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MSK Diseases > Knee > Flashcards

Knee Flashcards

(54 cards)

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1
Q

What usually causes meniscal tears?

A

Sporting injury eg twisting
Secondary to ACL tears (in 50% of cases)

Elderly degenerative tears (20% of over 50s), which can show early stages of OA

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2
Q

What is the most common meniscal tear?

A

Medial

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3
Q

What are the types of meniscal tear

A

Horizontal
Longitudinal
Parrot beak
Radial
Bucket handle

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4
Q

How do meniscal tears present?

A

Localised pain and tenderness, ‘knee about to give way’
Locking (bucket handle)
Inflammatory effusion

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5
Q

Why are bucket handle tears more severe?

A

Fragment displacement into intercondylar notch can obstruct normal knee mechanism- causes acute locking

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6
Q

How are meniscal tears investigated?

A

Mcmurray test positive
MRI- first line
Arthroscopy- gold standard can also be used to treat

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7
Q

How are meniscal tears treated?

A

RICE
NSAIDs for analgesia
Physio

Surgery/arthroscopy if required in more severe cases

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8
Q

What are the Ottawa rules for who needs an X-ray of the knee?

A

Age 55 or above
Patella tenderness (with no tenderness elsewhere)
Fibular head tenderness
Cannot flex the knee to 90 degrees
Cannot weight bear (cannot take 4 steps – limping steps still count)

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9
Q

What causes ligament tears

A

Often forceful rotational movement

Also high impact injury or sudden stops

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10
Q

What are the ligament tear grades?

A

1- sprain, microtears
2- partial tear
3- complete tear

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11
Q

What does each ligament do?

A

MCL resists valgus stress
rupture -> valgus instability

LCL and ACL resists varus stress
Rupture -> varus instability

PCL resists posterior subluxation of femur
Rupture -> hyperextension and general instability

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12
Q

Presentation of the different ligaments tears

A

MCL and LCL-
Swelling and ecchymosis, localised pain, bruising, tenderness over associated joint line
MCL valgus instability and LCL varus instability

PCL- popliteal pain and bruising

ACL- pop on injury and haemarthrosis
Diffuse pain, which settles but will leave rotational instability

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13
Q

What is a complication of LCL?

A

May cause foot drop due to possible peroneal nerve injury

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14
Q

How are ligament tears investigated?

A

Informed by symptoms

X-ray
MRI- gold standard

Drawer tests for cruciates and stress tests for collaterals

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15
Q

Management for knee ligament tears

A

ACL- surgery via tendon grafting often required
PCL- conservative management, surgery only needed if more severe or other structures involved
MCL- heals well with conservative management due to rich blood supply
LCL- poor blood supply so usually needs surgery, as well as extra complication risk

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16
Q

What causes patella dislocation

A

Direct impact
Sudden quad contraction
Most common in teenagers, particularly female

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17
Q

In what direction would a patella dislocate?

A

Always lateral, never medial

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18
Q

What are some risk factors for patellar dislocation

A

Hypermobility
High Q angle- more genu valgum
Underdeveloped lateral femoral condyle
High riding patella
Weak quad insertions

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19
Q

How do patellar dislocations present?

A

Medial pain, effusion
Positive patellar apprehension test

History of dislocation increases likelihood

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20
Q

How are patellar dislocations investigated and managed?

A

X-ray

Resolution may be spontaneous or may need manipulation

Aftercare involves physio and painkillers

In rare cases a brace and aspiration is needed

Surgically stabilise if it keeps happening

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21
Q

How does a complete knee dislocation differ from a patella dislocation?

A

Patellar involves just patella
Complete knee involves misalignment between tibia and femur

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22
Q

What causes a complete knee dislocation?

Study These Flashcards
A

Severe high impact injury

23
Q

How does a complete knee dislocation present?

Study These Flashcards
A

Severe pain and instability, knee grossly deformed

24
Q

How is a complete knee dislocation investigated?

Study These Flashcards
A

X-ray to confirm dislocation

CT angiogram if concerned about neurovascular status

MRI for ligament and soft tissue involvement

25
Management for complete knee dislocation
Neurovascular status is key, as prolonged ischaemia has very bad consequences Requires immediate surgical reduction
26
What causes patellar fracture?
Traumatic injury or rapid quad contraction with flexed knee
27
How does a patellar fracture present?
Severe localised pain with palpable defect Can’t lift leg or perform straight leg raise Haemarthrosis
28
How is a patellar fracture managed?
Conservative- knee immobilised in extension Operative- severity dependent, ORIF all the way to patellectomy
29
What is a tibial plateaux fracture and what causes them?
Fracture to the proximal part of the tibia, caused by high energy injuries (or low in elderly)
30
What assessment criteria is used to classify tibial plateau fractures?
Schatzer classification : I- lateral split II- lateral split with depression III- depression IV- medial split V- bicondylar VI- metaphysis diaphysis dissociation
31
Tibial plateaux fracture presentation and investigation
Presents with severe pain, instability, weight bearing difficulty X-ray: Horizontal lateral beam may show lipohaemarthrosis, bone fragments CT: To judge condylar involvement to guide treatment
32
Management for tibial plateaux fracture
Conservative- casting Operative- ORIF or TKR depending on severity
33
What are some complications of a tibial plateaux fracture?
Lateral blow many damage common fibular nerve Risk of associated soft tissue injury and compartment syndrome
34
What does the knee extensor mechanism consist of?
Tibial tuberosity Patellar tendon Patella Quadriceps tendon Quadriceps muscle
35
What causes an extensor mechanism rupture?
Middle aged running and jumping sports Blunt trauma Failing on flexed knee Rapid contractile force can trigger a rupture, especially with natural degeneration In younger patients patellar tendon most common but this becomes quadriceps with old age
36
What are the risk factors for an extensor mechanism rupture
History of tendonitis Steroids Renal failure Ciprofloxacin (and other quinolones) RA Diabetes
37
How does an extensor mechanism rupture present?
Knee pain and weakness Unable to straight leg raise Palpable gap
38
How is an extensor mechanism rupture diagnosed
Clinical- if they can do a straight leg raise you can rule it out X-ray- effusion, displaced patella USS MRI- tears, also better for larger patients
39
Management for an extensor mechanism rupture
Usually urgent surgical repair -> physio However small tears can be treated by immobilisation
40
What are loose bodies in the knee
Small bone or cartilage fragments that can move freely in knee synovium
41
What causes a loose body?
Trauma Joint degeneration Osteochondritis dissecans
42
How do loose bodies present?
Random sharp pain- never constant Suggestive signs ie a lump, locking
43
What causes locking in a loose body
Can get nutrition from synovium so may grow and stick to synovium, causing locking
44
Investigation of a loose body
X-ray for calcifications, MRI for cartilaginous fragments Often overdiagnosed -> the fabella is an accessory ossicle found in 40% of people which may be confused as one
45
How can loose bodies be treated?
Can be surgically removed but outcome is dependent on cause- If cause is degenerative disease like arthritis then removal won’t help degenerative related pain
46
What can cause bone bruising, and what is the management plan?
Microscopic fracture of trabecular bone with bleeding and inflammation Caused by direct trauma or secondary to tears Often presents with major pain after meniscal or ligament tears Investigated by MRI and settles on its own after a few months
47
What is a patellofemormal disorder?
A disorder in patellofemoral articulation that results in anterior knee pain
48
How does a patellofemoral disorder present, and how is it managed and diagnosed?
Anterior knee pain made worse by walking downhill Grinding and clicking, inactivity related stiffness Locking- either literal locking or pain related restriction Diagnosed clinically and managed with physio and taping
49
What is a bakers cyst and what does it often rise in conjunction with
Ganglion cyst found in popliteal fossa Rises in conjunction with OA
50
How does a bakers cyst present and how are they managed?
Fullness and softness of bursa Managed via controlling underlying OA (or any other causative condition)
51
What is bursitis?
Inflammation of the synovium lined sacs that protect bony prominences and joints Caused by repeated pressure or trauma
52
How can bursitis present?
Pre patellar- kneecap Olecranon- elbow tip Trochanteric
53
How is bursitis managed?
Goes away itself, just stay off knees and take analgesia
54
What is the presentation of bursitis similar to?
Septic arthritis so must rule this out via aspiration

MSK Diseases (18 decks)

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