Knee conditions

Question 1

what can cause a meniscal tear ?

Answer 1

acute - twisting, especially in deep flexion

degenerative - osteoarthritis

Question 2

how does a meniscal tear present ?

Answer 2

pain
clicking
locking
intermittent swelling

Question 3

what are signs of a meniscal tear ?

Answer 3

look - effusion
feel - tender joint line at point of tear
move - mechanical block to movement, mcmurrays test positive, fail deep squat, thessalys test positive

Question 4

what is McMurray’s test ?

Answer 4

flex knee
externally rotate foot
valgus stress at knee

Question 5

what is Thessaly’s test ?

Answer 5

stand on affected leg, flex knee to 20 degrees

twist body side to side

Question 6

how do you investigate a meniscal tear ?

Answer 6

X ray - arthritis, fracture

MRI - high false positive rate

Question 7

is a meniscal tear likely to heal and why ?

Answer 7

unlikely to heal

poor blood supply

Question 8

what are non-operative treatments for a meniscal tear ?

Answer 8

rest
NSAIDs
physio - thigh strengthening

Question 9

what are operative managements for meniscal tears ?

Answer 9

arthroscopy - repair, resection

Question 10

what is osteoarthritis ?

Answer 10

degenerative change of synovial joints
progressive loss of articular cartilage
secondary bony changes
worsening pain and stiffness

Question 11

where does the ACL run ?

Answer 11

from between tibial eminences

to lateral wall of intercondylar notch of femur

Question 12

what is the blood and nerve supply to the ACL ?

Answer 12

blood - middle geniculate artery

nerve - posterior articular nerve, branch of posterior tibial

Question 13

what is the function of the ACL ?

Answer 13

primary - prevent anterior displacement of joint

secondary - restrain tibial rotation and various/valgus stress

Question 14

what causes an ACL tear ?

Answer 14

non-contact pivot injury

Question 15

are men or women more prone to ACL tear and why ?

Answer 15

females more prone 4.5:1

landing biomechanics and neuromuscular activation patterns - quads

Question 16

how does an ACL tear present ?

Answer 16

heard pop or crack
immediate swelling - haemarthrosis
unable to continue playing - can still walk in straight line
deep pain

Question 17

what are the signs of an ACL tear ?

Answer 17

look - effusion

move - anterior draw positive, lachmanns test positive, pivot shift

Question 18

how do you investigate ACL tear ?

Answer 18

Xray - second fractures avulsion of anterolateral ligament

MRI

Question 19

how do you treat an ACL tear ?

Answer 19

non-operative - focused quadriceps programme

operative - reconstruction, +/-partial meniscectomy +/-ligament repair or augmentation, hamstring graft

Question 20

what is the difference between the superficial and deep MCL ?

Answer 20

superficial - primary restraint to valgus stress

deep - contributes in full knee extension, attaches to medial meniscus, continuous with joint capsule

Question 21

what is the most common ligament injury of the knee ?

Answer 21

MCL tear

Question 22

what causes an MCL tear ?

Answer 22

severe valgus stress

usually contact related

Question 23

what is the presentation if an MCL tear ?

Answer 23

heard pop or crack
very painful medial side
unable to continue playing
bruising medial knee
localised swelling

Question 24

what are the signs of an MCL tear ?

Answer 24

look - medial swelling, bruising
feel - tender medial joint line, tender femoral insertion of MCL
move - painful full extension, opening on valves stress

Question 25

how do you investigate an MCL tear ?

Answer 25

Xray - can be normal, calcification at femoral insertion | MRI

Question 26

what is non-operative management of an MCL tear ?

Answer 26

``` mostly non-op rest NSAIDs physio brace ```

Question 27

when is operative management used for MCL tear ?

Answer 27

severe tears | failed non-operative management

Question 28

what are the options for operative management of MCL tear ?

Answer 28

repair avulsions - midsubstance tear with good tissue | reconstruction - damaged tissue

Question 29

what is osteochondritis dissecans ?

Answer 29

pathological lesion affecting articular cartilage and subchondral bone

Question 30

what are the two forms of osteochondritis dissecans ?

Answer 30

juvenile - 10 - 15 years while growth plate still open | adult

Question 31

what are the causes of osteochondritis dissecans ?

Answer 31

hereditary traumatic vascular - adult form

Question 32

what is the most common location for osteochondritis dissecans ?

Answer 32

knee - posterolateral aspect of medial femoral condyle

Question 33

how does osteochondritis dissecans present ?

Answer 33

poorly localised, activity-related pain recurrent effusions mechanical symptoms - locking, block to full movement

Question 34

what are signs of osteochondritis dissecans ?

Answer 34

may be normal look - effusion feel - localised tenderness move - stiffness, block to movement, Wilson's test (dangle legs, internal rotation painful)

Question 35

how do you investigate osteochondirits dissecans ?

Answer 35

xray - with tunnel view | MRI - lesion size, status of cartilage and subchondral bone, oedema suggest instability of fragment

Question 36

how do you treat osteochondritis dissecans ?

Answer 36

non-operative - restricted weight-bearing, ROM brace | operative - arthroscopy (subchondral drilling, fix loose fragments), open fixation