Knee

Question 1

What two joints make up the knee?

Answer 1

Tibiofemoral

Patellofemoral

Question 2

What caps the top of the tibia?

Answer 2

Menisci

Question 3

What is the role of menisci?

Answer 3

They act as shock absorbers and distribute the weight across a wider area.

Question 4

Name the four important ligaments within the knee

Answer 4

Medial & Lateral Collateral ligaments
Anterior Cruciate Ligament
Posterior Cruciate Ligament

Question 5

What is the job of the ACL?

Answer 5

Prevents abnormal internal rotation of tibia

Question 6

What is the job of the PCL?

Answer 6

Prevents hyperextension and posterior movement of the tibia

Question 7

What does the MCL resist

Answer 7

Valgus forces

Question 8

What does the LCL resist

Answer 8

Varus forces and external rotation

Question 9

If a patient has Genu Varum where in the knee is the OA likely to be?

Answer 9

Medial

Question 10

If a patient has Genu vagus where in the knee is the OA likely to be?

Answer 10

Lateral

Question 11

History in meniscal tears

Answer 11

Twisting force on a loaded knee.
Localised pain along joint line, effusion develops.
Knee locks unable to fully extend.

Question 12

History in ACL tears

Answer 12

Higher rotation onto a planted foot.
Patient hears a pop.
Haemarthrosis develops quickly with deep pain within the knee.
Patients complains of knee giving away when turning.

Question 13

Valgus stress injury (tackle fro the side)

Answer 13

MCL torn but also risk of ACL rupture.

Question 14

PCL tear

Answer 14

Direct blow to anterior tibia with knee flexed

Question 15

Varus stress

Answer 15

Can rupture lateral collateral ligament, +/- PCL

Question 16

What is the issue surrounding examination of a knee post injury?

Answer 16

Very painful for the patient. Swelling and apprehension can make it difficult.
MRI used acutely if severe injury suspected.
Otherwise reassess in 2-7 days

Question 17

What percentage of the force applied to the knee does the menisci take?

Answer 17

60%

Question 18

In what portion of the menisci is there a blood supply?

Answer 18

Outer 1/3

Question 19

Which menisci are more likely to be damaged?

Answer 19

Medial are 10x more likely to be damaged than the lateral.

Question 20

Why is the medial menisci more likely to be ripped?

Answer 20

As it is fixed whilst the lateral menisci are more mobile.

Question 21

What are the four types of meniscal tear?

Answer 21

Longitudinal
Radial
Oblique
Horizontal

Question 22

What is a large longitudinal tear called?

Answer 22

Bucket Handle

Question 23

What is the clinical sign of a bucket handle tear?

Answer 23

Locking knee which is unable to fully extend.

Question 24

What imaging is used to confirm a diagnosis?

Answer 24

MRI

Question 25

When is meniscal repair considered?

Answer 25

In younger patients with a tear in the outer 1/3. Meniscus is sutured to its bed. 25% of repairs fail

Question 26

What is the other method of surgically treating meniscal tears

Answer 26

Athroscopy so removal of the menisci

Question 27

How does treatment vary in degenerative meniscal tears?

Answer 27

The menisci should not be removed as this works to only make the OA worse.

Question 28

What are the non surgical options in the treatment of meniscal tears?

Answer 28

Steroid injection

Question 29

What is main complaint in an ACL rupture?

Answer 29

Rotary instability, giving away on turning

Question 30

How quickly does swelling arise in any tendon rupture?

Answer 30

Within the hour. | Haemarthrosis due to the blood supply.

Question 31

What are the two options for ACL rupture treatment

Answer 31

Repair - not very effective | Reconstruction

Question 32

Which candidates are aimed straight for reconstruction?

Answer 32

Professional athletes and those wanting to continue high impact sports, as quickly as possible.

Question 33

What occurs in ACL reconstruction?

Answer 33

Tendon graft is passed through tibial and femoral tunnels and secured to the bone.

Question 34

What tendons are use as grafts in ACL reconstruction

Answer 34

Patellar Semitendinosis Gracilis

Question 35

How long with physiotherapy involved is the recovery time?

Answer 35

Up to a year

Question 36

In MCL tears what is the main complication post recovery?

Answer 36

Laxity and or pain on Valgus stress. | Tenderness over MCL insertion.

Question 37

How are acute MCL tears usually treated?

Answer 37

Hinged knee brace as MCL healing is expected in majority of partial and even full tears.

Question 38

In a chronic MCL instability what are the treatment options?

Answer 38

MCL tightening | Reconstruction with tendon graft.

Question 39

What makes up the extensor mechanisms in the knee?

Answer 39

Patellar tendon Patellar Quadriceps tendon Quadriceps Muscles

Question 40

What age group do patellar tendon ruptures usually occur in?

Answer 40

<40

Question 41

What age group do quadricep tendon ruptures usually occur in?

Answer 41

>40

Question 42

What are some predisposing condition for extensors mechanism ruptures?

Answer 42

``` Tendonitis Chronic steroid use or abuse Diabetes Rheumatoid arhtritis Chronic renal failure ```

Question 43

What antibiotics increase the risk of tendon rupture?

Answer 43

Quinolones | Ciprofloxacin

Question 44

Why should steroid injections never be used to treat tendonitis?

Answer 44

As steroids break down muscle fibre leading to tendon rupture.

Question 45

What test should be used in a suspected extensor mechanism rupture.

Answer 45

Straight Leg Raise Test

Question 46

How will a partial tear in the Extensor mechanism present?

Answer 46

They will have some extensor mechanism function but reduced power.

Question 47

What is the treatment in extensor mechanism rupture?

Answer 47

Surgical tendon to tendon repair or reattachment.

Question 48

Clinical signs of an extensor mechanism rupture?

Answer 48

-ve straight leg raise Palpable gap X-ray or US imaging

Question 49

What is usual method of injury in an EMR?

Answer 49

Falling onto flexed knee with quadriceps contraction.

Question 50

Method of injury in an patellar dislocation?

Answer 50

Direct blow or sudden twist of the knee.

Question 51

In which direction does the patellar usually displace?

Answer 51

Laterally

Question 52

What factors increase your risk of a patellar dislocation?

Answer 52

Ligament laxity. Female Valgus knees High riding patellar

Question 53

What is the risk of recurrent dislocations?

Answer 53

10%

Question 54

What ligament is damaged or torn in a patellar dislocation?

Answer 54

Patellofemoral ligament

Question 55

Treatment of a patellar dislocation

Answer 55

Manual manipulation to reset the patellar then a straight leg brace. Recurrent then surgery to reconstruct patellofemoral ligament.