Knee- Soft Tissue Injuries Flashcards Preview

MSK- Pelvis and Lower Limb > Knee- Soft Tissue Injuries > Flashcards

Flashcards in Knee- Soft Tissue Injuries Deck (84):
1

Where do the menisci have a blood supply? What is the significance of this?

Only at their periphery- tears aren't particularly painful and also won't heal well

2

Knees pivot through what compartment during flexion and extension? What is the significance of this (regarding meniscal tears)?

Medial compartment, medial meniscus is more likely to tear

3

What way does the tibia rotate on flexion?

Internally

4

Which has a better blood supply, MCL or LCL?

MCL

5

What will be seen on clinical examination of a patient with a meniscal tear?

Effusion (following day), joint line tenderness, + Steinmann's test (tibial rotation)

6

Where is a longitudinal meniscal tear?

Near the periphery

7

What is a bucket handle meniscal tear?

An extensive longitudinal tear, causing locking

8

What type of meniscal tear will cause the knee to click painfully?

Parrot beak

9

Why are medial meniscal tears more common?

The medial meniscus is more fixed and less mobile, force from pivoting movements is centred there

10

What will a locked knee in a displaced bucket handle meniscal tear present like?

15 degree springy block to extension

11

What is the mechanism of injury for a meniscal tear?

Usually as a sporting injury in young patients, or getting up from a squatting position (twisting force on a loaded knee)

12

Can meniscal tears occur spontaneously?

Yes, degenerate tears in older patients can (>40)

13

Rupture of what ligament is closely associated with meniscal tears?

ACL

14

What is the investigation of choice for a meniscal tear?

MRI

15

What features imply worse healing of a meniscal tear?

Radial tears, aged > 25, increased time from injury

16

What type of meniscal tears should be considered for repair?

Reasonably fresh bucket handle tears involving the outer 1/33rd of the meniscus in a younger patient

17

What happens in a meniscal repair?

The meniscus is sutured to its bed

18

What is the failure rate of meniscal tear repairs?

25%

19

When should an arthroscopic meniscectomy be considered?

In patients who still have pain or mechanical problems after 3 months

20

If meniscal repair surgery fails, what happens next?

Remove it (you only get one shot at repair)

21

An acute locked knee signifies what?

Displaced bucket handle meniscal tear

22

How soon must arthroscopic repair be done following a bucket handle meniscal tear?

6 weeks

23

If the knee remains locked following a meniscal tear, what may this result in?

Fixed flexion deformity

24

What do degenerate meniscal tears signify?

The first stage of knee OA

25

Will the Steinmann's test be positive in degenerate meniscal tears? What other signs and symptoms will be associated with this?

No, Steinmann's will be negative. There will be signs and symptoms of OA

26

What should you not treat degenerate meniscal tears with?

Arthroscopy

27

What may help control the symptoms in the early period of a degenerate meniscal tear?

Steroid injections

28

What is a grade 1 ligament injury?

Sprain- tearing of some fibres but macroscopically intact

29

What is a grade 2 ligament injury?

Partial tear, some fascicles disrupted

30

What is a grade 3 ligament injury?

Complete tear

31

Does the MCL heal well?

Yes

32

When would the MCL not heal well?

If associated with ACL or PCL rupture

33

How do you treat MCL rupture?

Bracing, early motion and physio

34

How long can it take for pain from an MCL rupture to settle?

Several months

35

What treatment can be used in chronic MCL instability?

Tightening or reconstruction with a tendon graft

36

Where may patients with an MCL rupture have laxity and pain?

On valgus stress, over the origin/insertion of the MCL

37

Do LCL ruptures happen alone?

Not often, they are usually part of multiple ligament injuries

38

What motions can cause LCL rupture?

Hyperextension or varus

39

Does the LCL heal well? What problems can you be left with?

It does not heal well- can be left with varus and rotatory instability (especially external)

40

Excessive stretch from varus/hyperextension in LCL ruptures can cause what nerve injury? What can this result in?

Damage to the common fibular nerve which can cause a permanent foot drop

41

LCL rupture is often found in combination with what other ligament ruptures?

PCL/ACL

42

If found within 2 weeks, how is an LCL rupture treated? What happens if it presents later than this?

Urgent repair. If late then reconstruction.

43

The ACL is the main stabiliser against what movement?

Internal rotation of the tibia

44

What is the principle complaint of ACL deficiency?

Rotatory instability which gives way on turning

45

How are ACL ruptures usually acquired?

Sports injury- football/rugby/skiing turning the upper body laterally on a planted foot

46

How are ACL ruptures treated?

Reconstruction

47

What will examination of an ACL rupture reveal?

Knee swelling with excessive anterior translation of the tibia on anterior drawer test and Lachmann's test

48

To give stability, the ACL can be stuck to which other ligament?

PCL

49

Recovery from ACL rupture comes under the rule of thirds, what is this?

1/3rd compensate and function well, 1/3rd avoid instability by avoiding certain movements, 1/3rd have frequent instability

50

When should surgery be considered for an ACL rupture?

Rotatory instability, no response to physio, protect a meniscal repair, return to professional sport, multi-ligament damage

51

After surgery for ACL repair, what is the recovery like?

Can be up to 1 year of intense rehab, some never get back to sport, often have arthritis within 10 years

52

What is the mechanism of injury of a PCL rupture?

Direct blow to the anterior tibia or hyperextension

53

How will a PCL rupture occur?

Popliteal pain and bruising

54

Is isolated PCL rupture common?

No

55

When is reconstruction used for PCL rupture?

If part of multi-ligament injury or if severe instability

56

What can PCL ruptures cause long term?

Instability, recurrent hyperextension, feeling unstable going downstairs

57

How would you describe a knee dislocation?

High impact injury with a high incidence of complications

58

What are some complications of knee dislocation?

Popliteal artery injury, nerve injury, compartment syndrome

59

What is the treatment for a knee dislocation?

Emergency reduction with possible external fixation, multiple ligament reconstruction

60

The patella will almost always dislocate in what direction?

Laterally

61

When the patella dislocates, what ligament is torn?

Medial patellofemoral ligament

62

As well as the torn ligament, what else may happen alongside patellar dislocations?

Osteochondral fracture (small opacification on x-ray)

63

What movements can cause a patellar dislocation?

Rapid turn or direct blow

64

What are some factors which predispose to patellar dislocations?

Female, adolescent, ligamentous laxity, values knees, high patella, femoral neck ante version, shallow trochlear groove

65

What % of people will have a recurrent patellar dislocation?

10%

66

What is the treatment for recurrent patellar dislocations?

Surgical stabilisation

67

What occurs following a patellar dislocation which causes a characteristic x-ray appearance?

Lipo-haemarthrosis

68

After a patellar dislocation, physiotherapy to strengthen which muscles may help?

Quadriceps

69

What components make up the extensor mechanism of the knee?

Tibial tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscles

70

What is the mechanism of injury for an extensor mechanism rupture?

Fall onto a flexed knee with quadriceps contracted

71

What are some risk factors for extensor mechanism rupture?

Previous tendonitis (quinolones), steroids, chronic renal failure, diabetic, RA

72

What are the clinical signs of an extensor mechanism rupture?

Unable to straight leg raise and a palpable gap

73

What treatment should be avoided in an extensor mechanism rupture?

Steroid injections

74

At what ages are a) patellar tendon ruptures and b) quadriceps tendon ruptures more common?

a) < 40 b) > 40

75

On an x-ray, where will the patella lie in a) patellar tendon ruptures and b) quadriceps tendon ruptures?

a) high lying patella b) low lying patella

76

If a patient is obese and there is no palpable gap, what test can be used to assess for extensor mechanism rupture?

Ultrasound

77

What is the treatment for an extensor mechanism rupture?

Tendon to tendon repair or reattachment of the tendon to the patella

78

If there is a loose mechanical fragment in a meniscal tear, how may this present?

Feeling like the knee is going to give way

79

Is it possible to have a meniscal tear without locking?

Yes

80

Is pseudo-locking a sign of meniscal injury?

No

81

How soon after an ACL rupture will a haemarthrosis develop?

An hour

82

Valgus stress injuries usually tear which ligament? What other injuries may occur?

MCL - can also cause ACL damage and lateral tibial plateau fracture

83

A varus stress injury will usually damage what ligament? What other ligament may or may not be involved?

LCL +/- PCL

84

If a knee injury is though to be significant, what is the best test to do?

MRI