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MSK > soft tissue knee injury > Flashcards

soft tissue knee injury Flashcards

1
Q

who usually presents with meniscal tear?

A
  • usually young, sporty patients

- however can also be atraumatic spontaneous degenerate tear in older patients (middle aged onwards)

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2
Q

how does a meniscal tear present?

A

pain and tenderness localised to joint line and +ve meniscal provocation test (steinmans test)

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3
Q

is there an association with meniscal tear and ACL injury?

A

yes- 50% of ACL ruptures have meniscal tear

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4
Q

what investigations are done if meniscal tear is suspected?

A
  • MRI

- Steinmens test

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5
Q

which meniscus is a meniscal tear more common in?

A

medial meniscus (approx 9-10 times more common than lateral meniscus tear)

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6
Q

what are the different patterns of meniscal tears?

A

longitudinal, bucket handle, radial and parrot beak

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7
Q

what type of meniscal tear is this?

A

longitudinal tear

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8
Q

what type of meniscal tear is this?

A

bucket handle tear

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9
Q

what type of meniscal tear is this?

A

radial tear

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10
Q

what type of meniscal tear is this?

A

parrot beak tear

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11
Q

what type of meniscal tear wont heal?

A

radial

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12
Q

what procedure is considered for acute traumatic peripheral meniscal tears in younger patients?

A

arthroscopic meniscal repair

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13
Q

what procedure should be considered for an irreparable meniscal tear with recurrent pain, effusion or mechanical symptoms (catching, clicking, locking)?

A

arthroscopy menisectomy

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14
Q

what does an acute locked knee signify?

A

-a displaced bucket handle meniscal tear

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15
Q

what is management for acute locked knee due to meniscal tear?

A
  • may be reparable with surgery if picked up early

- if irreparable needs partial meniscectomy to unlock knee

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16
Q

what ligament resists varus stress?

A

LCL

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17
Q

what ligament resists valgus stress?

A

MCL

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18
Q

what ligament resists anterior subluxation of the tibia and internal rotation of the tibia in extension?

A

ACL

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19
Q

what ligament resists posterior subluxation of the tibia ie anterior subluxation of the femur and hyperextension of the knee?

A

PCL

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20
Q

what may occur to movement of knee if MCL if ruptured?

A

valgus instability (there may be passive abduction)

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21
Q

what may occur to movement of the knee if ACL is ruptured?

A

-rotatory instability, patient will usually complain of knee giving way when turning on planted foot

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22
Q

what may occur to movement is PCL ruptures?

A

-recurrent hyperextension or instability descending stairs

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23
Q

treatment for MCL injury?

A
  • usually heals well even if complte tear, rarely requires surgery (if surgery needed reconstruct with tendon graft)
  • physio
24
Q

how does an ACL injury usually present?

A

classic history of ‘pop’, haemarthrosis and giving away on turning usually during a sports injury

25
Q

what is the management plan for ACL injury

A

physiooooo!!!

sometimes need surgery to reconstruct with graft (50%)

26
Q

tests for diagnoses of ACL rupture?

A

positive lachman test

need to do MRI!!

27
Q

how does LCL injury present?

A
  • can cause varus and rotatory instability

- hyperextension

28
Q

what commonly occurs in combination with a LCL injury?

A

PCL or ACL injury

29
Q

what treatment would a complete LCL rupture require?

A

urgent repair (surgery) withing 2-3 weeks and later on reconstruction using hamstring or other tendon

physiooooo

30
Q

how does a PCL rupture usually present?

A

popliteal knee pain and bruising

31
Q

when would PCL reconstruction be considered?

A

if patient was unstable and had recurrent hyperextension or feeling of instability when going down the stairs

32
Q

what are some complications of knee dislocation?

A
  • popliteal artery injury
  • nerve injury
  • compartment syndrome
33
Q

treatment for knee dislocation?

A

emergency reduction, recheck neurovascular status

any concerns with vscular status then vascular surgery review as it may need revascularisation

34
Q

what may cause patella dislocation?

A

rapid turn or direct blow?

35
Q

who is more likely to experience patellar dislocation?

A
  • females
  • adolescents
  • ligamentous laxity
  • valgus knee
  • torsional abnormalities
36
Q

what is patellofemoral pain syndrome also known as?

A

idiopathic adolescent anterior knee pain or chondromalacia patellae

37
Q

what may cause patellofemoral pain syndrome?

A

muscle imbalance (gluteal weaknes), tightness of lateral tissues, bony malalignment (valgus, internal rotation) or flat feet

38
Q

how to tell someone has had an extensor mechanism rupture?

A

-unable to straight leg raise
-palpable gap
can check on ultrasound or MRI if in doubt

39
Q

who is more susceptible to extensor mechanism rupture?

A

patients with:

  • previous tendonitis
  • steroids
  • chronic renal failure and are on ciprofloxacin
40
Q

treatment for ectensor mechanism rupture?

A

:0 URGENT SURGICAL REPAIR!!!

41
Q

what is osteochondritis dissecans?

A

when an area of the surface of the knee loses its blood supply and cartilage +/- bone can fragemtn off

42
Q

who is osteochondritis dissecans more common in?

A

adolescence

43
Q

how does osteochondritis dissecans present?

A

-pain, loss of joint movement but can be asymptomatic

44
Q

treatment for osteochondritis dissicans ?

A
  • may heal or resolve spontaneously
  • if MRI shows detaching can pin in place
  • if MRI shows detached can fix or remove

NEED SPECIALIST REFERRAL

45
Q

how is bone brusing/ bone marrow oedema diagnosed?

A

MRI

46
Q

what is bone brusing/ bone marrow oedema?

A

-impaction to articular surface which has lead to microscopic fracture of trabecular bone with bleeding and inflammation

47
Q

how long does it take to heal bone brusing/ bone marrow oedema?

A

usually 3 months but can take a year

48
Q

what can loose bodies in the knee come from?

A

trauma, OCD and joint degeneration can cause a fragment of cartilage +/- bone to detach causing loose body in joint

49
Q

investigations for loose body?

A

MRI or serial X ray and history of mobile lump

50
Q

how may a loose body present in a patient?

A

sharp occasional pain and locking/ catching

51
Q

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

what may this suggest?

A

ACL rupture

52
Q

getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain and catching +/- locking

what does this suggest?

A

meniscal tear

53
Q

role of the medial and lateral menisci?

A
  • to deepen the articular surface of the tibia, thus increasing stability of the joint
  • to act as shock absorbers by increasing surface area to further dissipate forces
54
Q

damage to the MCL usually damages what meniscus and why?

A

the medial meniscus as they are attached

55
Q

what do the PCL and ACL attach to?

A
  • The ACL attaches at the anterior intercondylar area on the tibia and the lateral aspect of the interchondylar notch of the femur
  • The PCL attaches at the posterior intercondylar area on the tibia and the medial aspect of the interchondylar notch of the femur
56
Q

role of ACL and PCL?

A

ACL- stops tibia sliding forward in relation to femur

PCL-stops tibia sliding backwards in relation to femur

MSK (64 decks)

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