Knee Flashcards by Jade Fellows

Ligaments in the knee

ACL
PCL
MCL
LCL

How well did you know this?

Not at all

Perfectly

What are the clinical features of osteoarthritis

Hx - worse on prolonged activity, crepitus, background ache

Exam - crepitus, effusion, elsewhere such as DIP and PIP

How well did you know this?

Not at all

Perfectly

Radiological findings

Loss of joint space
Osteophytes
Subchondrial cyts
Subarticular sclerosis

How well did you know this?

Not at all

Perfectly

Types of OA

Primary - degenerative 
Degeneration of the articulations cartilage, and its surface of a joint 
With no predisposing factors 
Secondary - underlying precipitant
Post-trauma
Post-op 
Post infection 
Mechanical instability
Malposition
Osteochondroses dissecans

How well did you know this?

Not at all

Perfectly

What is OA primary associated with

Inc BMI 
Genetic 
Age
Occupation 
Sport
Armed forces
Trauma
Surgery

How well did you know this?

Not at all

Perfectly

Tx OA knee

Exercise to improve local muscle strength and general aerobic fitness - irrespective of age 
Physio 
TENS
OT
Topical capsaicin 
Topical NSAIDS + PPI
Steroid injections 
Hyalourinic acid injections 
Surg 
Arthroscopy
Osteotomy
Arthroplasty

How well did you know this?

Not at all

Perfectly

What is osgood-schlatters disease

Tibial tubercle apophysitis
Pain and swelling over the tibial tuberosity
Children 10-15 yo
Theory suggest that the repeated traction causes inflammation and chronic avulsion of the secondary ossification centre of the tibial tuberosity
Pain below the knee is worse of physical activity and quad contraction
Tuberosity enlarged and tender
Self limiting >90%

How well did you know this?

Not at all

Perfectly

Tx osgood schlatters

Limitation of activity 
Ice 
Oral anti-inflammatory 
Knee padding 
Physio 
If fails surgery may be needed to remove the tibial tuberosity when skeletally mature

How well did you know this?

Not at all

Perfectly

What test is positive in patello-femoral OA

And what is it

Clarke’s test
Discomfort due to degenerative changes in the patella-femoral joint
Knee flexed and extended as pressure is applied to the patella compressing the patellofemoral joint causing discomfort

How well did you know this?

Not at all

Perfectly

What is patella-femoral pain syndrome

Young athletes - runners, overuse, limb malalignment, muscle imbalance , patella tracking abnormality
Patella ache after sitting /climbing/descending stairs
Recent trauma inc activity
Patella subluxation/dislocation Hx
+ve Clark’s test
Inc/dec patella mobility

How well did you know this?

Not at all

Perfectly

Tx patella-femoral syndromes

Rest
Quad and hip strengthening exercises
NSAIDS
No surg

How well did you know this?

Not at all

Perfectly

What is patella tendinopathy

Micro/macro patella tendon tears
Associated with sudden sporting loads - jumpers knee
Not inflammatory it is degenerative
Can occur anywhere along the patella tendon

How well did you know this?

Not at all

Perfectly

Tx patella tendinopathy

Con - rest and physio
Med NSAIDS
Steroid injection not into the tendon but around the tendon
Platelet rich plasma injections but the efficacy of these needs to be further evaluated before NICE recommends then for regular practise
Eccentric training exercises

How well did you know this?

Not at all

Perfectly

What is patella maltracking

The definition of maltracking refers to the dynamic malpositioning of the patella within the trochlear groove that occurs during active range of motion of the knee usually tracks lateral to the groove. Patellar maltracking is typically observed during physical examination, and the “J” sign is a commonly cited manifestation of this

How well did you know this?

Not at all

Perfectly

Types of knee locking

True locking

Pseudo locking

How well did you know this?

Not at all

Perfectly

What is true locking

When something in the knew joint gets stuck in one position and you cannot move it at all

How well did you know this?

Not at all

Perfectly

What is pseudo locking

Feel at though you can’t move the knee because you are in so much pain
There isn’t something in your knee preventing you from moving your leg
Our body is causing a muscle spasm triggered by the pain accompanied by an inability to move the knee
Other symptoms include - catching sensation, brief locking sensation, free or open sensations of the knee

How well did you know this?

Not at all

Perfectly

What causes true locking

Meniscus tear

Loose body

How well did you know this?

Not at all

Perfectly

What do you need to assess in patella maltracking

Anatomy

Any rotational abnormalities

How well did you know this?

Not at all

Perfectly

Tx of patella maltracking

Refer to physio if not any better
Refer to a knee specialist - look for skeletal abnormalities trochlear dysplasia or muscle vastus medius of the quads may not function properly

How well did you know this?

Not at all

Perfectly

What is the q angle

Measure the line drawn from the ASIS the centre of the patellar and then the line from centre of the patellar to the tibial tuberosity if there is an inc angle there is anatomical malalignment causing patella maltracking

How well did you know this?

Not at all

Perfectly

What is housemaids knee

Pre patellar bursitis

How well did you know this?

Not at all

Perfectly

What can cause prepatellar bursitis

Kneeling
Infection
Crystalarthropathies
RA

How well did you know this?

Not at all

Perfectly

Tx prepatellar bursitis

Study These Flashcards

Aspirated +/- steroid injection
If persists may needs excision
Topical NSAIDS

What should you always consider in prepatellar bursitis

Septic arthritis - the aspiration will be able to differentiate If you stain MCS it

What is infrapatellar bursitis also known as and what causes in

Clergymans knee | Kneeling upright

What are the colloquial names important in bursitis

Highlights the importance of occupation to the condition | And occupational changes may help with the conditions

What causes patellar dislocation

Twisting lower leg and contraction of the quads = squatting

What does the a patellar dislocation look like

Flexed with lateral deformity

How to treat patellar dislocation

Firm medial pressure hilts extending the knee

What to do once you’ve treated patellar dislocation and why

X ray Check for patellar fracture And check extensor mechanism of the knee

What continued mx is needed of a treated patellar dislocation

Immobilise in a cast or brace | Rehabilitation with quad strengthening exercises

What causes recurrent subluxation

Developmental abnormalities around the knee | Tight lateral retinaculum

What happens in recurrent subluxation

Knees give way

Who does recurrent subluxation happen in most

Girls who are knock kneed - valgus deformity | FHx, joint laxity, high riding patella, hypotrophic lateral femoral condyle

Signs of recurrent subluxation

Inc lateral patellar movement | + pain +reflex contraction of the quads +ve patellar apprehension test

How to get a patellar fracture

Fall on a flexed knee | Dashboard injury in car

How to mx a patellar fracture

No -displaced can be mx conservatively | Displaced - surgical

What causes injury to the MCL

Blow to the lateral aspect of the knee whilst foot is flexed

Signs of MCL injury

Effusion | +/- tenderness

Tx MCL. Injury

Rest and support | Conservative

How does an ACL injury happen

Twisting injury of the knee with the foot fixed to the ground

Signs of ACL injury

Effusion Haemarthrosis +ve ant draw and Lachmans

Tx ACL

Conservative - rest physio | May need surg - ligament reconstruction

Is the PCL more or less frequently damaged than the ACL

Less because it is stronger

How does the PCL become injured

Dash board car crash

Sign PCL

Post drawer

Mx PCL injury

Con mx due to PCL construction being difficult

Which meniscus is most likely to teared and why

Medial meniscus Bucket handle tear - due to the it being securely attached the joint capsule and consequently more frequently torn compared to the lateral meniscus

Mechanisms of medial meniscus tear

Twists a flexed knee

Mechanism of a lateral meniscus tear

Adduction and internal rotation

Symp/sign meniscal tear

Locking true Extension is limited due to displaced ligament lodging between the femoral and tibial condyle Tender joint line and +ve mcmurrays

Tx meniscal tear

Surg - repair - tear is in the vascular area otherwise wont heal

What is the mcmurrays test

Bend and extend the knee and twist it to the to produce discomfort and locking

What is osteochondritis dissecans

Joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone Usually causes pain and swelling of the affects joint which catches and locks during movement

What clinical presentation of cartilage defects

``` Adolescence Young adult Long Hx of effusion Locking caused by loose body Flakes of articular cartilage coming off ```

Mx of cartilage defects

Difficult to tx due to not being able to regrow the articular cartilage Microfracture - holes in the subchondrial bone to encourage scar tissue formation - fibrocartilage formed not hyaline OATS - cartilage transfer mosaicplasty move less important cartilage such as behind the patellar to more important weight bearing areas Autologous chondrocytes implantation - grow in lab and insert them under the membrane SC implantation- inject into the bone to try to grow more articular cartilage

Young osteoarthritis

``` Under 50 Physio steroid Arthroscopy Unicompartmental osteotomy realign leg Biological resurfacing Over 50 partial joint replacement Replace joint that’s failing ```

Knee Flashcards

(58 cards)