Knee- Cartilage Injuries, Arthritis, Patello-Femoral Dysfunction

Question 1

The knee joint consists of what compartments?

Answer 1

Medial and lateral compartments of the tibiofemoral and patellofemoral joints

Question 2

The surfaces of the knee joint are all covered with what?

Answer 2

Hyaline cartilage

Question 3

Within which sub-joint of the knee are the menisci found?

Answer 3

Tibiofemoral joint

Question 4

The menisci of the knee ensure congruence between where?

Answer 4

The concave femoral condyles and the flat tibial plateaus

Question 5

What are the roles of the menisci?

Answer 5

Shock absorbers, and act to distribute load evenly

Question 6

What is the role of the ACL?

Answer 6

Prevent abnormal internal rotation of the tibia

Question 7

How is the ACL tested?

Answer 7

By assessing anterior translation of the tibia

Question 8

What are the roles of the PCL?

Answer 8

Prevents hyperextension and anterior translation of the femur

Question 9

How is the PCL tested?

Answer 9

By assessing posterior translation of the tibia

Question 10

What is the role of the MCL?

Answer 10

Resist valgus stress

Question 11

What are the roles of the LCL?

Answer 11

Resist varus stress and abnormal external rotation of the tibia

Question 12

Most injuries of the knee joint can predispose to OA. What are some common predisposing injuries?

Answer 12

Joint instability, malalignment, ACL deficiency, meniscal tears

Question 13

If you have gene varum, what type of knee OA will you have?

Answer 13

Medial compartment OA

Question 14

If you have gene valgum, what type of knee OA will you have?

Answer 14

Lateral compartment OA

Question 15

Knee joint instability will predispose to what type of knee OA?

Answer 15

Patellofemoral

Question 16

What are some non-operative management options for knee joint OA?

Answer 16

Weight loss, stick, exercise, analgesics, activity modification

Question 17

When are steroid injections used for knee OA?

Answer 17

Only for acute flare ups

Question 18

When can an osteotomy of the proximal tibia be used as a treatment for knee OA?

Answer 18

Varus knees with isolated medial compartment OA (usually younger patients)

Question 19

What is the aim of an osteotomy of the proximal tibia as a treatment for isolated medial compartment OA?

Answer 19

Shift the load to the lateral compartment. Useful for manual workers where a knee replacement would fail.

Question 20

What are the disadvantages of an osteotomy for the treatment of isolated medial compartment OA?

Answer 20

There can sometimes be neuropathic pain after. Will only last 7-10 years and after this procedure a knee replacement would not be as successful

Question 21

When should knee replacements be offered to those with knee arthritis?

Answer 21

In older patients with severe disability and conservative management is no longer effective

Question 22

What is the difference between a total and partial knee replacement?

Answer 22

A total replacement resurfaces all 3 compartments while a partial replacement only resurfaces 1

Question 23

If a knee replacement is successful, how long will it last?

Answer 23

15-20 years

Question 24

What are some risks of knee replacement surgery?

Answer 24

Unexplained pain, stiffness, DVT/PE

Question 25

Why should knee replacements not be used in younger patients?

Answer 25

Higher chance of requiring revision surgery later which then has a higher rate of failure

Question 26

Who has unicompartmental knee replacement been proposed as a treatment for?

Answer 26

Patients with isolated medial or lateral compartment OA and also for younger patients

Question 27

If failure occurs following a UKR, can a TKR be used?

Answer 27

Yes

Question 28

Which ligament of the knee is usually excised in TKRs and which is also often sacrificed?

Answer 28

Usually always excised = ACL, often sacrificed = PCL

Question 29

Ongoing pain and effusion after a knee injury warrants further investigation to look for what?

Answer 29

Cartilage defects

Question 30

What investigations can be used to assess for cartilage damage?

Answer 30

X-ray, MRI, arthroscopy

Question 31

Articular cartilage injuries can occur in response to trauma, or they can be atraumatic. Give some examples of atraumatic causes?

Answer 31

Osteochondritis dissicans, osteoarthritis, inflammatory arthritis

Question 32

What type of cartilage injuries can heal and why?

Answer 32

Only full thickness injuries can heal and they are the only ones to receive a blood supply

Question 33

During healing of cartilage injuries, what takes the role of articular cartilage?

Answer 33

Fibrocartilage (not as good as hyaline but does the job)

Question 34

What is osteochondritis dissicans?

Answer 34

Part of the joint temporarily loses blood supply, which causes dead bone and cartilage to fragment off

Question 35

Who does osteochondritis dissicans typically occur in?

Answer 35

Adolescents

Question 36

How is osteochondritis dissicans treated?

Answer 36

Can heal or resolve spontaneously in kids, or it can be fixed/removed

Question 37

How should acute injuries involving large osteochondral fractures with a substantial portion of bone be treated?

Answer 37

Fixed with pins

Question 38

How should cartilage injuries from a non-weight bearing area or those with little bone attached be treated?

Answer 38

Arthroscopic removal

Question 39

Cartilage repair surgeries will not work if what is already present?

Answer 39

Osteoarthritis showing radiographic changes, inflammatory arthritis or joint instability

Question 40

If a child presents with knee pain, what should you always check for?

Answer 40

The hips for SUFE

Question 41

What knee condition commonly occurs in people who are on their knees a lot?

Answer 41

Bursitis

Question 42

What is Osgood-Schlatter's disease?

Answer 42

Anterior knee pain in adolescents, will go away with time

Question 43

What is an autograft?

Answer 43

Tissue from the patient

Question 44

What is an allograft?

Answer 44

Tissue from a donor

Question 45

How many bundles does the ACL have? How many are reconstructed?

Answer 45

2 bundles, 1 reconstructed

Question 46

What is patello-femoral dysfunction?

Answer 46

Any disorder of the patellofemoral articulation, resulting in anterior knee pain

Question 47

What conditions does patella-femoral dysfunction include?

Answer 47

Chondromalacia patellae, adolescent anterior knee pain, lateral patellar compression syndrome

Question 48

What is chondromalacia patellae?

Answer 48

Softening of the hyaline cartilage

Question 49

The quadriceps muscle pulls the patella in what direction?

Answer 49

Lateral

Question 50

Patello-femoral dysfunction is commoner in who? Why?

Answer 50

Females (wider hips meaning more lateral pull of quadriceps) and adolescents (ligamentous laxity)

Question 51

Apart from being female and adolescent, what are some other risk factors for patello-femoral dysfunction?

Answer 51

Joint hyper mobility, genu valgum, femoral neck anteversion

Question 52

Patients with patello-femoral dysfunction tend to complain of what?

Answer 52

Anterior knee pain, worse going downhill, a grinding or clicking sensation, stiffness after prolonged sitting (pseudo locking)

Question 53

What are the treatment options for patello-femoral dysfunction?

Answer 53

> 90% of cases resolve with physiotherapy, aimed at rebalancing the quadriceps muscles. Taping can alleviate symptoms. Surgery is a last resort.