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Knee Flashcards

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1
Q

how much fibre damage in ligament injuries? (grade 1 vs 2 vs 3)

A

grade 1 - 10%
grade 2 - 50%
grade 3 - 90%

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2
Q

how much bruising / swelling in grade 1/2/3 ligament injuries?

A

grade 1 - minor, takes hours to appear
grade 2 - moderate, within 4 hours
grade 3 - extensive and distal

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3
Q

how bad is the dysfunction in grade 1/2/3 ligament strain?

A

grade 1 - minor
grade 2 - moderate
grade 3 - severe - cant weight bear

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4
Q

how bad is the laxity/instability in a grade 1/2/3 ligament strain?

A

grade 1 - mild, end feel ok
grade 2 - variable, firm end feel
grade 3 - severe, no firm end feel

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5
Q

what is a ligament avulsion?

A

ligamentous attachment pulled off bone

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6
Q

is a ligamentous avulsion more common in younger or older patients and why?

A

younger patients, ligaments are more elastic and incomplete ossification of bone

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7
Q

what are the knee ottowa rules?

A

age 55+
isolated tenderness of the patella (no bone tenderness of knee elsewhere)
tenderness of the head of fibula
cannot flex to 90 degrees
unable to weight bear both immediately and in the ER department (4 steps, limping allowed)

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8
Q

when are the OTTOWA rules applicable?

A

in the first 7 days of injury

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9
Q

what is the most commonly injured ligament?

A

ACL

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10
Q

where does the ACL attach?

A

anterior aspect of intercondylar area of tibia
to posterior aspect of intercondylar area of femur

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11
Q

what stress is applied in an ACL injury?

A

dynamic valgus stress

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12
Q

what percentage of ACL injuries are non contact?

A

72%

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13
Q

are ACL tears more common in males or females and why?

A

females
anatomical variations - higher Q angle due to wider pelvis, greater angle at knee
menstrual cycle - greater ligamentous laxity
neuromuscular control - greater hamstring flexibility, decreasing passive protection of ACL (hamstring function can mimic ACL function)

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14
Q

what are the two common tests for ACL injury and which is more sensitive/specific?

A

anterior drawer test
lachmans test (more sensitive and specific)

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15
Q

what is the most common site they take from for ACL reconstruction?

A

hamstring tendon

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16
Q

how long does it take to return to sport after ACL reconstruction?

A

9-12 months, up to 2 years rehab for adolescents

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17
Q

where does the PCL attach?

A

posterior intercondylar area of tibia to anterior part of lateral aspect of medial femoral condyle

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18
Q

what is the most common cause of a PCL injury?

A

dashboard injury - road traffic collision

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19
Q

what happens in a PCL injury?

A

tibia pushed back

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20
Q

which part of the menisci has better healing capacity and why?

A

periphery because better blood supply

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21
Q

what is a partial meniscectomy?

A

removing part of the meniscus that is torn. simple keyhole procedure, useful for relieving pain and mechanical symptoms in the short term

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22
Q

what is the risk of a partial meniscectomy?

A

may increase long term OA risk as exposing subchondral bone to degenerative change

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23
Q

why are meniscal injuries less likely to heal?

A

poor vascularisation of tissue

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24
Q

what are the pros of repairing a meniscal injury with sutures?

A

may reduce development of OA, can relieve pain and mechanical symptoms

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25
what are the cons of repairing a meniscal injury with sutures?
requires 6+ weeks of non weight bearing post op cant repair all tears, some repairs will fail
26
what is the unhappy triad of o'donoghue?
combination of MCL, ACL and medial meniscus injuries
27
what does subluxation mean?
when something relocates immediately
28
whats the most common patella dislocation and why?
lateral dislocation due to the shape of the trochlear groove (lateral femoral condyle is smaller, less passive stability in lateral direction)
29
where is the pain located in a patella tendinopathy?
inferior pole of the patella
30
what position is the fat pad in compression?
hyperextension
31
what does ITB attach to?
pelvis via TFL
32
what is the cause of ITB syndrome?
friction of the ITB flicking over the lateral femoral condyle, compression of the underlying fat
33
what are the three things needed to diagnose OA without imagine?
age > 45 activity related joint pain no EMS or EMS < 30 mins
34
what causes pre patella bursitis?
carpet layers / housemaids / rug cutters knee
35
what causes pes anserine bursitis?
repetitive flexion and extension
36
what causes popliteal bursitis?
usually a symptom of OA
37
what are the two tests for a PCL injury?
posterior draw test posterior sag sign
38
what is the tests for a MCL injury?
valgus stress test if pain and laxity in 30 degrees only, this isolates MCL
39
what is the test for an LCL injury?
varus stress test
40
what are the two tests for a menisci tear?
McMurrays Thessalys
41
what are two tests for PFPS?
compression of patella resisted mid range extension
42
what are two tests for a patella tendinopathy?
single leg decline squat resisted knee extension
43
what is the test for fat pad impingement?
hoffa's test
44
what are the attachments and function of the MCL?
medial epicondyle of femur to medial condyle of tibia limits abduction of the tibia
45
what is the function of the PCL?
prevents tibia being pushed back or femur sliding forwards
46
what are the attachments and function of the LCL?
runs from the lateral epicondyle of the femur to the head of the fibula limits adduction
47
what are the menisci and what do they do?
two pieces of fibrocartilage that improve congruency between tibia and fibula
48
what is more susceptible to injury, lateral or medial meniscus and why?
the lateral menisci is less susceptible to injury because it is more mobile as doesnt attach to the LCL
49
is the MCL or LCL more commonly injured and why?
the MCL is more commonly injured valgus stress is more common LCL has better support from surrounding structures
50
what is fat pad impingement?
irritation and inflammatory response to infrapatella fat pad
51
what is ITB syndrome?
ITB becomes tight / irritated due to friction between the ITB and lateral femoral epicondyle causing inflammation and irritation of the bursa underneath
52
which compartment of the knee is more susceptible to OA and why?
medial, most weight is transmitted through the medial compartment
53
what two tests would you do for ITB syndrome?
modified thomas test single leg squat
54
what two tests would you do for OA of knee?
flexion/extension ROM squat
55
what is bursitis?
irritation, swelling and fluid content increase of bursa due to overuse of surrounding tendons, excess pressure and mechanical forces
56
describe the pain, swelling, force and key features of ACL injury
quick swelling diffuse pain valgus force snap/pop
57
describe the pain, swelling, force and key features of PCL injury
quick swelling diffuse pain tibia pushed back
58
describe the pain, swelling, force and key features of MCL injury
slower swelling pain localised medial knee valgus force
59
describe the pain, swelling, force and key features of LCL injury
slower swelling pain localised lateral knee varus force
60
describe the pain, swelling, force and key features of medial meniscus injury
slow swelling pinpoint pain on joint line valgus force locking, catching
61
why is swelling slowest in meniscus injuries and fastest in cruciate ligaments compared to collateral ligaments?
cruciate ligaments are intra articular (within joint) best blood supply collateral ligaments are extra articular (outside joint), not as good blood supply menisci - mostly avascular (apart from outer rim has small blood supply)
62
why is the pain diffuse in cruciate ligaments, localised in collateral ligaments and pinpoint in menisci?
because the cruciate ligaments are deep and the collateral ligaments are more superficial

MSK lower body (7 decks)

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