soft tissue knee injury Flashcards
who usually presents with meniscal tear?
- usually young, sporty patients
- however can also be atraumatic spontaneous degenerate tear in older patients (middle aged onwards)
how does a meniscal tear present?
pain and tenderness localised to joint line and +ve meniscal provocation test (steinmans test)
is there an association with meniscal tear and ACL injury?
yes- 50% of ACL ruptures have meniscal tear
what investigations are done if meniscal tear is suspected?
- MRI
- Steinmens test
which meniscus is a meniscal tear more common in?
medial meniscus (approx 9-10 times more common than lateral meniscus tear)
what are the different patterns of meniscal tears?
longitudinal, bucket handle, radial and parrot beak
what type of meniscal tear is this?
longitudinal tear
what type of meniscal tear is this?
bucket handle tear
what type of meniscal tear is this?
radial tear
what type of meniscal tear is this?
parrot beak tear
what type of meniscal tear wont heal?
radial
what procedure is considered for acute traumatic peripheral meniscal tears in younger patients?
arthroscopic meniscal repair
what procedure should be considered for an irreparable meniscal tear with recurrent pain, effusion or mechanical symptoms (catching, clicking, locking)?
arthroscopy menisectomy
what does an acute locked knee signify?
-a displaced bucket handle meniscal tear
what is management for acute locked knee due to meniscal tear?
- may be reparable with surgery if picked up early
- if irreparable needs partial meniscectomy to unlock knee
what ligament resists varus stress?
LCL
what ligament resists valgus stress?
MCL
what ligament resists anterior subluxation of the tibia and internal rotation of the tibia in extension?
ACL
what ligament resists posterior subluxation of the tibia ie anterior subluxation of the femur and hyperextension of the knee?
PCL
what may occur to movement of knee if MCL if ruptured?
valgus instability (there may be passive abduction)
what may occur to movement of the knee if ACL is ruptured?
-rotatory instability, patient will usually complain of knee giving way when turning on planted foot
what may occur to movement is PCL ruptures?
-recurrent hyperextension or instability descending stairs
treatment for MCL injury?
- usually heals well even if complte tear, rarely requires surgery (if surgery needed reconstruct with tendon graft)
- physio
how does an ACL injury usually present?
classic history of ‘pop’, haemarthrosis and giving away on turning usually during a sports injury
what is the management plan for ACL injury
physiooooo!!!
sometimes need surgery to reconstruct with graft (50%)
tests for diagnoses of ACL rupture?
positive lachman test
need to do MRI!!
how does LCL injury present?
- can cause varus and rotatory instability
- hyperextension
what commonly occurs in combination with a LCL injury?
PCL or ACL injury
what treatment would a complete LCL rupture require?
urgent repair (surgery) withing 2-3 weeks and later on reconstruction using hamstring or other tendon
physiooooo
how does a PCL rupture usually present?
popliteal knee pain and bruising
when would PCL reconstruction be considered?
if patient was unstable and had recurrent hyperextension or feeling of instability when going down the stairs
what are some complications of knee dislocation?
- popliteal artery injury
- nerve injury
- compartment syndrome
treatment for knee dislocation?
emergency reduction, recheck neurovascular status
any concerns with vscular status then vascular surgery review as it may need revascularisation
what may cause patella dislocation?
rapid turn or direct blow?
who is more likely to experience patellar dislocation?
- females
- adolescents
- ligamentous laxity
- valgus knee
- torsional abnormalities
what is patellofemoral pain syndrome also known as?
idiopathic adolescent anterior knee pain or chondromalacia patellae
what may cause patellofemoral pain syndrome?
muscle imbalance (gluteal weaknes), tightness of lateral tissues, bony malalignment (valgus, internal rotation) or flat feet
how to tell someone has had an extensor mechanism rupture?
-unable to straight leg raise
-palpable gap
can check on ultrasound or MRI if in doubt
who is more susceptible to extensor mechanism rupture?
patients with:
- previous tendonitis
- steroids
- chronic renal failure and are on ciprofloxacin
treatment for ectensor mechanism rupture?
:0 URGENT SURGICAL REPAIR!!!
what is osteochondritis dissecans?
when an area of the surface of the knee loses its blood supply and cartilage +/- bone can fragemtn off
who is osteochondritis dissecans more common in?
adolescence
how does osteochondritis dissecans present?
-pain, loss of joint movement but can be asymptomatic
treatment for osteochondritis dissicans ?
- may heal or resolve spontaneously
- if MRI shows detaching can pin in place
- if MRI shows detached can fix or remove
NEED SPECIALIST REFERRAL
how is bone brusing/ bone marrow oedema diagnosed?
MRI
what is bone brusing/ bone marrow oedema?
-impaction to articular surface which has lead to microscopic fracture of trabecular bone with bleeding and inflammation
how long does it take to heal bone brusing/ bone marrow oedema?
usually 3 months but can take a year
what can loose bodies in the knee come from?
trauma, OCD and joint degeneration can cause a fragment of cartilage +/- bone to detach causing loose body in joint
investigations for loose body?
MRI or serial X ray and history of mobile lump
how may a loose body present in a patient?
sharp occasional pain and locking/ catching
football injury, twist, pop, haemarthrosis, generalised pain, pain settles after a few days, rotatory instability
what may this suggest?
ACL rupture
getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain and catching +/- locking
what does this suggest?
meniscal tear
role of the medial and lateral menisci?
- 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
damage to the MCL usually damages what meniscus and why?
the medial meniscus as they are attached
what do the PCL and ACL attach to?
- 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
role of ACL and PCL?
ACL- stops tibia sliding forward in relation to femur
PCL-stops tibia sliding backwards in relation to femur
