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Semester 2 PM Exam 8 > Surgical Knee Disorders > Flashcards

Surgical Knee Disorders Flashcards

1
Q

Areas that will refer pain to the knee

A

Hip
Back
Leg

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2
Q

Patellofemoral Disorders (2)

A

Patellofemoral Pain Syndrome

Patellar Instability

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3
Q

Patellofemoral Pain Syndrome

A

Patellar malalignment

Patellar compression syndrome

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4
Q

Patellar instability

A

recurrent subluxations and/or dislocations

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5
Q

With patellofemoral pain syndrome what might someone have in subjective/objective findings

A 
Injury history
Overuse injury
Swelling
Clicking, popping, catching
Giving way
NO patellar dislocation history
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6
Q

Patellar malalignment

A

just pain not instability
most commonly is an anatomical malalignment risk factor
Excessive lateral traction
No subluxation hx

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7
Q

Hx with patellar malalignment

A 
Subpatellar/peripatellar pain
Pain w/ stair climbing/descent 
Movie sign
Pain with running
Giving Way
Locking, popping, clicking
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8
Q

Patellar Malignment - Physical Exam

A

Genu valgum
Inc femoral anteversion
Medial facet tenderness
Inc Q (more than 20 F, more than 15 M)

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9
Q

Patellar Compression Syndrome

A

Similar symptoms to patellar malaligment, but alignment is normal
VMO weakness
Tight lateral retinaculum - shortened and thick lateral retinaculum
Lateral release indicated

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10
Q

Recurrent Patellar Instability

A

+ patellar apprehension sign
Osteochondal fractures
A lot of them have dislocated

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11
Q

Mechanism - Recurrent Patellar Instability

A

Direct blow

Indirect - patellar malalignment

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12
Q

Patellofemoral disorders - nonoperative treatment

A 
PT
Activity modification
NSAIDs
Ice
Patellar bracing
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13
Q

Patellofemoral disorders - surgical indication

A

failure to respond to non-operative Rx after 6 months

Persistent pain with ADLs

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14
Q

Patellofemoral Disorders - Operative treatment

A 
Arthroscopy - chondroplasty 
Lateral release
Proximal realignment 
Distal realignment 
Combinations
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15
Q

Surgical treatment for patellar compression syndrome

A

Lateral release

Open v. arthroscopic

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16
Q

Proximal realignment

A

Medial retinaculum repair, plication, VMO advancement
Lateral release
Skeletally immature
Patellar instability

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17
Q

Distal Realignment

A

Tibial tubercle anteromedialization osteotomy
Dec Q angle
Anteriorization dec patellofemoral contact stresses
Need to be skeletally mature

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18
Q

Combined reconstructions for patellofemoral disorders

A

Proximal and distal realignments

Medial restrains loose and inc Q angle

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19
Q

Patellar Instability - First Patella Dislocation tx and risk for recurrent instability

A

initial tx is non-operative unless an osteochondral fracture occurs that can be repaired or removed
Risk for recurrent instability 15-44%

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20
Q

Patella Instability - Recurrent Patella disloaction TX

A

Offer MPFL reconstruction for skeletally mature

Add distal realignment if TT - TG bigger than 20 mm

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21
Q

Plica syndrome

A

Synovitis - trauma or overuse
Crepitation
Clicking and popping
Pseudolocking

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22
Q

Where is the pain with plica syndrome

A

Superior
Anteromedial
Infrapatellar

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23
Q

Tx for plica syndrome

A

Similar to PFPS
Corticosteroid injections
Arthroscopic excision

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24
Q

IT Band syndrome - common in

A

Runners and cyclists

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25
Q

IT band syndrome - what happens

A

ITB rubs over lateral femoral epicondyle

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26
Q

IT Band Syndrome - Treatment

A 
Activity modification
Stretching - ITB, quads, hams
Ice, NSAIDs
Corticosteroid injections
Valgus producing orthotics
Surgery is rare
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27
Q

Prepatellar bursitis - mechanism

A

Trauma related

Acute or repetitive

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28
Q

Prepatellar bursitis - common in

A

wrestling

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29
Q

Prepatellar bursitis - what is it

A

inflammation of prepatellar bursa

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30
Q

Treatment for prepatellar bursitis

A

Compression, ice, immobilization/padding
NSAIDs
Aspiration and cortisone injection
Surgery - bursa excision is rare

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31
Q

Patellar tendonitis

A

Jumpers knee
Pediatric - sinding larsen johansson
Overuse injury patellar tendon
Degenerative tendon distal pole patella

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32
Q

Patellar tendonitis - tenderness over

A

patellar tendon, distal pole patella

Chronic pain

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33
Q

Treatment for patellar tendonitis

A 
Activity motification, ice, NSAIDs
Chopat brace
Stretching of quads and hams
Progressive pain free strengthening 
Surgery is rare
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34
Q

Patellar tendon rupture - more common in

A

younger patients 20-40 years old

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35
Q

Patellar tendon rupture - description of it

A

defect in the inferior pole patella
Large effusion
Loss of active knee extension

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36
Q

Treatment for patellar tendon rupture

A

surgical repair with nonabsorbable sutures through drill holes in the patella

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37
Q

Quadriceps tendon rupture - normal patient population

A

50 years or older

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38
Q

Quadriceps tendon rupture - description of it

A

defect superior pole patella
large effusion
loss of active knee extension

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39
Q

Treatment for quadriceps tendon rupture

A

Surgical repair - torn retinaculum with interrupted sutures

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40
Q

Extensor mechanism disruptions - post operative rehab

A

need to protect the repair

  • crutches 4-8 wks
  • cast or brace protected ROM 3 months
  • avoid open chain quad resistance 3 months
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41
Q

Extensor mechanism disruptions - post operative rehab - full recovery

A

3 months for soft tissues to heal to bone in healthy lab animals
6-12 months for full recovery

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42
Q

Internal Derangement - list

A 
Meniscus tear
Osteochondritis dissecans
Loose bodies
Ligament sprain
Chondromalacia - DJD
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43
Q

Meniscus - function

A 
Fibrocartilage
Load bearing
Shock absorption
Joint stability 
Lubrication
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44
Q

Meniscus tear - Mechanism

A

Traumatic

Degenerative

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45
Q

Meniscus tear - age related changes

A

Fraying
Stable tears
Necrosis
CPPD

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46
Q

Meniscus tear - traumatic mechanisms

A

Twisting

Deep flexion

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47
Q

Meniscus tears - mechanical symptoms

A

locking
catching
popping
instability - giving way, due to pain

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48
Q

Meniscus tear - exam findings

A

Effusion
Joint line tenderness
Focal swelling
McMurrys test +

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49
Q

Treatment for meniscal tear

A

Partial menisectomy

Meniscus repair

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50
Q

Partial menisectomy

A

Removal of 50% or greater alters contact stress

Inc risk for degenerative changes over time

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51
Q

Meniscus tear - factors that affect healing

A 
Age
Location
Knee stability
Size of tear
Ability to coapt edges
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52
Q

Post-menisectomy knee

Meniscus allograft reconstruction - factors that affect success

A

Knee stability
Alignment
Chondromalacia - no grade 4 changes
Precise reproduction of attachment sites

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53
Q

Osteochondritis Dissecans - etiology

A

Trauma - acute vs overuse
Vascular
Variant of ossification
Most say overuse

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54
Q

Osteochondritis Dissecans - description

A

Joint line pain
Locking
Effusion
Radiographs demonstrate lesion

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55
Q

Osteochondritis Dissecans - Stage 1

A

Surface intact but ballotable

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56
Q

Osteochondritis Dissecans - Stage 2

A

Surface fracture but not displaced

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57
Q

Osteochondritis Dissecans - Stage 3

A

Fragment hinged

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58
Q

Osteochondritis Dissecans - Stage 4

A

Detached fragment

59
Q

Osteochondritis Dissecans - Treatment if skeletally immature

A

Immobilize
Activity modification
Good prognosis

60
Q

Osteochondritis Dissecans - Treatment if skeletally mature

A

Drilling
Bone graft and internal fixation
Debridement and microfracture
Poor prognosis if completely detached

61
Q

Loose body - description

A

Joint line pain
Locking
Effusion

62
Q

Etiology - loose body

A

Patellar instability, fractures
OCD
DJD

63
Q

Loose body treatment

A

Arthroscopic removal

ORIF if bone fragment large

64
Q

Articular cartilage - mechanism

A

Traumatic - fall, direct blow, ligament tear, patellar instability
Degenerative

65
Q

Articular cartilage History

A

Pain with activity
Swelling, stiffness
Locking, catching, popping

66
Q

Articular cartilage - physical exam

A

Joint line tenderness
Effusion
Might have malalignment
Might have limited ROM

67
Q

Articular Cartilage - Imaging

A

Radiographs normal early on
Progressive joint space narrowing, osteophytes
MRI - small lesions may be missed

68
Q

Articular Cartilage - Classification Stage 1

A

Softening

69
Q

Articular Cartilage - Classification Stage 2

A

Fibrillation (less than 50%)

70
Q

Articular Cartilage - Classification Stage 3

A

Deeper fissuring (more than 50%)

71
Q

Articular cartilage - classification stage 4

A

exposed bone

72
Q

Articular cartilage - Arthroscopic debridement (chondroplasty)

A

Short term improvement (70% 1 yr, 50% 2 yrs)

Does not alter natural history

73
Q

Articular Cartilage Treatment

A

Marrow stimulation
Microfracture, drilling, abrasion arthroplasty
Fibrocartilage repair

74
Q

Articular cartialge treatment and improvement

A

Short term improvement (75% 5 yrs)

Does not alter natural history

75
Q

Other treatments for articular cartilage

A

Osteochondral transfers
OATs
Mosaicplasty
Fibrocartilage btw grafts

76
Q

Articular Cartilage chondrocyte implantation

A

Two procedures
Step 1 = chrondral biopsy (scope)
Step 2 = implantation (open)
Expensive

77
Q

Articular Cartilage = DeNovo

A 
Particulated juvenille cartilage 
Less than 13 yo
Potential for healing
One step procedure
No long term studies
78
Q

Articular Cartilage - treatment indications

A 
Traumatic lesions
Less than 50 yo
Normal radiographs
Not DJD
Correctable malalignment 
Normal meniscus
79
Q

Articular Cartilage - Treatment Algorithm

Lesions less than 2 cm

A

Marrow stimulation

Autogenous OATs

80
Q

Articular Cartilage - Treatment Algorithm

Lesion more than 2 cm

A

ACI
DeNovo
Allograft OATs

81
Q

Articular Cartilage - Treatment Algorithm

Multiple lesions

A

ACI
DeNovo
Allografts
Non-op until TKA

82
Q

Articular Cartilage Post-op Rehabilitation

A 
Crutches 6 to 12 weeks
3-6 wks NWB
3-6 wks PWB
Immediate ROM
CPM, AROM
6-12 month recovery
83
Q

Degenerative Joint Disease

A

Long term outcome of untreated (or treated) cartilage lesions
Management depends on patient age and severity of disease
TKA last option

84
Q

Degenerative Joint Disease - Non operative treatment

A 
NSAIDs, acetaminophen
PT
Bracing
Activity modification
Corticosteroid injections
Controversial glucosamine, hyaluronates, PRP, stem cells
85
Q

DJD - Operative treatments - Arthroscopic Debridement

A

Mild DJD with meniscus tear
After failed non-op Rx
Short term improvement

86
Q

DJD - operative treatments - osteotomies

A

Unicompartment DJD
Younger patients, heavy labor
Delay TKA 5-10 yrs

87
Q

DJD - operative treatments - arthroplasties

A

UKA

TKA

88
Q

DJD - osteotomies - Varus knee

A

Tibial
Closing wedge lateral
Opening wedge medial
Distraction Callotasis

89
Q

DJD - osteotomies - Varus knee - Closing wedge

A

Lateral - no bone graft

TKA more difficult after

90
Q

DJD - osteotomies - Varus knee - Opening wedge

A

Medial - need bone graft

Delayed weight bearing

91
Q

DJD - osteotomies - Varus knee - Distraction Callotasis

A

External fixator

No bone graft

92
Q

DJD - osteotomies - Valgus knee

A

Femoral
Closing wedge medial
Opening wedge lateral

93
Q

DJD - patellofemoral DJD

A

Osteotomies - Tibial tubercle elevation
Patellectomy - rare
Arthroplasty - new implants, no long term results, older patients

94
Q

DJD post op rehab

A

Immediate ROM
Opening wedge osteotomy - protect WB until bone graft heals (6 wks)
Tibial Tubercle - no resistance to extension 6 wks

95
Q

DJD Arthroplasty - Unicompartment UKA

A

Single compartment
More normal feeling knee
Smaller incision
10+ yrs survivorship

96
Q

DJD - arthroplasty - TKA

A

last option
15-20 yr survivorship
minimally invasive

97
Q

Mechanism for ACL injury

A

Twisting, pivoting
Hyperextension
Isolated - noncontact
Combined - contact

98
Q

ACL injury - history

A

Pop
Knee gives out - pivot shift
Rapid onset swelling

99
Q

ACL injury - exam

A

Effusion
+ Lachman
+/- Anterior drawer
+ pivot shift

100
Q

ACL injury - exam

What to be aware of

A

Need to be aware of false pos for ant drawer and lachman due to PCL tear

101
Q

ACL injury - diagnosis

A

Pivot shift test

102
Q

ACL injury - Radiographs

A

Most normal
Tibial bony avulsion - 2 to 4%
Segond’s fracture 6% - anterolateral ligament

103
Q

ACL injury Diagnosis

A 
MRI accuracy is 88-100%
PE accuracy is 90-100%
Instrumented measurement
KT-2000
Arthroscopy
104
Q

ACL injury - natural history of ACL deficient knee

A

Repeated giving way episodes leads to meniscus tears and articular cartilage injuries
Eventual DJD
No proof that surgery leads to less arthritis

105
Q

ACL injury - Treatment depends on

A 
Degree of instability 
Patients activity level 
Age
If meniscuc is repairable
Multi ligament
Patient goals and willingness to rehab
106
Q

ACL non operative treatment

A

Swelling control
Restore ROM
Hamstring strengthening
Pivot shift control program

107
Q

ACL injury - operative treatment

A

ACL repair + augmentation
Autogenous grafts
No artificial grafts
Allografts

108
Q

ACL injury - Rehab

A 
Emphasize early return of ROM and full activities 
Ext = less than 2 wks
Flex = 6 wks
Closed chain ex
Functional ex
Less bracing
Return to full function 6-12 months
109
Q

PCL resists

A

posterior tibial displacement

Larger than ACL

110
Q

PCL injury

A 
less common than ACL (10:1)
Fall onto flexed knee
Dashboard injuries
Hyperextension
\+ post drawer
111
Q

PCL injury - Grade 1

A

0-5 mm

112
Q

PCL injury - Grade 2

A

6-10 mm

113
Q

PCL injury - Grade 3

A

11-15 mm

Tibia subluxes behind femoral condyles

114
Q

PCL injury - treatment if isolated tear

A

quad strengthening

115
Q

PCL injury - treatment if combined ligament tear

A

Operative repairs/reconstruction

116
Q

MCL injury

A

Valgus stress
Local tenderness and swelling
+/- effusion
Pathologic laxity

117
Q

MCL injury grade 1

A

Tender over MCL to palpation

Tender with valgus stress but no laxity at 30 degrees

118
Q

MCL injury grade 2

A

Tender over MCL to palpation

Valgus stress laxity of 5-10 mm but with and endpoint

119
Q

MCL injury grade 3

A

tender over MCL
greater swelling and usually an effusion
valgus stress laxity greater than 10mm with no endpoint

120
Q

MCL injury - treatment

A

Usually non-operative with good long term results
Early ROM exercises
Bracing for grades 2 and 3

121
Q

MCL injury Results of early ROM vs casting vs surgery are

A

equal

122
Q

MCL injury - pediatric patients

A

Beware for physeal plate injuries
Ligaments are stronger then physis
Stress x-rays are recommended

123
Q

Knee dislocations

A

Tears of ACL, PCL, and collateral ligaments

Limb threatening injury - need to do vascular studies - 10% amputation risk

124
Q

Non operative treatment for knee dislocations

A

Cast or brace, low demand patients

125
Q

Operative treatment for knee dislocations

A

Reconstruct ACL and PCL
Repair/reconstruct collaterals
Acute repair better results than chronic

126
Q

Post op rehab for knee dislocation

A

Crutches TTWB 6-12 wks
May restrict ROM 2-3 wks
No open chain quads or hams for 6 months

127
Q

Patella fractures mechanism

A

direct blow, fall onto knee, dashboard injury
Disrupts extensor mechanism
Variable pattern

128
Q

Treatment for patellar fractures

A

Cast if less than 2 mm displaced
ORIF if displaced
Excise/Repair - inf pole fracture, highly communuted
Patellectomy - highly comminuted

129
Q

Patella fracture - rehab

A

if fixation is stable ROM early
No ext against resistance until fx healed
WBAT with brace

130
Q

Patellectomy - rehab

A

Wait for soft tissue healing

About 6 weeks

131
Q

Tibial plateau fracture

A

Falls - elderly, osteoporotic

High velocity trauma, younger patients

132
Q

Tibial plateau fractures - non operative if

A

minimally displaced fx

133
Q

Tibial plateau fracture - operative

A

ORIF
Medial (more than 2 mm displaced)
Lateral (more than 5)
Bone graft

134
Q

Tibial Plateau fractures rehab

A

Start ROM early
Non WB for about 6 weeks
Hinged brace or cast brace

135
Q

Tibial intercondylar eminence fractures

A

Bicycle accidents
Hyperextension or rotator mechanism
8 to 15 yrs old
ACL attached to fragment

136
Q

Tibial intercondylar eminence fracture type 1

A

nondisplaced

137
Q

Tibial intercondylar eminence fracture type 2

A

hinged

138
Q

Tibial intercondylar eminence fracture type 3

A

complete displacement

139
Q

Tibial intercondylar eminence fracture treatment for type 1

A

cylinder cast or brace

140
Q

Tibial intercondylar eminence fracture for type 2 and 3

A

operative reduction and fixation

141
Q

Supracondylar femur fractures

A

high velocity trauma younger patients

low velocity trauma elderly osteoporotic patients

142
Q

Supracondylar femur fractures - treatment

A

usually ORIF
plates and screws
IM rods locked

143
Q

Supracondylar femur fractures - rehabilitation

A

start ROM early
protect WB 6-8 wks
hinged brace or cast brace

Semester 2 PM Exam 8 (5 decks)

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