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MSK Continued > Knee > Flashcards

Knee Flashcards

1
Q

What is the knee joint composed of?

A

medial and lateral compartments of the tibiofemoral joint

the patellofemoral join

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2
Q

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

A

retropatellar surface

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3
Q

What is the purpose of the fibrocartilaginous menisci?

A

“shock absorbers” and act to distribute load evenly

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4
Q

What is the principal role of the anterior cruciate ligament?

A

prevent abnormal internal rotation of the tibia

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5
Q

What does the PCL do?

A

prevents hyperextension AND anterior translation of the femur

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6
Q

What does the MCl do?

A

resists valgus force

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7
Q

What does the LCL do?

A

resists varus force and abnormal external rotation of the tibia.

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8
Q

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

A

T

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9
Q

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

A

T

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10
Q

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.

A

T

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11
Q

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

A

Meniscal injury

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12
Q

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

A

Meniscal injury with miniscal fragment catching in knee

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13
Q

What is the definition of true knee locking?

A

mechanical block to full extension

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

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14
Q

What is pseudo-locking?

A

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

Caused by pathologies such as arthritis

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15
Q

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

A

Acl rupture: excessive internal rotation of the tibia

Haemoarthrosis due vascular supply in ACL)

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16
Q

Rugby tackle from the side and knee pain

A

MCL - valgus stress injury

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17
Q

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

A

rupture the PCL whilst hyperextension

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18
Q

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

A

T

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19
Q

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

A

Menisci

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20
Q

Bucket handle meniscal tear will present with?

A

15° or so springy block to full extension

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21
Q

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

A

T

22
Q

Why are medial meniscal tears more common than lateral?

A

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

23
Q

What is a bucket handle tear?

A

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

24
Q

The menisci do not degenerate with age

A

F

Degenerate and can tear spontaneously

25
Q

The menisci have a large blood supply

A

F

only has an arterial blood supply in its outer third

26
Q

menisci have a high healing potential

A

F

limited

27
Q

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

A

T

28
Q

How to manage meniscal tears?

A

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

29
Q

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

A

T

30
Q

What is the principal complaint of acL rupture?

A

rotatory instability with giving way on turning

31
Q

Who is a good candidate of CAL reconstruction

A

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

32
Q

Treatment options acl tear?

A 
ACL reconstruction involves tendon graft 
Primary repair (usually unsuccessful)
33
Q

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

A

T

34
Q

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

A

T

35
Q

How are acute MCL rupture treated?

A

hinged knee brace

36
Q

How is chronic MCL rupture treatment?

A

tightening (advancement) or reconstruction with tendon graft

37
Q

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

A

rupture of all four ligaments

neurovascular injury

38
Q

How are multi ligament knee injuries treated?

A

surgical reconstruction due to degree of instability

39
Q

How is a complete knee dislocation managed?

A
  1. reduce immediately
  2. external fixation for temp stabilisation
  3. regular checks on circulation
  4. Check for compartment syndrome
40
Q

What does the extensor mechanism of the knee consist of?

A

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

41
Q

How does the patellar tendon or quadriceps tendon rupture?

A

rapid contractile force i.e. lifting a heavy weight

42
Q

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

A

patellar

43
Q

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

A

quadriceps tendon

44
Q

Quinolone antibiotics can cause what?

A

tendonitis

45
Q

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

A

Avoided, can risk tendon rupture

46
Q

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

A

surgical with tendon to tendon repair or reattachment

47
Q

What is Patellofemoral dysfunction?

A

disorders of the patellofemoral articulation resulting in anterior knee pain

48
Q

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”

A

Patellofemoral dysfunction

49
Q

Patellofemoral dysfunction is treated with

A

physiotherapy aimed at rebalancing the quadriceps muscles

50
Q

The patella virtually always dislocates in which direction?

A

laterally

51
Q

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

A

T

52
Q

What predisposes to patellar dislocation?

A

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

MSK Continued (10 decks)

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