Knee PLL

Question 1

Injury mechanisms of ACL tear

Answer 1

• tibia rotates interiorly
• knee is in excessive tension

Question 2

Effects of ACL tear

Answer 2

• popping sound in the knee
• can possibly cause OA in the future

Question 3

Treatments of ACL tear (surgical)

Answer 3

Allograft
* sourced from cadaver

Autograft
* sourced from hamstring tendon or patellar tendon

Question 4

Explain the effect of menstrual cycle on ACL injuries

Answer 4

• increased injury in the preovulatory phase
• estradiol correlated with lower fibroblast/collagen synthesis (opposite for progesterone)

Question 5

Explain the effects of hormonal contraceptives on ACL injuries

Answer 5

• 20% reduction in injury risk with hormonal contraceptives
• less hormonal fluctuations

Question 6

Explain the ACL laxity during menstrual cycle

Answer 6

• knee laxity greatest during ovulatory phase
• estradiol at its peak

Question 7

What two bone does the MCL connect?

Answer 7

femur and tibia

Question 8

Who tears MCL?

Answer 8

People active in CONTACT sports

Question 9

Is MCL more frequent in males or females

Answer 9

Males, male:female = 2:1

Question 10

MCL injury mechanism

Answer 10

caused by valgus points

Question 11

Explain the mcl injury grades

Answer 11

Grade I: mild stretch injury
Grade II: partial tear
Grade III: complete tear

Question 12

Symptoms of MCL tear

Answer 12

Grade I: mild pain, swelling, tenderness
Grade II: moderate pain, swelling, tenderness
Grade III: severe pain, swelling, tenderness

Question 13

MCL tear treatments

Answer 13

• knee brace
• physical therapy
• rice test

extreme cases: surgery

Question 14

What are the most frequent ligament tears in the knee?

Answer 14

MCL and ACL tear

Question 15

What does meniscus mean in greek

Answer 15

crescent

Question 16

How many meniscus does each knee have

Answer 16

two (medial, lateral)

Question 17

Four functions of meniscus

Answer 17

1. Load distribution
2. Joint lubrication
3. Shock absorbant
4. Stability

Question 18

Who tears their meniscus?

Answer 18

• athletes during twisting motions
• people with discoid meniscus
• kneeling, squatting, heavy lifting
• older age (wear and tear, athiritis)

Question 19

Symptoms of meniscus tear

Answer 19

• locking of the knee
• pain when bending knee
• pain in knee joints
• limping
• stiffness

Question 20

Diagnostic methods of meniscus tear

Answer 20

• physical examinations
  McMurray’s test

Medial
- external rotation + valgus stress

Lateral
- lateral rotation + varus stress

• X-ray
• rule out bone-related issues
• MRI
• provides detailed images of soft-tissues, including the meniscus

Question 21

Name the three areas of the meniscus and describe which regions have higher chance of recovery with respect to blood vessel

Answer 21

1. Red area
2. Red-white area
3. White area

Red area has the most blood supply. This area has the highest chance of recovery than the other two regions

Question 22

Treatments of meniscus tear

Answer 22

• physical therapy
• rest, ice, medication
• surgery
• meniscus transplant
• tissue engineering
• knee replacement
• arthroscope

Question 23

Describe the difference between meniscus-based and capsule-based repair

Answer 23

Meniscal-based: only manipulating meniscus throughout repair surgery

Capsule-based: secure meniscus to other surrounding tissues through anchors

Question 24

All-inside vs inside-out outcome and surgery time

Answer 24

Similar outcome, all inside offers shorter recovery time

All-inside
- avoid risks of nerve injury
- does not fix meniscus to the surrounding tissue

Inside-outside
- passing sutures through knee joint capsule and meniscus