Soft Tissue Knee Injury - 24/10/18 Flashcards
What are four modes of failure in the knee?
Extensor mechanism injuries
Meniscal tears
Ligament injuries
Knee and patellar dislocation
What is pseudolock?
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
How is pseudolock treated?
Physiotherapy
Weight loss
Which gender are more likely to tear ACL?
Women
Why are females more likely to tear their ACL?
Women’s hamstring torque doesn’t come on as quickly from rest as it does from males
What causes extensor mechanism rupture?
Fall on flexed knee with quad contraction
Quads tendon or patellar fracture, or patellar tendon
What are risk factors for extensor mechanism rupture?
Previous tendonitis
Steroids
CKD
Ciprofloxacin
What is seen on examination extensor mechanism rupture?
Unable to straight leg raise
Palpable gap
How is extensor mechanism rupture treated?
Surgery
Should you inject steroids into a tendon?
NO
What is seen on xray in extensor mechanism rupture?
Large gap between patella and femur
What is a non-traumatic cause of extensor mechanism rupture?
Femoral nerve palsy?
What are 4 causes of extensor mechanism rupture?
Rectus femoris tear
quadriceps tendon rupture
Patellar fracture
Patellar tendonrupture
What is the function of the meniscus?
Carry load
Transmit load equally throughout bone
Which menisci is fixed?
Medial
What are 4 types of meniscal tear?
Radial
Longitudinal
Parrot beak
Bucket handle
How can meniscal tears occur?
Sporting injuries
Spontaneous (over 40)
ACL rupture
How are meniscal tears investigated?
MRI
Which side of meniscal tear is much more common?
Medial
How are meniscal tears treated?
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
what signifies displaced bucket handle tear?
Acute locked knee
15 degree springy block to extension
How are bucket handle tears treated?
Emergency surgery
Why do meniscal tears struggle to repair?
Environment
Low blood supply
Not exposed
Lots of movement
What do degenerate meniscal tears probably suggest?
Osteoarthritis
How are degenerative meniscal tears treated?
Initial swelling will settle
Flares may occur
Results of surgery are lower in patients with evidence of osteoarthritis
When should surgery NOT be done for meniscal tears?
Advanced structural Osteoarthritis
When should urgent arthroscopic surgery be done for meniscal tears?
Locked Knee
When should surgery be considered for meniscal tears?
Acute injury with MRI proven meniscal tear
Meniscal tear and corresponding symptoms
What does MCL resist?
Valgus stress
What does LCL resist?
Varus stress
What does ACL resist?
ANterior subluxation
Internal rotation of tibia
What does PCL resisit?
Posterior subluxation
External rotation of tibia?
What is a grade 1 knee ligament injury?
Sprain
Torn fibres
What is a grade 2 knee ligament injury?
Partial tear
Some fasicles affected
What is a grade 3 knee ligament injury?
Complete tear
What is a grade 4 knee ligament injury?
Knee dislocation
What happens if the MCL ruptures?
Valgus instability
What happens if the ACL ruptures?
Rotatory instability
What happens if the PCL ruptures?
Recurrent hyperextension and instability
What happens when the posterolateral corner ruptures?
Varus and rotatory instability
What occurs with multiligament injury?
Gross instability
What causes an increase in signal on an MRI?
Bone bruising
bleeding inside of bone
How is a bone bleed treated?
No treatment
Will repair over 12-14 months
Does the MCL heal?
Yes
How is MCL treated?
Physio
Bracing
Early motion
Rarely requires surgery
What causes ACl rupture?
Sports injury
Does ACL repair usually work?
No
What does ACL repair entail?
Autograft of hamstring or patellar tendon
Allograft of Achilles
ACL can stick to PCL to give stability
How can ACL be stabilised?
Physiotherapy
Is full repair possible in ACL tears?
Nope
Can range of movement be restored in ACL tears and how long does it take?
Yes
10-12 months
How do patients cope after ACL ruptire?
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
What % of ACL ruptures have surgery?
40%
When should ACL surgery occur?
Rotatory instability not responsing to physion
Protect meniscal repair
How long does ACL repair take?
up to 1 year
Some never repair
What can occur with ACL repair?
Stiffness
Infection
Arthritis within 10 years
What are the characteristics of LCL Injury?
Uncommon
Varus and hyperextension
LCL doesnt heal
+
What are the characteristics of PCL rupture?
Direct blow to anterior tibia Hyperextension Posterior sag Occurs in cyclists \+
What are the characteristics of Knee dislocation?
High energy injury Popliteal artery injury Nerve injury compartment syndrome Emergency reduction Vascular surgery Temporary stabilisation Multilagament reconstruction
What can be a consequence of knee dislocation?
Dropped foot
What is Homokawasakitis? (sp?)
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
Which patients are more likely to have a knee dislocation?
Overweight patients
Slipping
How are knee dislocations treated?
Surgery
External fixator
Don’t open up compromised area
What are the characteristics of Patellar dislocation?
Rapid Runs in families Females Adolescents Valgus knee Laxity Chondral or ostechondral problems
What are some important history points?
Pop or crack Knee cap dislocation Temperature Giving way Pain Locking Clicking or catching Recurrent swelling Recurrent patellar dislocation
What are the characteristics of OA?
Biomarkers needed
Non uniform
Pharmacological and non!
surgical
What is important to consider in the treatment of OA?
What function the patient has
Symptoms over X-ray
What are the consequences of knee replacement?
Limited movement
stiffer than normal
What are the symptoms of OA?
Holiday knee Pain Inflammatory flares Stiffness Loss of movement Loss of function
