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Flashcards in Knee & Leg Deck (14):

What are the important questions in the knee history?

Pain =
- what does it stop you from doing?
- what analgesia have you had?
- location: inside or outside, referred from groin
- timing: rest (biological pain), activity (mechanical pain)
- progression: acute (traumatic), gradual (degenerative)
- night pain

Stiffness =
- start-up
- flexion e.g. low chair, toilet, squatting
- occupation

Instability = actual or threatened, with what activities

Swelling = subjective, small effusions easily detectable

Locking = physical block to flexion/extension caused by loose body jamming the articular surfaces

Red flags =
- severe night pain
- inability to bear weight on limb
- Hx of malignancy
- rapid deterioration of knee symptoms


What are the important features of a knee exam?

- wasting (esp. quads)
- alignment: foot everted so you see more toes on that side than the other
- gait: varus thrust, stiff knee gait, bow-legged, knock-kneed
- scars: minor trauma, knee replacement, arthroscopy
- varicosities
- walking aids
- foot orientation and perfusion

FEEL (flexion and extension)
- swelling: sweep test, patellar test
- bony landmarks
- joints: femur, tibia, patella, fibula
- osteophytes
- pulses
- patellar grind




What are the special tests of the knee exam?

Striaght leg raise = extensor mechanism tested (quads, patellar ligament and tendon ---> tibial tuberosity)

Stability of medial and lateral collateral ligaments = flex knee to 90 degrees and push knee medially and laterally

Mobile or fixed varus/valgus deformities = try to correct

Anterior/posterior drawer test = flex knee to 90 degrees (check hamstrings are flexed) and put thumbs on front whilst fixing foot and rocking knee back and forth

Lachman's test = more senstive than anterior drawer test; knee flexed to 30 degrees, encircle femur with one hand and tibia with the other

Pivot shift test = put thumb behind fibula and use other hand to flex and pivot knee into valgus, tests for ACL tear (tibia moves with when flexed with varus movement)

McMurray's test = tests for meniscal tears, place hand between femur and tibia on both sides whilst flexing and extending knee (meniscus pinched ---> pain)


What are the investigations in the acute, traumatic knee?

Swelling, instability, joint line tenderness

X-ray to rule out fracture/dislocation


Splint and re-examine at 3wks


What are the key features of anterior knee pain?

Occurs when going downstairs

Gives way




Patellar tracking (patella shifts out of place)


What are the key features of a meniscal tear?

Twisting/hyperflexion injury



Joint line tenderness

Arthroscopy to repair/excise meniscus


What are the key features of an ACL tear?

Body thrown over planted foot

Acute swelling

Giving way

Positive Lachmann test/anterior draw test/pivot shift test


What is osteochondritis dissecans?

Separation of articular cartilage and subchondral bone fragment from joint surface ---> fragment becomes avascular and exists as loose body within joint

e.g. genetic, ischaemia, repetitive trauma


What are the key features of septic arthritis?



Tense effusion

Very stiff

Aspirate for culture and washout


What is a Segond fracture?

Avulsion fracture of knee involving lat. aspect of tibial plateau (freq. associated with ACL tear)


What is the management of a tibial plateau fracture?

ORIF OR external fixation


What is a high tibial osteotomy?

Correct valgus/varus deformity by sawing through tibia and hinging it with plate and screws/inserting a bone graft to correct the angle of weight distribution to the knee


What is Hoffa's fat pad?

Infra-patellar fat pad

Can become impinged between patella and femur, causing significant effusion


What is Osgood-Schlatter disease?

Inflammation of patellar ligament at tibial tuberosity characterised by painful lump just below knee (tibial tubercle)

Caused by osteochondritis or traction apophysitis of tibial tubercle