Acute injuries of the knee

Question 1

Things to consider in a history of an acute knee injury?

Answer 1

1) Environment:
- Sport or recreation
- Workplace

2) Activity:
- Sports tackle
- Jumping

3) Energy:
- How fast
- How heavy

4) Systemic symptoms

5) Chronology:
- Acute or chronic onset
- Previous injury

6) Hear or feel a pop/crack

7) Swelling:
- Early or late onset
- Early mean haemarthrosis

Question 2

What can lead to a meniscal injury?

Answer 2

Twisting moment on a loaded fixed knee

Question 3

What sound may a meniscal injury produce?

Answer 3

“Squelch”

Question 4

How may a meniscal injury present?

Answer 4

1) Painful “squelch”
2) Slow swelling (Quicker in young)
3) Painful to weight bear
4) “Locked” knee

Question 5

What sound may an ACL tear injury produce?

Answer 5

“Pop”

Question 6

What can lead to a ACL tear injury?

Answer 6

Forward momentum, leg fixed +/- rotation

Question 7

How may a ACL tear present?

Answer 7

> “Pop”
Quick swelling
Often able to weight bear

Question 8

How may a Collateral Tear present?

Answer 8

> Lateralised pain
feel of “crack”, sharp pain
no or minimal effusion
bruising to one side

Question 9

How would you examine an acute knee injury?

Answer 9

Look, feel and move:

1) Look for:
- Scars
- Bruising and swelling
- Joint line irregularity

2) Feel for:
- Feel for effusion
- Crepitus
- Heat
- Tenderness
- Tissue lumps or defects

3) Move:
- Passive and active
- Straight leg raise
- Range of movement
- Ligament testing
- Dynamic testing

Question 10

Which acute knee injuries can be seen with an X-ray?

Answer 10

Fracture

Loose bodies

Ligament avulsion

Osteochondral defect

Degenerative joint disease

Lipohaemarthrosis

Question 11

Which acute knee injuries can be seen with a ultrasound?

Answer 11

Tendon rupture

Some meniscal tears

Swelling

Cysts

Question 12

When is a MRI used in acute knee injuries?

Answer 12

> For clinical confirmation

> Variable sensitivity & specificity

> Not good for DJD or mobile pathology

Question 13

When is surgery indicated in acute knee injuries?

Answer 13

> Failure of conservative Rx

> Demands of work

> Demands of sport

> Problems with daily activities

> Prevention of further joint injury

> Prevention of falls

Question 14

Non-surgical management for acute knee injuries?

Answer 14

> Restoration of function

> Physiotherapy

> Analgesia

> Swelling reduction

> Range of motion

> Normal movement

Question 15

If the meniscus is damaged how is it managed

Answer 15

1) Meniscal repair
2) Partial meniscenctomy
3) Meniscal tranplantation

Question 16

What are meniscii made of?

Answer 16

Fibro and chondroblasts in matrix of type 1 collagen

Question 17

Shape of the medial meniscii of the knee?

Answer 17

Semicircular

Question 18

Shape of the lateral meniscii of the knee?

Answer 18

Almost circular

Question 19

Fibrous structure of meniscus?

Answer 19

> Circumferential “hoop” fibres
Superficial randomly oriented fibres
Radially oriented “tie” fibres

Question 20

Vascular anatomy of the meniscus?

Answer 20

Perimeniscal capillary plexus originates from branches of the inferior medial and lateral geniculate arteries

Perimeniscal plexus forms circumferential vessels and penetrating radial vessels

Question 21

Meniscal repair techniques?

Answer 21

> Open Technique
Outside - In
Inside - Out
All Inside

Question 22

ACL reconstruction indication?

Answer 22

> Prevention further injury
Back to work
Back to sport
Prevention of osteoarthritis

Question 23

Management of osteochondral injuries?

Answer 23

> Debridement
> Reattachment of fragment
> Removal of loose bodies
> Microfracture chondroplasty
> ACI