Knee

Question 1

What is the knee joint composed of?

Answer 1

medial and lateral compartments of the tibiofemoral joint

the patellofemoral join

Question 2

Where is the thickest layer of hyaline cartilage in the body?

Answer 2

retropatellar surface

Question 3

What is the purpose of the fibrocartilaginous menisci?

Answer 3

“shock absorbers” and act to distribute load evenly

Question 4

What is the principal role of the anterior cruciate ligament?

Answer 4

prevent abnormal internal rotation of the tibia

Question 5

What does the PCL do?

Answer 5

prevents hyperextension AND anterior translation of the femur

Question 6

What does the MCl do?

Answer 6

resists valgus force

Question 7

What does the LCL do?

Answer 7

resists varus force and abnormal external rotation of the tibia.

Question 8

Many cases of knee OA are “primary” OA with no obvious causative factor.

Answer 8

T

Question 9

Knee replacements can resurface all 3 compartments of the knee or be a partial knee replacement

Answer 9

T

Question 10

there are serious implications of performing knee replacement in the younger patient as they have a higher likelihood of requiring revision surgery with a higher risk of early failure.

Answer 10

T

Question 11

Young man playing football and experienced LOCKING sensation whilst turning

Pain localised to medial joint line and effusion develops following day

+ve Steinmann’s test

Answer 11

Meniscal injury

Question 12

Athlete experienced catching sensation while squatting

Some pain lateral joint line

knees feel like they are going to give way when walking

+ve steinmann’s test

Answer 12

Meniscal injury with miniscal fragment catching in knee

Question 13

What is the definition of true knee locking?

Answer 13

mechanical block to full extension

caused by the significantly torn meniscus flipping over and becoming stuck in the joint line

Question 14

What is pseudo-locking?

Answer 14

knee can “become stuck” with temporary difficulty in straightening the joint

Caused by pathologies such as arthritis

Question 15

Patient was skiing and rotated torso with planted foot
Heard “pop” and developed effusion within an hour
Effusion contains blood
Deep pain in knee
Knee gives way when turning on planted foot

Answer 15

Acl rupture: excessive internal rotation of the tibia

Haemoarthrosis due vascular supply in ACL)

Question 16

Rugby tackle from the side and knee pain

Answer 16

MCL - valgus stress injury

Question 17

Motorcycle crash with force hitting knee face on while knee is bent

Answer 17

rupture the PCL whilst hyperextension

Question 18

knee can be difficult to examine in the aftermath of an injury as pain and apprehension may limit examination finding

Answer 18

T

Question 19

around 25% of acute ACL ruptures also have a tear where?

Answer 19

Menisci

Question 20

Bucket handle meniscal tear will present with?

Answer 20

15° or so springy block to full extension

Question 21

Medial meniscal tears are approximately 10 times more common than lateral meniscal tears

Answer 21

T

Question 22

Why are medial meniscal tears more common than lateral?

Answer 22

medial meniscus is more fixed and less mobile than the lateral meniscus

Question 23

What is a bucket handle tear?

Answer 23

large meniscal fragment is able to flip out of its normal position and displace anteriorly or into the intercondylar notch where the knee locks and is unable to fully extend

Question 24

The menisci do not degenerate with age

Answer 24

F

Degenerate and can tear spontaneously

Question 25

The menisci have a large blood supply

Answer 25

F | only has an arterial blood supply in its outer third

Question 26

menisci have a high healing potential

Answer 26

F | limited

Question 27

More than 90% of meniscal tears are not suitable for repair

Answer 27

T

Question 28

How to manage meniscal tears?

Answer 28

pain and inflammation may settle with time Steroid injection in degenerate tears may help symptoms arthroscopic partial menisectomy can be performed if symptoms don't settle within 3onths

Question 29

Knees with degenerate change (i.e. osteophytes, hyaline cartilage loss) are unlikely to benefit from arthroscopic menisectomy

Answer 29

T

Question 30

What is the principal complaint of acL rupture?

Answer 30

rotatory instability with giving way on turning

Question 31

Who is a good candidate of CAL reconstruction

Answer 31

those who have a strong desire to get back to high impact sport but cannot do so despite physiotherapy

Question 32

Treatment options acl tear?

Answer 32

``` ACL reconstruction involves tendon graft Primary repair (usually unsuccessful) ```

Question 33

ACL reconstruction requires intensive rehabilitation to get back to high impact sport

Answer 33

T

Question 34

MCL is a fairly forgiving knee ligament with healing expected in the majority of partial and complete tears and little or no instability

Answer 34

T

Question 35

How are acute MCL rupture treated?

Answer 35

hinged knee brace

Question 36

How is chronic MCL rupture treatment?

Answer 36

tightening (advancement) or reconstruction with tendon graft

Question 37

What is a complete knee dislocation? What is the main complication here?

Answer 37

rupture of all four ligaments | neurovascular injury

Question 38

How are multi ligament knee injuries treated?

Answer 38

surgical reconstruction due to degree of instability

Question 39

How is a complete knee dislocation managed?

Answer 39

1. reduce immediately 2. external fixation for temp stabilisation 3. regular checks on circulation 4. Check for compartment syndrome

Question 40

What does the extensor mechanism of the knee consist of?

Answer 40

tibial tuberosity, the patellar tendon, the patellar, the quadriceps tendon and the quadriceps muscles.

Question 41

How does the patellar tendon or quadriceps tendon rupture?

Answer 41

rapid contractile force i.e. lifting a heavy weight

Question 42

Which tendon is likely to rupture in <40 y olds?

Answer 42

patellar

Question 43

Which tendon is likely to rupture in >40 y olds?

Answer 43

quadriceps tendon

Question 44

Quinolone antibiotics can cause what?

Answer 44

tendonitis

Question 45

Steroid injections to treat tendonitis should be avoided or used? why?

Answer 45

Avoided, can risk tendon rupture

Question 46

In clinically obvious cases of tendon rupture or with ultrasound confirmation, the treatment is?

Answer 46

surgical with tendon to tendon repair or reattachment

Question 47

What is Patellofemoral dysfunction?

Answer 47

disorders of the patellofemoral articulation resulting in anterior knee pain

Question 48

Adolescent with anterior knee pain, worse going downhill, a griniding or clicking sensation at the front of the knee and stiffness after prolonged sitting causing “pseudolocking”

Answer 48

Patellofemoral dysfunction

Question 49

Patellofemoral dysfunction is treated with

Answer 49

physiotherapy aimed at rebalancing the quadriceps muscles

Question 50

The patella virtually always dislocates in which direction?

Answer 50

laterally

Question 51

In patellar dislocation the patella may spontaneously reduce wen the knee is straightened

Answer 51

T

Question 52

What predisposes to patellar dislocation?

Answer 52

Female patient with ligamentous laxity, hallow trochlear groove, genu valgum, femoral neck anteversion