Conditions of the Knee

Question 1

Acute cause of meniscal tears

Answer 1

Twisting in deep flexion

Question 2

Degenerative cause of meniscal tears

Answer 2

Osteoarthritis

Question 3

Why are medial meniscal tears more common?

Answer 3

Attached to medial collateral ligament, fixed structure

Question 4

Presentation of meniscal tear

Answer 4

Pain
Clicking
Locking
Intermittent swelling

Question 5

Examination findings in meniscal tear

Answer 5

Effusion
Tender joint line at point of tear
Mechanical block to movement
McMurrays test positive
Fail to deep squat
Thessaly's test positive

Question 6

Investigation for meniscal tear

Answer 6

Xray

MRI

Question 7

Treatment for meniscal tear

Answer 7

Rest
NSAIDs
Physio - Quad and hamstring strengthening

Operative - arthroscopy - repair and resection

Question 8

Positive tests for meniscal tear

Answer 8

McMurray’s

Thessaly’s

Question 9

Describe osteoarthritis

Answer 9

Degenerative change of synovial joint - loss of cartilage and secondary bony changes
Pain and stiffness of affected joint

Question 10

The anterior cruciate ligament runs between which structures?

Answer 10

Tibial eminences

Question 11

What is the blood supply of the anterior cruciate ligament?

Answer 11

Middle geniculate artery

Question 12

What is the nerve supply of the anterior cruciate ligament?

Answer 12

Posterior articular nerve - branch of tibial

Question 13

Function of the ACL

Answer 13

Restraint to anterior translation of tibia relative to femur

Secondary restraint to tibial rotation and varus/valgus stress

Question 14

How is the ACL most commonly injured?

Answer 14

Non contact pivotal injury
Females
Weak quadriceps

Question 15

Presentation of ACL tear

Answer 15

Popping/cracking
Immediate swelling
Cannot continue playing
Deep pain

Question 16

Findings on examination of ACL

Answer 16

Effusion

Anterior Draw
Lachmann’s test
Pivot shift - do under anaesthetic

Question 17

Investigations for ACL tear

Answer 17

X-ray
MRI
Look at menisci

Question 18

Non-operative treatment for ACL tear

Answer 18

Focused Quadriceps programme

Question 19

Operative treatment for ACL tear

Answer 19

ACL reconstruction
+ partial menisectomy
+/- ligament repair or augmentation
+ hamstring graft

Question 20

Which movement does the MCL assist?

Answer 20

Full knee extension

Question 21

What is the most common ligamen injury of the knee?

Answer 21

Medial Collateral ligament

Question 22

How is the MCL injured?

Answer 22

Severe valgus stress

Contact related

Question 23

Associated injuries with MCL tear

Answer 23

ACL

Medial meniscus

Question 24

Presentation of MCL tear

Answer 24

Cracking, popping
Pain
Unable to continue playing
Bruising medial side of knee
Localised swelling

Question 25

Examination of MCL tear

Answer 25

Medial swelling and bruising Tender medial joint, tender femoral insertion Painful in full extension, opening on valgus stress

Question 26

Investigation of MCL tear

Answer 26

X-ray | MRI

Question 27

Treatment of MCL tear

Answer 27

Rest NSAIDs Physio Brace Repair or reconstruction

Question 28

What is osteochondritis dissecans?

Answer 28

Pathological lesion affecting articular cartilage and subchondral bone Juvenile form or Adult

Question 29

Causes of osteochondritis dissecans

Answer 29

Hereditary Trauma Vascular

Question 30

What is the adult-only cause of osteochondritis dissecans?

Answer 30

Vascular

Question 31

Most common location of osteochondritis dissecans

Answer 31

Posterolateral aspect of medial femoral condyle

Question 32

Presentation of osteochondritis dissecans

Answer 32

Activity-related pain Recurrent effusions Locking and block to full movement

Question 33

Examination findings for osteochondritis dissecans

Answer 33

Effusion Tenderness Block to movement Wilsons test positive - internal rotation

Question 34

Investigation for osteochondritis dissecans

Answer 34

Xray | MRI

Question 35

Non-operative treatment for osteochondritis dissecans

Answer 35

Restrict weight-bearing | ROM brace

Question 36

Operative treatment for osteochondritis dissecans

Answer 36

Arthroscopy - subchondral drilling Fixation of loose fragment Open fixation