Knee

Question 1

which of the menisci is fixed?

Answer 1

medial meniscus

Question 2

what do menisci do?

Answer 2

distribute load from convex femoral condyles to relatively flat tibial articular surfaces

Question 3

which plateau is slightly more concave?

Answer 3

medial

Question 4

what does the MCL resist?

Answer 4

valgus stress

Question 5

what does the LCL resist?

Answer 5

varus stress

Question 6

what does the ACL resist?

Answer 6

anterior subluxation of the tibia /femur

hyperextension of the knee

Question 7

what can an MCL rupture lead to?

Answer 7

valgus instability

Question 8

what can an ACL rupture lead to?

Answer 8

rotatory instability

Question 9

what can an PCL rupture lead to?

Answer 9

recurrent hyperextension or instability descending stairs

Question 10

what can an posterolateral corner rupture lead to?

Answer 10

varus & rotatory instability

Question 11

which kinds of patients usually have meniscal tears?

Answer 11

sporting injury in younger patients or getting up from squatting in younger patients

Question 12

which patients can you see an atraumatic meniscal tear in?

Answer 12

spontaneous degenerate tears in older patients (40+)

Question 13

what associated injury to 50% of ACL ruptures have?

Answer 13

meniscal tears

Question 14

how would you investigate a meniscal tear?

Answer 14

MRI

Question 15

which side is more commonly torn in meniscal tears?

Answer 15

medial

Question 16

how would you repair a meniscal tear?

Answer 16

arthroscopic repair

Question 17

how you repair a meniscal tear with mechanical symptoms (pain/catching), irreparable tears or failed meniscal repair?

Answer 17

arthroscopic menisectomy

Question 18

what does acute locked knee signify?

Answer 18

displaced bucket handle meniscal tear

Question 19

what is required with a displaced bucket handle meniscal tear?

Answer 19

urgent surgery (arthroscopic repair/partial meniscectomy)

Question 20

what can develop if a knee remains locked?

Answer 20

FFD

Question 21

what does a degenerate meniscal tear probably signify?

Answer 21

1st stage of OA

Question 22

what’s a grade 1 knee ligament injury?

Answer 22

sprain

tear some fibres but macroscopically still intact

Question 23

what’s a grade 2 knee ligament injury?

Answer 23

partial tear

some fascicles disrupted

Question 24

what’s a grade 3 knee ligament injury?

Answer 24

complete tear

Question 25

describe what the healing like with an MCL injury?

Answer 25

usually heals well even if completely torn unless combined with ACL/PCL rupture

Question 26

how would you treat an MCL injury?

Answer 26

brace early motion physiotherapy

Question 27

how does ACL rupture usually come about?

Answer 27

sports injury - football, rugby, skiing

Question 28

how do you treat ACL rupture?

Answer 28

reconstruction - autograft - allograft - synthetic graft

Question 29

how does an LCL injury usually come about?

Answer 29

varus stress & hyperextension

Question 30

describe the healing of an LCL injury?

Answer 30

doesn't heal & can cause various & rotatory instability

Question 31

what nerve damage can occur in LCL injury?

Answer 31

peroneal nerve palsy

Question 32

what does an LCL injury often occur in combination with?

Answer 32

PCL/ACL injury

Question 33

when would urgent repair be required in an LCL injury?

Answer 33

if complete rupture occurs

Question 34

how does a PCL rupture usually occur?

Answer 34

direct blow to anterior tibia (dashboard/motorbike) or hyperextension injury

Question 35

what will be seen clinically with PCL rupture?

Answer 35

popliteal knee pain & bruising

Question 36

what complications can occur with knee dislocation?

Answer 36

popliteal artery injury nerve injury compartment syndrome

Question 37

what's required fro knee dislocation to occur?

Answer 37

serious high energy injury

Question 38

how does patellar dislocation occur?

Answer 38

rapid turn or direct blow

Question 39

in which patient groups is patellar dislocation more likely?

Answer 39

``` females adolescents ligamentous laxity valgus knee torsional abnormalities ```

Question 40

what can patellar dislocation cause?

Answer 40

chondral or osteochondral injury

Question 41

how can extensor mechanism rupture occur?

Answer 41

all onto flexed knee with quads contracted

Question 42

what will you usually find in the history of a patient with extensor mechanism rupture?

Answer 42

previous tendonitis steroids chronic renal failure -> ciprofloxacin

Question 43

what will be found clinically in extensor mechanism rupture?

Answer 43

unable to straight leg raise | palpable gap

Question 44

how is extensor mechanism rupture treated?

Answer 44

requires surgical repair

Question 45

haemarthrosis

Answer 45

knee fills up with blood, comes up within an hour, causes generalised pain across the knee

Question 46

effusion

Answer 46

comes up the following day

Question 47

what does a haemarthrosis suggest?

Answer 47

ACL, fracture or very peripheral meniscal tear

Question 48

what does an effusion suggest?

Answer 48

meniscal or chondral injury

Question 49

what does pain along the joint line mean?

Answer 49

meniscal or chondral injury or a generalised haemarthrosis

Question 50

what does hyaline cartilage do within a knee?

Answer 50

decreases friction & distributes load

Question 51

which type of articular cartilage injury can heal?

Answer 51

only full thickness injuries can heal

Question 52

how does hyaline cartilage heal?

Answer 52

with fibrocartilage which has greater friction & is less wear resistant

Question 53

what atraumatic articular cartilage defects can occur?

Answer 53

osteochondritis dissecans ostoearthritis inflammatory arthritis

Question 54

osteochondritis dissecans

Answer 54

an area of the surface of the knee loses its blood supply & cartilage +/- bone can fragment off

Question 55

when is osteochondritis discerns most common?

Answer 55

in adolescence

Question 56

what are the options of techniques for cartilage regeneration?

Answer 56

drilling/microfracture osteochondral autograft/allograft mosaicplasty MACI

Question 57

MACI

Answer 57

membrane induced autologous chondrocyte implantation

Question 58

which compartment does load go through in varus knees?

Answer 58

medial compartment

Question 59

which compartment does load go through in valgus knees?

Answer 59

lateral compartment