Knee conditions

Question 1

general treatment for someone with knee pain that presents to their GP

Answer 1

physio

Question 2

which knee ligament strain is most common

Answer 2

MCL

Question 3

inflammation of patellar ligament at tibial tuberosity

Answer 3

Osgood schlatters disease

Question 4

crack in articular cartilage and underlying subchondral bone in teenages bc of shear stress on joint

Answer 4

osteochondritis dissecans (OCD)

Question 5

teenager with joint ‘catching and locking’

Answer 5

osteochondritis dissecans (OCD)

Question 6

in osteochondirits dissecans (OCD) if an area of the knee surface looses its blood supply what can happen

Answer 6

a bit of bone can break off

Question 7

if someone gets osteoarthritis in the medial part of their knee, what kind of stance did they have (valgum or varum)

Answer 7

varum

opposite to what youd think

Question 8

if someone gets osteoarthritis in the lateral part of their knee, what kind of stance did they have (valgum or varum)

Answer 8

valgum

opposite to what youd think

Question 9

aetiology of osteoarthritis in the knee

Answer 9

any previous trauma, infection, injury etc etc

malalignment (varus or valgum)

Question 10

first line treatment for knee osteoarthritis (3)

Answer 10

weight loss
increase activity
mobility aids

Question 11

second line treatment for knee osteoarthritis (after weight loss, increase activity etc)

Answer 11

surgery - total knee replacement, partial knee replacement

Question 12

who gets total knee replacements for knee osteoarthritis

Answer 12

end stage disease in elderly patients

Question 13

who gets partial knee replacement for knee osteoarthritis

Answer 13

young patients

Question 14

how long does a total knee replacement last

Answer 14

15-20 years

Question 15

investigation for soft tissue knee injuries (2)

Answer 15

MRI - to see ligaments

xray - to exclude fracture

Question 16

first line treatment for anyone with a ?soft tissue knee injury

Answer 16

pain relief = 1-10mg morphine sulphate

Question 17

MCL rupture presentation (incl alignment) (2)

Answer 17

valgus instability (knock kneed) - think about if you removed MCL how there would be nothing to stop knee from going inwards

pain for several months (reassure patient this is normal)

Question 18

treatment of MCL

Answer 18

probs nothing, heals well on its own

encourage early movement to prevent stiffness

Question 19

aetiology of LCL

Answer 19

football tackles (remember bc their usually on the lateral side of leg)

Question 20

presentation of LCL rupture (incl alignment) (2)

Answer 20

varum (bow legged)

hyperextension of knee

Question 21

in a MCL rupture what else may also be damaged

Answer 21

ACL

Question 22

in a LCL rupture what else may also be damaged

Answer 22

PCL

Question 23

treatment of LCL

Answer 23

surgery if full tear (tendon graft)

Question 24

complications of LCL rupture

Answer 24

common fibular nerve injury

Question 25

aetiology of ACL rupture

Answer 25

sports injury

Question 26

presentation of ACL rupture (3)

Answer 26

haemarthrosis (swelling with blood) pain for a few days locking/catching/twisting/popping

Question 27

what fraction of people are fine after an ACL rupture

Answer 27

1/3

Question 28

what fraction of people need to avoid certain activities but are otherwise fine after an ACL rupture`

Answer 28

1/3

Question 29

what fraction of people need surgery after ACL rupture

Answer 29

1/3

Question 30

which tests are positive in ACL rupture (2)

Answer 30

anterior drawer test | lachmans test

Question 31

what test is; bend knee at 90 degrees, put you hand behind tibia and try to pull it forward to see if it moves what is it testing

Answer 31

anterior drawer test ACL rupture

Question 32

what test is; leg in air at a 30 degree angle, put hand above and below tibia and try to pull tibia forward what is it testing

Answer 32

lachman test ACL rupture

Question 33

investigation for ACL rupture

Answer 33

MRI | xray to rule out fractures

Question 34

if someone gets a ligament surgical repair, what are they actually getting done

Answer 34

ligament graft from somewhere else in the body

Question 35

treatment of ACL rupture

Answer 35

physio | surgery (1/3)

Question 36

what tendons can be used for tendon grafts in the knee

Answer 36

Achilles tendon medial 1/3 of patellar tendon hamstring tendon

Question 37

requirements for tendon after a tendon graft

Answer 37

good blood supply

Question 38

are PCL ruptures common

Answer 38

no rare

Question 39

recurrent hyperextension instability descending stairs bruising in popliteal fossa 'sagging tibia'

Answer 39

PCL rupture presentation

Question 40

positive examination for PCL rupture

Answer 40

posterior drawer test

Question 41

what test is; bend both knees at 90, push tibia backwards to see if it moves what is it testing

Answer 41

posterior drawer test PCL rupture

Question 42

what happens if 3 or 4 ligaments rupture

Answer 42

dislocated knee

Question 43

treatment of multiligament injury

Answer 43

surgery

Question 44

unhappy triad of ruptures

Answer 44

medial collateral ligament anterior cruciate ligament medial meniscus ligament (the medial/front ones!)

Question 45

aetiology of meniscal tears

Answer 45

sporting injury/twisting injury

Question 46

which meniscus is more likely to tear why

Answer 46

medial under more stressed

Question 47

what is the largest type of meniscal tear

Answer 47

bucket handle tear

Question 48

``` joint line tenderness sharp sudden localised pain effusion the next day 'catching and locking' springy block test positive steinmans test ```

Answer 48

meniscal tear

Question 49

what test is this; put fingers on joint line of knee bend knee to 90 degrees medially and laterally rotate knee, feeling for any joint line tenderness what is it testing for

Answer 49

steinmans test meniscal tear

Question 50

treatment of meniscal tear if young and acute tear

Answer 50

surgery

Question 51

treatment of acute meniscal tear if old/previous surgeries failed

Answer 51

partial meniscectomy

Question 52

complication of all knee ligament tears

Answer 52

osteoarthritis

Question 53

what is the blood supply to the meniscus why is this significant in the healing process

Answer 53

peripheral 1/3 has blood supply poor healing

Question 54

definition of knee dislocation

Answer 54

3 or 4 of ligaments have ruptured

Question 55

which nerve is commonly affected in knee dislocations how does this present

Answer 55

common fibular foot drop

Question 56

who do PCL ruptures present in

Answer 56

rugby players | anterior tibial injury (eg in car crash)

Question 57

treatment of knee dislocation

Answer 57

emergency surgery

Question 58

treatment of knee dislocation if the patient has arthritis too

Answer 58

knee replacement

Question 59

complications of knee dislocation (3)

Answer 59

popliteal artery injury common fibular and tibial nerve injury compartment syndrome

Question 60

why are females more likely to get a patellar dislocation

Answer 60

more lax in ligaments

Question 61

which group (age and sex) of people are most likely to get patellar dislocations

Answer 61

female teenagers

Question 62

investigation of patellar dislocation

Answer 62

xray to look for fractures

Question 63

in which direction does the patella (knee cap) usually dislocate (move) to

Answer 63

laterally

Question 64

treatment of patellar dislocation

Answer 64

splint for 3 weeks, physio

Question 65

which is more severe, patellar dislocation or knee dislocation

Answer 65

knee dislocation

Question 66

which is more common patellar dislocation or knee dislocation

Answer 66

patellar dislocation

Question 67

are recurrent patellar dislocations common

Answer 67

yes - 1 in 5

Question 68

what condition typically occurs when you fall onto your knee when your quads are contracted

Answer 68

extensor mechanism rupture

Question 69

what are the 5 components of the extensor mechanism

Answer 69

``` quads quads tendon patella patellar retinaculum patellar ligament ```

Question 70

in a <40 year old, what component of the extensor mechanism is most likely to rupture

Answer 70

patellar tendon

Question 71

in a >40 year old, what component of the extensor mechanism is most likely to rupture

Answer 71

quads tendon

Question 72

how many components of the extensor mechanism do you need to rupture before you get an extensor mechanism rupture

Answer 72

one

Question 73

which knee condition are chronic steroid users (body builders) most likely to get

Answer 73

extensor mechanism rupture

Question 74

what is Osgood schlatters disease

Answer 74

apophysitis at tibial tubercle (insertion of the patellar tendon)

Question 75

who does osgood schlatters disease typically occur in

Answer 75

adolescent boys

Question 76

presentation of Osgood schlatters disease

Answer 76

bony lump at tibial tubercle | pain worse after exercise

Question 77

examination test for extensor mechanism rupture

Answer 77

straight leg raise

Question 78

treatment of extensor mechanism rupture (2 + 1 not + 1 stop)

Answer 78

surgery and physio NOT INJECTION, STOP STEOIDS

Question 79

anterior knee pain worse going downhill, clicking

Answer 79

patellofemoral dysfunction

Question 80

valgus

Answer 80

MCL

Question 81

varus

Answer 81

LCL

Question 82

twisting/popping

Answer 82

ACL or meniscal tear

Question 83

dashboard/hyperextension

Answer 83

PCL

Question 84

getting up from squatting

Answer 84

meniscal tear

Question 85

haemarthrosis

Answer 85

ACL

Question 86

swelling (effusion) next day

Answer 86

meniscal tear

Question 87

pain in joint line

Answer 87

meniscal tear

Question 88

swelling in popliteal fossa

Answer 88

bakers cyst

Question 89

what type of cyst is a bakers cyst and example of

Answer 89

ganglion cyst

Question 90

what is a bakers cyst filled with

Answer 90

mucous/synovial fluid

Question 91

treatment of bakers cyst

Answer 91

nothing, leave alone

Question 92

why does mucous/synovial fluid build up in the popliteal fossa in a bakers cyst

Answer 92

weakness in synovial tendon sheath