Knee

Question 1

inflammation where the patellar tendon attaches to tibial tuberosity

Answer 1

Osgood Schlatter’s

Question 2

___ distribute wt from ___ femoral condyles to tibial plateau

Answer 2

menisci

convex

Question 3

compared to the lateral ones the medial plateau is more ___ and the medial meniscus is ___

Answer 3

concave

fixed (lateral is more mobile)

Question 4

knee pivots on ___ compartment through flexion (tibial __ rotates) and extension (tibial __ rotates) => ___ meniscus under more shear stress

Answer 4

medial
internally
externally
medial

Question 5

MCL resists ___ stress

rupture => __ instability

Answer 5

valgus x2

Question 6

LCL resists ___ stress

Answer 6

varus

Question 7

ACL resists ___ of the tibia and __ of the tibia in extension

Answer 7

anterior subluxation

internal rotation

Question 8

PCL resists ___ of the tibia/ __ of femur and knee ___

rupture => __+___

Answer 8

posterior subluxation of tibia
anterior subluxation of femur
knee hyperextension
=> recurrent hyperextension
instability descending stairs

Question 9

posterolateral corner = +++ that resist ___ of tibia in flexion
rupture => + instability

Answer 9

LCL
PCL
popliteus and other ligs
external rotation
varus and rotatory

Question 10

in younger ptnts meniscal tears usually caused by __/__

Answer 10

sport / rising from squat

Question 11

in elderly ptnts meniscal tears are usually caused by __

Answer 11

atraumatic degenerative tears

Question 12

__% of ACL ruptures have a meniscal tear

Answer 12

50

Question 13

menisci that is 10x more likely than the other to tear

Answer 13

medial

Question 14

Ix for meniscal tears

Answer 14

MRI

Question 15

___ in knee menisci have blood supply therefore __ tears wont heal

Answer 15

peripheral 1/3

radial

Question 16

appearance of a normal knee menisci on MRI

Answer 16

uniformly black

Question 17

acute locked knee =

Answer 17

displaced bucket handle meniscal tear

Question 18

in a displaced bucket handle meniscal tear patient will have a ___ block to extension

Answer 18

15 degree springy

Question 19

Rx of displaced bucket handle meniscal tear =

if not within a few wks =>

Answer 19

Sx - arthroscopic repair / partial menisectomy

fixed flexion deformity

Question 20

Grd 1 ligament injury =

Answer 20

tear some fibres but macroscopically intact = a sprain

Question 21

Grd 2 ligament injury =

Answer 21

partial tear - some fascicles disrupted

Question 22

Grd 3 ligament injury =

Answer 22

complete tear

Question 23

Rx of MCL injury =

Answer 23

brace, early motion, physio

rarely needs Sx - advancement/reconstruction

Question 24

how is MCL injured ?

Answer 24

severe valgus stress

Question 25

how is ACL injured?

Answer 25

twisting

Question 26

__% of ACL rupture ptnts have reconstruction

Answer 26

40%

Question 27

Sx for ACL rupture if:

Answer 27

``` to protect meniscal repair to return to professional sport/ high demand job young multiligament reconstruction DOESNT treat pain/prevent arthritis ```

Question 28

mechanism of LCL injury =

Answer 28

varus and hyperextension

Question 29

if LCL injury doesnt heal there is a high incidence of ___

Answer 29

common peroneal nerve injury

Question 30

usually LCL is injured along with __+__

Answer 30

PCL and ACL

Question 31

complete rupture of LCL needs __ in <=2-3wks and then later ___

Answer 31

repair | reconstruction

Question 32

mechanism of PCL injury =

Answer 32

direct blow to anterior tibia | hyperextension

Question 33

isolated PCL rupture is __ and doesnt need __ | get ____ pain and bruising

Answer 33

rare reconstruction popliteal

Question 34

complications of knee dislocation =

Answer 34

popliteal artery injury common peroneal nerve injury compartment syndrome

Question 35

Rx of knee dislocation

Answer 35

emergency reduction recheck neurovascular supply perhaps externally fix temporarily and multiligament reconstruction

Question 36

mechanism of patellar dislocation

Answer 36

rapid turn/direct blow

Question 37

risk factors for patellar dislocation (5)

Answer 37

F, adolescents, ligament laxity, valgus knee, torsional abnormalities

Question 38

mechanism of extensor mechanism rupture =

Answer 38

fall on flexed knee with quads contracted => patellar/quad tendon rupture

Question 39

predisposing factors to extensor mechanism rupture =

Answer 39

previous tendonitis steroids renal failure ciprofloxacin

Question 40

if in Extensor mechanism rupture there is no __ and a palpable __ => Sx repair

Answer 40

straight leg raise | gap

Question 41

dashboard injury to knee =

Answer 41

PCL rupture

Question 42

pain on joint line =

Answer 42

meniscal/chondral pathology

Question 43

___ cartilage covers bone in synovial joint

Answer 43

hyaline

Question 44

provides tensile strength to hyaline cartilage

Answer 44

collagen

Question 45

provide compressible strength to hyaline cartilage | as they are highly ___

Answer 45

proteoglycans | hydrophilic

Question 46

proteoglycans = ____ attaching __ branches with keratin sulfate and ____ chains

Answer 46

hyaluronic acid protein chondroitin sulfate

Question 47

hyaline cartilage: only ___ thickness can heal heals with ___ which has more friction and less wear resistance

Answer 47

full | fibrocartilage

Question 48

osteochondritis dissecans affects ____ age group= most common site =

Answer 48

subchondral bone adolescents medial femoral condyle

Question 49

area of knee surface loses blood supply and cartilage +/- bone fragments off -

Answer 49

osteochondritis dissecans

Question 50

osteochondritis dissecans can heal spontaneouslybut is unlikely to heal after __

Answer 50

puberty

Question 51

Rx of osteochondritis dissecans

Answer 51

if detaching on MRI = pin in place if detached = fix/remove if severe may = cartilage regeneration / micro# - better for smaller defects (not if OA/ inflam arth/joint instability)

Question 52

cartilage regeneration is unsuccessful in ___ joint

Answer 52

patellofemoral

Question 53

Rx for varus knee with isolated early medial compartment OA

Answer 53

osteotomy - shifts load to lateral compartment | affedcts result of later TKR ; good for heavy manual workers