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Trauma and Orthopedics YR3 > ACL, PCL and meniscal tear > Flashcards

ACL, PCL and meniscal tear Flashcards

1
Q

Clinical features of ACL tear

A
  • Twisting knee while weight bearing
  • Without contact
  • Unable to weight bear
  • Rapid joint swelling
  • Significant pain
  • Laxity in Lachman/Anterior drawer test
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2
Q

What causes rapid joint swelling in ACL tear?

A
  • Highly vascular ligament
  • –> haemoarthrosis
  • Clinically apparent within 15-30mins
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3
Q

Lachman test

A

More sensitive than ADT

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4
Q

Differentials for ACL tear presentation

A
  • Tibial plateau #
  • Distal femoral #
  • Meniscal tear
  • Collateral ligament injury
  • Quadriceps tendon injury
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5
Q

Imaging for ACL tear

A
  • AP and lateral X-rays
  • MRI scan of knee - GOLD STANDARD - confirm and pick up any meniscal tears additonally

half of ACL tears have meniscal tear too

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6
Q

Fracture that suggests ACL tear

A
  • Segond fracture
  • Bony avulsion of lateral proximal tibia
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7
Q

Immediate management ACL tear

A
  • RICE - rest, ice, compression, elevation
  • Can apply cricket pad knee splint for comfort
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8
Q

two options for ACL management

A
  • Dependent on current levels of activity and suitability for surgery
  • Conservative vs surgical reconstruction
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9
Q

Conservative management ACL

A
  • Rehabilitation
  • Strength training quadriceps to stabilise knee
  • Use cricket pad knee splint for comfort - rarely need admissio
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10
Q

Surgical management ACL

A
  • Surgical reconstruction - following a period of pre-rehabilitation, physio prior to surgery, autograft or allograft
  • Acute surgical repair - depends on location of tear in ligament - GA knee arthroscopy, resuture ends together

Auto - from self, allo - from someone else

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11
Q

Why is timing of swelling important in knee injuries?

A
  • Haemoarthrosis vs post traumatic effusion
  • Rapid = haemoarthrosis often associated with ruptured cruciate or # bone within joint capsule
  • Slower = reactive synovitis - meniscal or chondral pathology
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12
Q

PCL injury mechanism

A
  • High energy trauma
  • Eg direct blow to proximal tibia during RTA
  • OR can be low energy when hyperflexed knee and plantarflexed foot
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13
Q

Clinical features PCL tear

A
  • Immediate posterior knee pain
  • Instability of joint - +ve posterior drawer test
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14
Q

Imaging PCL

A
  • MRI - gold standard
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15
Q

Management PCL tear

A
  • Conservative
  • Knee brace and physio
  • If continues to be symptomatic and recurrent instability may require surgery with insertion of graft

If associated with other injuries then specialist knee surgery needed

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16
Q

Function menisci

A
  • Shock absorbers
  • Increased articulating SA
17
Q

Medial vs lateral menisci

A
  • Medial is less circular than lateral
  • Attached to medial collateral ligament
  • Lateral collateral is NOT attached to lateral menisci
18
Q

Cause of meniscal tears

A
  • Trauma or degenerative disease
  • Trauma = twisted knee while flexed and weight bearing
19
Q

Types of meniscal tear

A
  • Longitudinal - most common, aka ‘Bucket Handle’
  • Vertical
  • Transverse - parrot beak
  • Degenerative
20
Q

Patient symptoms of mensical tear

A
  • Tearing sensation
  • Intense, sudden onset pain
  • Swells SLOWLY - 6-12 hrs
21
Q

Signs of meniscal tear on examination

A
  • Tenderness along joint line
  • Joint effusion
  • Limited knee flexion
22
Q

Specific tests for meniscal tears

A
  • McMurrays test
  • Apleys Grind test
23
Q

Investigations for meniscal tear

A
  • X-ray - exclude #
  • MRI = gold standard for soft tissue
24
Q

Management menisci injuries - small <1cm

A
  • Rest and elevation
  • Tear will heal and pain subside over next few days
25
Q

Larger tears/remaining symptomatic menisci tears

A
  • Arthroscopic surgery
  • If tear in outer 1/3 - repair with sutures as rich vascular supply
  • If inner 1/3rd - trim tear to reduce locking
  • Middle third may be repaired or trimmed
26
Q

Complications post ligament/menisci injury

A
  • Secondary osteoarthirtis
  • Knee arthroscopy -damage to local structures eg saphenous nerve and vein, peroneal nerve and popliteal vessels, also DVT
27
Q
A

Trauma and Orthopedics YR3 (41 decks)

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