4- Knee Problems

Question 1

What makes up the knee joint

Answer 1

Medial and lateral compartments of the tibiofemoral joint and the patellofemoral joint

Question 2

Where is the thickest hyaline cartilage in the body found

Answer 2

The retropatellar surface in the knee joint

Question 3

What are the menisci

Answer 3

Fibrocartilaginous plates in the knee joint

They act as shock absorbers and help distribute load equally

Question 4

List the 4 main ligaments of the knee

Answer 4

Anterior cruciate
Posterior cruciate
Medial collateral
Lateral collateral

Question 5

What is the main role of the ACL

Answer 5

Prevent abnormal internal rotation of the tibia

Question 6

What is the main role of the PCL

Answer 6

Prevents hyperextension and anterior translation of femur

Question 7

What is the main role of the MCL

Answer 7

Resists valgus force

Question 8

What is the main role of the LCL

Answer 8

Resists varus force and abnormal external rotation of tibia

Question 9

What can predispose you to OA of the knee

Answer 9

Previous meniscal tears 
Ligament injuries 
Malalignment 
Genetic 
Hobbies - sport

Question 10

When would you consider a knee replacement

Answer 10

Patient has significant pain and disability

Conservative management isn’t work

Question 11

List some potential complications of TKR

Answer 11

Infection
Thrombosis
Medical complications

Question 12

Knee replacements have a lower risk of dislocation compared to hips = true or false

Answer 12

True

Question 13

How does an meniscal tear present

Answer 13

Localised pain
Effusion develops the day after injury
Locking of the knee
Might feel like knee is giving way

Question 14

What is a haemarthrosis

Answer 14

Effusion due to bleeding in the joint

Can occur after ACL rupture

Question 15

What might you find on clinical examination of meniscal tears

Answer 15

Effusion
Joint line tenderness
Pain on tibial rotation - positive Steinman’s test

Question 16

What is a bucket handle tear

Answer 16

Where a large meniscal fragment is able to flip out of normal position and causes mechanical obstruction
Knee ‘locks’

Question 17

How do degenerate meniscus tears occur

Answer 17

Meniscus weakness with age
Can tear spontaneously or with seemingly minor injury
Common in early OA

Question 18

Why does the meniscus have limited healing potential

Answer 18

Only has arterial blood supply in outer 1/3

Potential also decreases with age

Question 19

How do you treat meniscal tears

Answer 19

Usually they don’t heal and aren’t suitable for repair
Steroid injections can ease symptoms
May settle with tie
If it doesn’t then you can take out the torn meniscus

Question 20

What will be the main complaint with ACL deficiency

Answer 20

Instability when rotating knee

Feeling like it is giving way when turning

Question 21

Is isolated PCL rupture common

Answer 21

No

usually part of multi-ligament injury

Question 22

How do you treat acute MCL tears

Answer 22

Hinged knee brace

Good healing potential

Question 23

How does an MCL tear present

Answer 23

Laxity
Pain on valgus stress
Tenderness over origin or insertion of MCL

Question 24

How do you manage chronic MCL insatbilty

Answer 24

MCL tightening

Reconstruction with tendon graft

Question 25

How do you treat LCL rupture

Answer 25

Surgery | Early repair or late reconstruction (tendon graft)

Question 26

LCL injury has a high incidence of vascular injury

Answer 26

True | Popliteal injury

Question 27

How do you treat multi-ligament injury

Answer 27

Surgical reconstruction due to the high degree of instability

Question 28

What damage can a complete knee dislocation do to ligaments etc

Answer 28

Results in rupture of all 4 main knee ligaments | High incidence of neurovascular injury

Question 29

Which age groups are commonly affected by extensor mechanism ruptures

Answer 29

Patellar tendon ruptures in younger age group (<40) Quad tendon rupture in older patients (>40)

Question 30

List some predisposing factors for extensor mechanism rupture

Answer 30

History of tendonitis Chronic steroid use or abuse RA Renal failure

Question 31

Can you treat tendonitis of extensor mechanism with steroid injection

Answer 31

No | You should avoid steroid due to high risk of tendon rupture

Question 32

How do you treat extensor mechanism ruptures

Answer 32

Surgery Tendon to tendon repair Reattachment of tendon to the patella

Question 33

What is patellofemoral dysfunction

Answer 33

Disorders of the patellofemoral articulation | Causes anterior knee pain

Question 34

How do you manage patellofemoral dysfunction

Answer 34

Most improve with physio (try to rebalance quads) Taping can help Surgery is a last resort

Question 35

What mechanisms can cause dislocation of the patella

Answer 35

Direct blow | Sudden twist of the knee

Question 36

Which direction does the patella normally dislocate

Answer 36

Laterally

Question 37

What factors predispose you to patella dislocation

Answer 37

``` Ligamentous laxity Female gender Shallow trochlear groove Genu valgum Femoral neck anteversion A high riding patella ```

Question 38

What decreases risk of recurrent patellar dislocation

Answer 38

Physio to strengthen the quadriceps | As you age, risk goes down