repair - up to 40% failure rate

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18
Q

For a meniscal tear which is irreparable or a failed meniscal repair - in which the patient is experiencing painful catching or locking, what could be considered to treat this ?

A

Arthroscopic menisectomy for mechanical symptoms

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19
Q

What does an acute locked knee signify ?

A

A displaced bucket handle meniscal tear -Patient will have 15 degree springy block to extension

20
Q

Describe the classification of grading knee ligament injuries

A
  • Grade 1 – sprain – tear some fibres but macroscopic structure intact
  • Grade 2 – partial tear - some fascicles disrupted
  • Grade 3 – complete tear
21
Q

Which ligament in the knee has a good blood suplpy and hence even when ruputured rarley requires surgery?

A

MCL usually heals well even if complete tear unless combined with ACL or PCL rupture

22
Q

What is the usual treatment for an injury to the MCL?

A
  • Brace
  • early motion
  • physio
23
Q

When is the ACL usually injured ?

A

Usually sports injury – football, rugby, skiing

24
Q

What is the treatment for an ACL rupture?

A

Usually reconstruction using:

  • Autograft – Patellar tendon or hamstrings
  • Allograft – Achilles
  • (synthetic graft)

Physio can also stabilise the knee

25
Q

What is the rule of 1/3rds in ACL rupture?

A

n1/3 compensate and are able to function well

n 1/3 can avoid instability by avoiding certain activities

n 1/3 do not compensate and have frequent instability or can’t get back to high impact sport

26
Q

What are the reasons for carrying out an ACL reconstruction ?

A
  • Rotatory instability not responding to physio
  • Protect meniscal repair
  • Rapid return to professional sport or high demand job
  • Adolescent or young adult - ?more reliable option
  • Keen on high impact sport
  • As part of multiligament reconstruction
27
Q

What is the duration of rehab following an ACL reconstruction ?

A

3/12 to 1 year

28
Q

After 10 years following an ACL reconstruction what do patients usually have on radiograph?

A

Arthritic changes

29
Q
A
30
Q

Injury to LCL causes what?

A

varus instability and hyperextension

31
Q

In LCL injury what nerve is commonly damaged ?

A

High incidence common peroneal nerve palsy

32
Q

What does injury to LCL commonly occur with?

A

PCL or ACL injury

33
Q

What is the treatment for LCL rupture ?

A
  • Complete rupture needs urgent repair if early (within 2-3 wks)
  • Later à reconstruction (hamstring or other tendon)
34
Q

What is the common mechanism for injury to the PCL ?

A

Direct blow to anterior tibia, (Dashboard / Motorbike) or hyperextension injury

35
Q

Is it common to have an isolated rupture to the PCL ?

A

No - usually occurs with other injury

36
Q

If the PCL rupture is isolated what is usually the treatment plan ?

If PCL is involved in mutliligamenty injury what is the treatmeant ?

A

if isolated - often doesn’t require reconstruction so physio

If mutliligament - requires reconstruction followed by physio

37
Q

Knee dislocation is a serious high energy injury with high incidence complications, what are some of these complications ?

A
  • Popliteal artery injury (tear, intimal tera & thrombosis)
  • Nerve injury – common peroneal nerve
  • Compartment syndrome
  • Multiligament injury
38
Q

What is the treatment for knee dislocation ?

A

emergency reduction, recheck neurovascular status.

if concerns with vascular status may need vascular surgery

39
Q

What may need to be done to stablise the knee after dislocation ?

A

May need ex fix for temporary stabilisation

40
Q

What ligament holds the patella in place ?

A

MPFL (Medial patellofemoral ligament)

41
Q

What is the common mechanism for patellar dislocations?

A

Rapid turn or direct blow

42
Q

What factors predispose patients to soft tissue knee injuries?

A
  • Previous tendonitis
  • Steroids
  • Chronic renal failure, Ciprofloxacin
43
Q

Give an overview of the cmoon soft tissue knee injuries and their mechanisms for injury

A
  • Valgus à MCL
  • twisting à ACL or meniscal injury
  • varus à LCL
  • dashboard / hyperextension à PCL
  • getting up from squatting à meniscal tear
44
Q

Football injury, twist, pop, haemarthrosis, generalised pain, pain settles after a few days, rotatory instability.

What inury is this a classic histroy of ?

A

ACL rupture

45
Q

Getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain & catching +/- locking.

What injury is this a classic history of?

A

Meniscal tear

MSK (22 decks)

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