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Ortho > Chapter 39- Injured Knee And Patella > Flashcards

Chapter 39- Injured Knee And Patella Flashcards

(47 cards)

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1
Q

What is the differential for painful knee and no other findings on examination

A
  • referred from hip/ spine

- painful patellar syndrome (will have tenderness on underside of patella)

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2
Q

Differentials for pain on the anterior knee?

A

Patella: acute: fracture; chronic: chondromalacia

Extensor mechanism: acute: rupture
Chronic: tendonitis

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3
Q

Differentials for blood cause swelling of the knee joint

A

Swelling is immediate (hours)

  • haemarthrosis: confined to synovial space - 70 percent are due to ACL rupture
  • meniscal tear or collateral ligament injury
  • Intra articular fracture
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4
Q

Differentials for synovial fluid causing swelling of the knee

A

Occurs in days rather than hours

  • meniscal pathology
  • joint instability (ligament injury)
  • articular pathology
  • synovitis
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5
Q

Differentials ‘giving way’ of the knee joint?

A
  • ligamentous laxity (ACL)
  • loose body
  • meniscal tear
  • articular pathology
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6
Q

What does locking of the knee refer to?

A

Inability to extend the joint

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7
Q

What is the cause of locking of the knee?

A

Meniscal tear

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8
Q

What is anatomical valgus position of the legs

A

5 degrees in males and 7 degrees in females

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9
Q

Symptoms of the ACL Injury (at initial injury)

A
  • acute episode, usually rotational stress, during sporting activities
  • may have heard or felt a pop or snap sensation
  • immediate swelling
  • could not continue activities
  • pain: variable and sometimes may be mild
  • acute symptoms settle in +- 2 weeks
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10
Q

Symptoms of ACL tear (untreated or chronic)

A
  • present with giving way on rotational activities especially
  • intermittent swelling with episodes of giving way
  • no locking experienced unless a meniscus is torn as well
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11
Q

Findings on examination of an ACL tear

A

Effusion
Muscle wasting if chronic
Lachman test positive
Pivot shift positive

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12
Q

What is a possible X-ray finding of ACL tear

A

Avulsion of bony attachment of ACL or ITB

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13
Q

Treatment of ACL Tear in high level athlete

A

ACL reconstruction: refer to specialist

Rehabilitation: thigh muscle, hamstring in particular, rehab for propriception retraining

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14
Q

Treatment of ACL Low demand individual

A
  • rehab thigh muscles, especially hamstrings
  • brace
  • reconstruction of ACL is giving way and swelling is the problem
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15
Q

Typical history for collateral ligament tear ( acute)

A
  • varus or valgus stress injury
  • pain on medial or lat side
  • localized swelling
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16
Q

If persistant pain or instability is associated with the collateral ligament tear what are the likely associated conditions?

A
  • persistant pain: meniscal tear, articular cartilage damage or bone bruise
  • instability: associated PCL or ACL injury
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17
Q

Treatment of collateral ligament tear?

A
  • supportive: Robert jones or knee immobilizer
  • rehab: quads and hams
    Gradual return to activity as discomfort and swelling subsides
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18
Q

How may a chronic PCL tear present (history)

A
  • may present with anterior knee pain months after injury or medial compartment OA years later
  • posterior pain: associated postero-lateral capsule tear, meniscal tear or bone bruise
  • classic instability rare
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19
Q

Examination findings for PCL

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A
  • Minimal if any swelling in isolated history

- Posterior subluxation of the tibia on the femur (post sag sign, tibial step off sign)

20
Q

Describe the PCL brace

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A

Extension with thick foam pad behind calf muscle

21
Q

Treatment of PCL tear in high demand individuals

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A

Refer for repair/ reconstruction

22
Q

Treatment of PCL tears in low demand individuals

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A

Brace in extension with PCL brace for 2-3 weeks

Rehab focused on quads mainly

23
Q

In a knee dislocation, which other structures should be examined for injury?

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A
  • common perineal nerve and popliteal artery
24
Q

Treatment of knee dislocation

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A
  • all knee dislocations must be reduced as soon as possible and an angiogram performed if possible
  • vascular injury present: vascular repair, repair accessible tear of the posterior capsule, stabilize the knee with exoskeleton, address remaining instability at a later stage
  • no vascular injury: primary if status of tissue permit (i.e. If minimal swelling). If swollen, allow to settle and then address disrupted ligaments. Stabilize with POP cast or exoskeleton
25
What is the mechanism of injury in a meniscal tear
Tears occur with rotation of the knee in a flexed position
26
Symptoms of meniscal tear
- pain: posterio-medial/ postero- lateral corners - locked knee - intermittent swelling - flexion deformity - giving way with low energy activity - experience clunk or feel something move in the knee
27
Examination findings for meniscal tear
- tender- medial or lateral joint line - swelling - effusion - flex deformity - muscle wasting if >2 weeks - mcmurray and steinman positive
28
Treatment of meniscal tear
- endoscopic repair or partial menisectomy - Rehab: quads and hams - crepe or tubigrip support
29
What types of loose bodies are found in the knee and where do they originate from
- Chondral or osteochondral | - originate from injury to articular cartilage or osteochondritis dissecans fragment
30
Symptoms of Loose bodies in the knee
- patients can locate it if mobile - giving way - locking sporadically
31
Treatment of loose bodies in the knee
Remove | Replace intra articular defect if osteochondritis dissecans
32
Causes of extensor mechanism rupture in the knee
- quadriceps tendon: rupture in the elderly - patellar fracture - patellar tendon rupture in athletes
33
Describe quadriceps lag
Patient can passively extend the knee but cannot maintain active extension
34
Cause and treatment of popliteus tendon rupture
- sharp external rotation of the tibia on the femur may rupture or avulse the popliteus tendon, also seen with LCL injury - treatment is symptomatic and supportive
35
What injury is gastrocnemius rupture associated with?
Seen in association with severe lateral ligament disruption
36
What is the cause of iliotibial band tendinitis? what is the treatment?
- Caused by the ITB passing over the lateral femoral epicondyle during repetitive flexed knee activity - Treatment is LA and steroid, divide ITB under LA
37
Treatment of pes anserinus bursitis or tendinitis
Local anaesthetic and steroid- modify activity
38
Name and describe the types of patellar fractures
- Linear: Due to explosion contraction of the quads, such as jumping down from a height - Stellate or comminuted fracture: caused by direct blow
39
Clinical presentation of patellar fracture
- History of a fall/ jump from a height, or direct trauma - Swollen knee with bruising - Palapable gap in patella with separation of the fragments - Unable to elevate leg with knee fully extended - Movement limited by pain in the acute stage, usually in full flexion in chronic injury with an extensor lag
40
What are the parameters to define a displaced/undisplaced patellar fracture
Undisplaced: <2mm separation or step Displaced: >2 mm separation or step
41
Treatment of undisplaced patellar fractures
-POP cylinder or extension knee brace for 4-6 weeks then active flexion and extension exercises
42
Treatment of displaced patellar fractures
- Mid-patella: open reduction and internal fixation (tension band wiring) and POP cast in extension for 6 weeks - Proximal or distal pole: Excise small fragment and repair tendon and POP cast for 6 weeks - Longitudinal: interfragmentary screw fixation If irreducible/ irreparable or cartilage too badly damaged --patellectomy
43
Name a patellar stabilizer that is commonly torn, causing lateral dislocation of the patellar
-Medial Patello-femoral ligament
44
Causes of patellar dislocation
- Congenital - Acquired: direct blow forcing it out of position, indirect force: Strong quadriceps contraction with low leg in external rotation (jumping)
45
Examination findings of patellar dislocation
-Acute: knee held flexed and medial femoral condyle is prominent Look for -Overall leg alignment (usually valgus and anteversion of femoral neck with squinting patellae) -Quadriceps mechanism alignment (Q angle) -Ligamentous laxity -Size and position of the patellar
46
What is the skyline view used to view in a patellar dislocation
-Identify bony avulsion from medial side or an osteochondral injury to the crest of the patella
47
Treatment of patellar dislocation
Acute: - Analgesia and and extension to reduce the dislocation - If significant force: arthroscopy to look for chondral or osteochondral injury - Repair of retinacular tear in young, active individuals - immobilise with POP cast in 10-15 degrees flexion - Rehab of quads Chronic or recurrent: - Refer to specialist - Reconstruction of the medial patello-femoral ligament is recommended - Rehab of quads

Ortho (41 decks)

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