Knee

Question 1

Ligaments of knee

Answer 1

Medial/ lateral collateral ligament

Anterior/ posterior collateral ligament

Question 2

ACL injury

Answer 2

Landing or sudden deceleration - strong quadricep contraction with valgus collapse and femur internal rotation

Hyper-extension - femur posteriorly slides behind tibia with quadriceps contraction

Twisting injury - changing direction

Question 3

Meniscal injury mechanism

Answer 3

Twisting injuries whilst felxed and weight bearing

Question 4

Symptoms of meniscal injury

Answer 4

Locking and giving way

Question 5

Unhappy triad

Answer 5

Trauma to lateral knee causes tear of:

• medial collateral ligament
• medial meniscus
• ACL

Question 6

Special tests to assess ACL

Answer 6

Anterior drawer test

Lachman’s test

Question 7

PCL injury mechanism

Answer 7

Dashboard injury

Fall on front of knee

Question 8

Medial collateral ligament mechanism of injury

Answer 8

Valgus stress

Skiing

Question 9

Baker’s cyst

Answer 9

Bulge and feeling of tightness behind knee

Cause - knee trauma, OA, inflammatory arthritis, gout

Question 10

Foucher’s sign

Answer 10

Increase in tension of Baker’s cysts on extension of knee

Question 11

Infrapatellar bursitis

Answer 11

When kneeling on knees like praying

- Clergyman’s bursitis

Question 12

Prepatellar burstis

Answer 12

When kneeling on hands and feet

- housemaid’s bursitis

Question 13

ACL surgery

Answer 13

Gold-standard is autograft repair
• Usually semitendinosus ± gracilis (can use patella
tendon)

Question 14

Osteochondritis Dissecans

Answer 14

• Piece of bone and overlying cartilage dissects off into
joint space.
• Commonly knee (med. fem. condyle), also elbow, hip and ankle.
• Young adult / adolescent
• Symptoms: pain, swelling, locking, ↓ ROM
• X-ray: loose bodies, lucent crater
• Mx: arthroscopic removal

Question 15

Knee OA presentation

Answer 15

Pain around knee - can radiate to thigh and hip

Crepitus

Pain exacerbated by exercise and relieved by rest

Joint stiffness - reduced ROM

Question 16

Mx of knee OA

Answer 16

Lifestyle modification

Total knee replacement - gold standard

Question 17

ACL injury presentation

Answer 17

Immediate swelling

Significant pain

Question 18

Segond injury

Answer 18

Bony avulsion of the lateral proximal tibia - pathognomic of ACL injury

Question 19

Ix for Meniscal tears MCL, PCL and ACL injury

Answer 19

Xray - rule out other causes

MRI scan - gold standard

Question 20

ACL injury mx

Answer 20

RICE
Conservative - splint and rehab
Surgical - tendon or artifical graft

Question 21

Presentation of medial collateral ligament injury

Answer 21

May pop 
Immediate medial joint line pain
Swelling after hours 
Tender along joint line 
May be able to weight bear

Question 22

MCL injury mx

Answer 22

RICE
Strength training for 6 weeks
Analgesia

Grade II - moderate injury, with an incomplete tear:
- knee brace, strength training for 10 weeks

Grade III - severe injury, with a complete tear :
- Knee brace, crutches, strength training for 12 weeks

Question 23

Indication for surgery in medial collateral ligament injury

Answer 23

Distal avulsion on MRI

Question 24

Medial meniscus

Answer 24

Less circular than lateral meniscus

Attached to MCL

Question 25

Purpose of menisci

Answer 25

Shock absorber | Increase articulation surface area

Question 26

Types of meniscal tear

Answer 26

Longitudinal - bucket handle - central tear separates from lateral fragment Vertical Transverse (Parrot-beak) Degenerative

Question 27

Clinical features of meniscal tears

Answer 27

Tearing sensation in the knee Intense sudden onset pain Swells slowly - 6 - 12 hours Locked in flexion - unable to extend Tenderness Joint effusion

Question 28

Test for meniscal tears

Answer 28

McMurray’s Test* and Apley’s Grind Test

Question 29

Mx of meniscal tears

Answer 29

RICE Larger tears - arthroscopy If tear is in outer third - can be sutured Inner third - trimmed

Question 30

Complications of meniscal tears and tx

Answer 30

OA Arthroscopy can cause - DVT, damage to local structures such as the saphenous nerve and vein, the peroneal nerve, and the popliteal vessels

Question 31

Clinical features of patella fracture

Answer 31

Anterior knee pain Worse with movement Unable to straight leg raise Swollen and bruised Patella defect

Question 32

Bipartite Patella

Answer 32

Congenital condition whereby there is failure of patella fusion, leaving two separate bone fragments of the patella joined only by fibrocartilaginous tissue - asymptomatic

Question 33

Ix for patella frcature

Answer 33

Xrays - AP, Lateral , skyline CT

Question 34

Mx of patella fractures

Answer 34

Non displaced, minimally displaced - conservative - RICE - brace or cylinder cast- early weight bearing in extension Displaced or compromised extension - surgery - ORIF with tension band wiring - screw fixation if simple fracture

Question 35

Complications of patella fractures

Answer 35

OA | Loss of ROM