The Knee Lecture Powerpoint

Question 1

Patellar reflex tests ___ nerve root, achilles tendon is ___

Answer 1

L4, S1

Question 2

Sunrise view x ray

Answer 2

Knee x ray view that should be very frequently done as it is the only x ray that can see the patellofemoral joint

Question 3

Tunnel notch x ray

Answer 3

Allows for view of femoral tunnel at the patella to assess for avulsion or fracture, cannot assess ACL or PCL integrity

Question 4

Gradual onset of swelling around knee after falling indicates ___ type injury, while immediate is more likely___

Answer 4

meniscal tear, ACL

Question 5

Meniscal tears signs and symptoms (3)

Answer 5

• pain usually well localized
• pain with full flexion (inability to duck walk)
• may have knee locking (inability to fully extend knee)

Question 6

Best special test to evaluate meniscal tear

Answer 6

Mcmuray’s test

Question 7

Meniscal tear treatment options (3)

Answer 7

• compression, dressing, ice, elevation, crutches, ROM therapy
• aspirate if tense painful effusion only
• remove, debride, repair meniscus

Question 8

Aspiration of fluid from knee joint analysis (3)***

Answer 8

• mostly blood indicative of ACL tear
• clear yellowish fluid without fat cells or significant blood is meniscal tear
• blood and globules of fat is intra-articular fracture of the bone

Question 9

Baker’s (popliteal) cyst definition and management***

Answer 9

Normal variant enlargement of semimembranous bursae in medial popliteal space, may be found incidentally, may cause pain/paresthesias if nerve impingement if very inflamed and large, typically imaged on ultrasound or MRI, does NOT need to be excised often unless significantly problematic, often erroneously referred to ortho, can consider aspiration, rarely removed, may recur, treat any underlying cause

Question 10

MCL injury

Answer 10

• due to valgus stress applied to weight bearing knee
• more common than LCL injury, association with other tears
• unable to bear weight

Question 11

MCL diagnostic studies (2)

Answer 11

• plain films to rule out derangement or growth plate injury

- MRI

Question 12

MCL treatment options (2)

Answer 12

• knee immobilization, crutches, progress to ROM

- surgical repair results same as non-op

Question 13

LCL injury

Answer 13

• less common

- caused by varus stress on weight bearing knee

Question 14

LCL treatment options (2)

Answer 14

• sprain ROM brace and progress to ROM, crutches

- tears need surgical treatment

Question 15

ACL tear signs and symptoms (3)

Answer 15

• often audible pop after noncontact injury
• immediate effusion/hemearthrosis
• may be able to ambulate

Question 16

ACL tear diagnostic studies (2)

Answer 16

• x ray

- MRI shows torn ligaments

Question 17

ACL tear treatment options (2)

Answer 17

• young active athletes need reconstruction

- for those with limited activity or not surgical candidate, bracing may be possibility

Question 18

Chondromalacia patella (CMP) (runner’s knee) (patellofemoral syndrome)

Answer 18

Anterior knee pain syndrome very common cause of knee pain in young adult, present with peripatellar pain, snapping, catching, crepitus, aggravated by stairs, squats, sitting, may be due to tracking problems (can be treated with tibial tubercle transfer) and may be overuse injury

Question 19

Q angle

Answer 19

Angle from knee to ASIS compared to tibial tubercle, widened in females creating greater likelihood of knee pathology

Question 20

Diagnostic studies for Chondromalacia patella (CMP) (runner’s knee) (patellofemoral syndrome) (1)

Answer 20

-x rays, sunrise view important

Question 21

Chondromalacia patella (CMP) (runner’s knee) (patellofemoral syndrome) treatment options (4)

Answer 21

• stretch strengthen
• tracking brace
• NSAIDS
• footwear mod

Question 22

Patellar sublaxation/dislocation definition/diagnostic studies (1)/treatment options (2)

Answer 22

• Patellar malalignment usually lateral that can occur with repeating episodes, due to retinacular instability, can see significant pain around kneecap and lateral condyle but relocating it manually relieves
• x ray including sunrise and lateral
• rehab*** surgery for repeated episodes including lateral retinacular release or patellar realignment

Question 23

Plica syndrome definition

Answer 23

Synovitis of the folds of the knee, most often medial and may be due to trauma, overuse, treated with rest, activity restriction

Question 24

Osteochondritis dissecans definition

Answer 24

Localized subcondral necrosis of the lateral aspect of the medial femoral condyle most commonly, possibly from trauma

Question 25

Osteonecrosis of the femoral condyle

Answer 25

Avascular necrosis of the femoral condyle possibly caused by steroid use, alcoholism, etc.

Question 26

Prepatellar bursitis (housemaid’s knee)

Answer 26

Pain anterior and inferior well localized to the patella, have to rule out septic cause before treating conservatively

Question 27

Patellar tendonitis (jumper’s knee) treatment options (4)

Answer 27

• DO NOT INJECT
• rest, rehab, NSAIDS
• x ray for calcium deposits
• surgery for tendon debridement

Question 28

Tibial plateau fractures definition, diagnostic study (1), treatment (2),

Answer 28

• very common fracture most often on the lateral plateau
• oblique x ray***
• immobilize and splint or ORIF