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MSK lectures > Soft Tissue Knee Injury - 24/10/18 > Flashcards

Soft Tissue Knee Injury - 24/10/18 Flashcards

1
Q

What are four modes of failure in the knee?

A

Extensor mechanism injuries
Meniscal tears
Ligament injuries
Knee and patellar dislocation

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2
Q

What is pseudolock?

A

Patient’s standing up and experiencing pain and discomfort in their knees due to lack of synovial fluid in the joint for a short period after standing

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3
Q

How is pseudolock treated?

A

Physiotherapy

Weight loss

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4
Q

Which gender are more likely to tear ACL?

A

Women

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5
Q

Why are females more likely to tear their ACL?

A

Women’s hamstring torque doesn’t come on as quickly from rest as it does from males

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6
Q

What causes extensor mechanism rupture?

A

Fall on flexed knee with quad contraction

Quads tendon or patellar fracture, or patellar tendon

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7
Q

What are risk factors for extensor mechanism rupture?

A

Previous tendonitis
Steroids
CKD
Ciprofloxacin

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8
Q

What is seen on examination extensor mechanism rupture?

A

Unable to straight leg raise

Palpable gap

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9
Q

How is extensor mechanism rupture treated?

A

Surgery

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10
Q

Should you inject steroids into a tendon?

A

NO

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11
Q

What is seen on xray in extensor mechanism rupture?

A

Large gap between patella and femur

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12
Q

What is a non-traumatic cause of extensor mechanism rupture?

A

Femoral nerve palsy?

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13
Q

What are 4 causes of extensor mechanism rupture?

A

Rectus femoris tear
quadriceps tendon rupture
Patellar fracture
Patellar tendonrupture

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14
Q

What is the function of the meniscus?

A

Carry load

Transmit load equally throughout bone

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15
Q

Which menisci is fixed?

A

Medial

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16
Q

What are 4 types of meniscal tear?

A

Radial
Longitudinal
Parrot beak
Bucket handle

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17
Q

How can meniscal tears occur?

A

Sporting injuries
Spontaneous (over 40)
ACL rupture

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18
Q

How are meniscal tears investigated?

A

MRI

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19
Q

Which side of meniscal tear is much more common?

A

Medial

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20
Q

How are meniscal tears treated?

A 
Radial tears wont heal
Limited repair potential
Acute peripheral tears can be repaired in younger patients
Only peripheral 1/3 has a blood supply
Surgery
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21
Q

what signifies displaced bucket handle tear?

A

Acute locked knee

15 degree springy block to extension

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22
Q

How are bucket handle tears treated?

A

Emergency surgery

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23
Q

Why do meniscal tears struggle to repair?

A

Environment
Low blood supply
Not exposed
Lots of movement

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24
Q

What do degenerate meniscal tears probably suggest?

A

Osteoarthritis

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25
Q

How are degenerative meniscal tears treated?

A

Initial swelling will settle
Flares may occur
Results of surgery are lower in patients with evidence of osteoarthritis

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26
Q

When should surgery NOT be done for meniscal tears?

A

Advanced structural Osteoarthritis

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27
Q

When should urgent arthroscopic surgery be done for meniscal tears?

A

Locked Knee

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28
Q

When should surgery be considered for meniscal tears?

A

Acute injury with MRI proven meniscal tear

Meniscal tear and corresponding symptoms

29
Q

What does MCL resist?

A

Valgus stress

30
Q

What does LCL resist?

A

Varus stress

31
Q

What does ACL resist?

A

ANterior subluxation

Internal rotation of tibia

32
Q

What does PCL resisit?

A

Posterior subluxation

External rotation of tibia?

33
Q

What is a grade 1 knee ligament injury?

A

Sprain

Torn fibres

34
Q

What is a grade 2 knee ligament injury?

A

Partial tear

Some fasicles affected

35
Q

What is a grade 3 knee ligament injury?

A

Complete tear

36
Q

What is a grade 4 knee ligament injury?

A

Knee dislocation

37
Q

What happens if the MCL ruptures?

A

Valgus instability

38
Q

What happens if the ACL ruptures?

A

Rotatory instability

39
Q

What happens if the PCL ruptures?

A

Recurrent hyperextension and instability

40
Q

What happens when the posterolateral corner ruptures?

A

Varus and rotatory instability

41
Q

What occurs with multiligament injury?

A

Gross instability

42
Q

What causes an increase in signal on an MRI?

A

Bone bruising

bleeding inside of bone

43
Q

How is a bone bleed treated?

A

No treatment

Will repair over 12-14 months

44
Q

Does the MCL heal?

A

Yes

45
Q

How is MCL treated?

A

Physio
Bracing
Early motion
Rarely requires surgery

46
Q

What causes ACl rupture?

A

Sports injury

47
Q

Does ACL repair usually work?

A

No

48
Q

What does ACL repair entail?

A

Autograft of hamstring or patellar tendon
Allograft of Achilles
ACL can stick to PCL to give stability

49
Q

How can ACL be stabilised?

A

Physiotherapy

50
Q

Is full repair possible in ACL tears?

A

Nope

51
Q

Can range of movement be restored in ACL tears and how long does it take?

A

Yes

10-12 months

52
Q

How do patients cope after ACL ruptire?

A

1/3 compensate and can function well
1/3 can avoid instability by avoiding activities
1/3 do not compensate and have frequent instability and cant get back to high impact sport

53
Q

What % of ACL ruptures have surgery?

A

40%

54
Q

When should ACL surgery occur?

A

Rotatory instability not responsing to physion

Protect meniscal repair

55
Q

How long does ACL repair take?

A

up to 1 year

Some never repair

56
Q

What can occur with ACL repair?

A

Stiffness
Infection
Arthritis within 10 years

57
Q

What are the characteristics of LCL Injury?

A

Uncommon
Varus and hyperextension
LCL doesnt heal
+

58
Q

What are the characteristics of PCL rupture?

A 
Direct blow to anterior tibia
Hyperextension
Posterior sag 
Occurs in cyclists
\+
59
Q

What are the characteristics of Knee dislocation?

A 
High energy injury
Popliteal artery injury
Nerve injury
compartment syndrome
Emergency reduction 
Vascular surgery
Temporary stabilisation
Multilagament reconstruction
60
Q

What can be a consequence of knee dislocation?

A

Dropped foot

61
Q

What is Homokawasakitis? (sp?)

A 
Cut over front of tibia
Tibia forced back
Bruised over medial collateral
Knee full of blood
Haemarthrosis decompresses into calf
Serious knee injury and swollen calf
Capsule has ruptured and all of the blood in the knee has gone into the leg
62
Q

Which patients are more likely to have a knee dislocation?

A

Overweight patients

Slipping

63
Q

How are knee dislocations treated?

A

Surgery
External fixator
Don’t open up compromised area

64
Q

What are the characteristics of Patellar dislocation?

A 
Rapid
Runs in families
Females
Adolescents
Valgus knee
Laxity
Chondral or ostechondral problems
65
Q

What are some important history points?

A 
Pop or crack
Knee cap dislocation
Temperature
Giving way
Pain
Locking
Clicking or catching
Recurrent swelling
Recurrent patellar dislocation
66
Q

What are the characteristics of OA?

A

Biomarkers needed
Non uniform
Pharmacological and non!
surgical

67
Q

What is important to consider in the treatment of OA?

A

What function the patient has

Symptoms over X-ray

68
Q

What are the consequences of knee replacement?

A

Limited movement

stiffer than normal

69
Q

What are the symptoms of OA?

A 
Holiday knee
Pain
Inflammatory flares
Stiffness
Loss of movement
Loss of function

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