What could it be
acute on chronic degenerative joint disease
What are important things to uncover in the incidence of knee injury?
- sport or recreation
Activity: sports tackle, jumping
- how fast and how heavy
Presence of systemic symptoms
- Quick or slow onset
Previous injury or event
Hear or feel a pop or crack
Swelling - early or late onset, early means haemoarthrosis
What causes a meniscal knee injury?
twisting movement on a loaded fixed knee
What are the features of a meniscal injury?
slow swelling (quicker in the young)
painful to weight bear
What causes an ACL tear?
Forward momentum, leg fixed with or without rotation
What are the features of ACL tear?
Often able to weight bear
What are the features of collateral tears?
feel of “crack”, sharp pain
no or minimal effusion
bruising to one side
What is in the feel part of the examination for the knee?
scars, bruising and swelling
joint line irregularity
What do you feel for in a knee joint irregularity?
Feel for effusion
tissue lumps or defects
What do you test for in the movement section of the physical examination of the knee?
Passive and active
Straight leg raise
range of movement
What do you look for in X-rays of broken knees?
ligament avulsion (pulling or tearing away)
osteochondral defect (damage to the cartilage and underlying piece of bone)
degenerative joint disease
What is seen on ultrasound of knee injuries?
What is MRI used for?
Variable sensitivity and specificity
Not good for DJD or mobile pathology (degenerative joint diseases)
What are the indications for surgery in the knee?
Failure of conservative Rx
Demands of work
Demands of sport
Problems with daily activities
prevention of further joint injury
prevention of falls
What are the non-surgical management strategies?
restoration of function
range of motion
What are menisci?
In the knee they are two pads of fibrocartilaginous tissue which serves to disperse friction in the knee joint between the lower leg and the thigh.
What direction do the fibres in the menisci take?
Circumferential “hoop” fibres
Superficial randomly oriented fibres
Radially oriented “tie” fibres
Whcih arteries does the perimeniscal capillary plexus develop from?
Develops from the inferior medial and lateral geniculate arteries
What vessels of the perimeniscal plexus supply the meniscus?
Perimeniscal plexus forms circumferential vessels and penetrating radial vessels
How does the blood supply to the meniscus vary with age?
The blood flow of the meniscus is from the periphery (outside) to the central meniscus. Blood flow decreases with age and the central meniscus is avascular by adulthood, leading to very poor healing rates.
What are the two main types of meniscal injuries?
There are two general types of meniscus injuries, acute tears that are often the result of trauma or a sports injury and chronic or wear-and-tear type tears.
What is the treatment for acute and chronic meniscal injury?
Acute - usually surgery
Chronic - Chronic tears are treated symptomatically: physical therapy with or without the addition of injections and anti-inflammatory medications. If the tear causes continued pain, swelling, or knee dysfunction, then the tear can be removed or repaired surgically.
What are the possible repair techniques?
Outside - In
Inside - Out (in this instance you have created a portal from the outside to the inside of the knee which is a potential route for infection - this technique isn’t used particularly much anymore
Smith and Nephew
Fast fix (all inside) - this device is used on parts that will heal (red on red or red on white)
What is the failure rate of meniscal repair?
1: 5 fail/need re-arthroscopy and probable partial meniscectomy
1: 5 “fail” at re-scope/MRI
What are the reasons for surgery on ACL?
Prevention further injury
Back to work
Back to sport
Prevention of osteoarthritis - debateable
What is osteochondral injury?
Injury of the bone and the articular cartilage
What are the treatment options for osteochondral injuries?
Reattachment of fragment
removal of loose bodies