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P-2 Ortho 3 > Lecture 5 > Flashcards

Lecture 5 Flashcards

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1
Q

What is the MC knee injury in service members?

A

Meniscal tears are 10x more common

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2
Q

Which meniscus is most commonly torn?

A

Medial meniscus

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3
Q

Medial meniscus shape and what is it attached to?

A

It is semilunar and adherent to MCL

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4
Q

Shape and location of the lateral meniscus?

A

Circular

Covers more of the tibia

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5
Q

What is the purpose of a meniscus?

A

Distributes the load of the joint via circumferential or hoop stress

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6
Q

How much does lateral meniscus decrease compartment loads by>?

A

70%

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7
Q

Medial meniscus decreases compartment loads by___?

A

50%

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8
Q

Common tears of meniscus?

A

Vertical longitudinal (moon in the middle)

Vertical radial (a cut)

Horizontal (wear on the inside of the c)

Oblique (oblique cut)

Complex/degenerative (shit show)

Slide 8

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9
Q

What is the effect of a meniscal tear?

A

It disrupts the mechanics of the knee, leading to degenerative arthritis

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10
Q

Blood supply in meniscuses?

A

The more peripheral the higher the blood supply

The higher the blood supply the higher the chance of of healing

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11
Q

MOA for meniscus tear?

A

Usually pivot or twist

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12
Q

Meniscus warning signs

A

Joint line tenderness of medial or lateral side of knee

Pains worsens w twisting or squatting

Mechanical symptoms (locking, catching and popping)

Effusion >12hrs (slow leak)

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13
Q

PE for meniscal tear?

A

Joint line tenderness

Decreased ROM (esp w locked knee)

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14
Q

Special tests for meniscus tear?

A

McMurrays
Thessaly
Apley’s

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15
Q

Pt has a displaced “bucket handle” meniscal tear?

A

Surgery ASAP

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16
Q

What do radiographs show?

A

Eval for loose bodies/bone fragments

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17
Q

What grades of meniscus tear are visible on arthroscopy?

A

III and IV

You’re getting surgery

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18
Q

You get a meniscus tear and it gets fixed (or doesnt) what do you win?

A

Osteoarthritis will develop

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19
Q

Who should not get surgery?

A

Conservitavie management for:

  • 40+ w pain but no mechanical symptoms
  • degenerative tears and/or middle 1/3 (avascular)
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20
Q

Who should get surgery?

A 
Young population
Tears between 1 and 4cm
Vertical tear
Red-red tears
Meniscal root tear
Failure of nonopp
Bucket handle/locked knee
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21
Q

We decide not to get surgery how do we treat your meniscal tear?

A

The same as any other musculoskeletal inj

Acute Rehab
Subacute rehab
Bracing
Back to life

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22
Q

96% of the time what are the surgeons doing for meniscus tears?

A

Debride

Only 4% repair

(Civilians)

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23
Q

How does the military handle surgery for meniscal tears?

A

The military does many more repairs than the civilian sector does

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24
Q

What meniscus tears get referred?

A

Trauma, mechanical symptoms or instability

Failed non-opp

All bucket handle tears

Young people

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25
What is an OCD?
Osteochondritis dissecans : osteonecrosis of subchondral bone Usually occurs in the knee but not always
26
MC location for OCD?
Posterolateral side of the medial femoral condyle
27
What causes OCD?
Repetitive small stress to the subchondral bone that disrupts the blood supply to an area of bone Osteonecrotic bone separates Shear forces fracture the articular surface
28
What happens to the osteonecrotic fragment once it breaks free?
It can become a loose body in the joint
29
Clinical presentation of OCD?
Gradual onset of knee pain Knee effusion and catching or locking symptoms
30
MC site for OCD?
Medial femoral condyle, palpated with the knee flexed at 90*
31
What is the best x-ray to view OCD?
Tunnel and lateral views
32
What is the treatment goal for OCD?
Reduce shear forces allowing new bone formation Requires creeping substitution of new bone
33
How well does surgery work for OCD?
It may slow down the damage, but youre probably eventually getting a new knee
34
Does nonoperative tx work?
If the cartilage is still intact however... Doesnt really work after skeletal maturity
35
What do the surgeons do for the bone with OCD?
They will do microfracture Or drilling Can also do autograft (but thats not in the slides) Another option is temporary internal fixation (peads)
36
Does the physis matter?
Yes if the physis is still open the prognosis for healing is significantly higher (kids)
37
What is a plica?
A normal fold in the synovium There are 5 potential places for them but most are asymptomatic
38
Where is the medial plica?
Extends from the medial joint capsule to the medial anterior fat pad
39
How does plica present?
It becomes inflammed or thickened from trauma or overuse Aching over anterior or anteromedial aspec of knee Painful snapping or popping Buckling or instability may occur
40
Where are most symptomatic plicas?
Usually the medial plica
41
How stable are plicas?
Though buckling or sense of instability may occur the true giving way, locking or obvious effusion is uncommon
42
Can you palpate plica?
Sometimes you can palpate a “thickened band” with the knee flexed
43
Does radiology show anything?
They are usually normal but you get them to r/o other stuff (i.e. to bill insurance)
44
Management of plica?
Decrease inflammation and thickening NSAIDS or Tylenol Modify activities Local anesthetic and corticosteroid
45
What is diagnostic and therapeutic of plica?
Injection of local anesthetic and corticosteroid into the plica
46
Surgery for plica?
Not usually but in extreme cases you can do an arthroscopic resection
47
What is bipartite patella?
One or more secondary centers of ossification fail to fuse Mc the superolateral pole Basically 2 patellas
48
How are bipartite patellas usually diagnosed?
Typically its an incidental finding
49
Differentiating bipartite patella from a fx?
Remember fractures dont have smooth edges
50
PE for bipartite patella?
You may feel a prominence over the superolateral pole of the patella
51
5 bursal sacks of the knee?
1. Pre-patellar 2. Supra-patellar 3. Infra-patellar 4. Pes anserine 5. Iliotibial tract
52
What causes bursitis?
Chronic friction causes thickening of the synovial lining and subsequent excessive fluid formation -> localized edema and pain
53
Prepatella bursa aka?
Housemaids knee
54
Bursitis presentations?
Inflamed (bursitis) | Infected (septic bursitis)
55
MC infection agent in prepatellar bursitis?
Staph aureus
56
Where is the prepatellar bursa?
In front of the patella
57
Where is the suprapatellar bursa?
Between anterior surface of lower part of femur and the deep surface of the quadriceps femoris Above the knee
58
Where is the infrapatellar bursa?
Between the upper part of the tibia and patellar ligament Below the knee
59
Where is the pes anserinus bursa?
Under the insertion site of the sartorius, gracilis, and semitendinosus muscles on the medial flare of the tibia just below the tibial plateau
60
Who gets pes anserine bursitis?
Usually its pts w early osteoarthritis in the medial compartment
61
What causes iliotibial tract bursitis?
Repetitive flexion and movement of the knee inflames it Also causes iliotibial band friction syndrome
62
How does bursitis present?
At first pain w activity Gets worse after being sedentary Localized swelling over structure
63
What is pes anserine bursitis often confused with?
Medial meniscal pain But pes anserine is distal to the joint line
64
Difference infected bursitis from septic joint arthritis?
Septic knee arthritis has: - intense pain - large effusion - erythema - guarding w motion - limited ROM - low grade fever Infected bursitis is usually not super painful or erythematous
65
Which bursitis can cause numbness distal to the patella?
Pes anserine bursa can compress the saphenous nerve and its infrapetellar branch
66
Radiographs presentation of bursitis vs septic arthritis?
Anterior soft-tissue swelling w prepatellar bursitis Septic arthritis has an effusion most compressed in the suprapatellar pouch
67
What needs to be done with suspected septc bursitis?
The slides say aspirate but dont stick the needle into the erythematous skin He says cut them to drain and take sample
68
What labs does the sample for septic bursitis need?
Gram stain Culture Crystal analysis Synovial fluid analysis
69
Treatment for bursitis?
NSAIDS, RICE, stretching Corticosteroid Ultrasound phonophoresis (prob wont help)
70
Surgery for bursitis?
Rarely done but the slides say you can do a needle decompression or a surgical drainage He says dont do this
71
Abx for bursitis?
Early onset septic bursitis can be managed with oral abx More sever gets IV abx
72
What bursitis gets referred?
Dont respond to tx Recurrent pes anserine bursitis Prepatellar bursa that are recurrent
73
What does a rupture of the quad or patella tendon result in?
It disrupts the extensor mechanism of the knee
74
What causes quad and patella ruptures?
Trauma | Usually a fall or MVA
75
Who usually gets a quad or patella ruptures?
Men 40-60 (weekend warriors) Prolonged use of fluoroquinolones
76
Presentation of quad and patella rupture?
Significant pain after acute injury Limited walking (Can ambulate w incomplete rupture)
77
PE for quad and patella rupture?
Large effusion Palpable defect Fx is obvious but rupture may be harder to find
78
What is the key to diagnosis for quad and patella ruptures?
Patients inability to extend the knee against gravity or perform a straight leg raise
79
Diagnostic tests for quad and patella ruptures?
Plain radiographs (Patella is lower or higher than it should be) MRI can confirm rupture of the tendon but is rarely necissary
80
Patella alta and patella baja?
Patella alta: high riding patella Patella baja: low riding patella
81
Blumensaat line?
Line drawn along the roof of the intercondylar notch of the femur as seen on lateral radiograph of the knee joint
82
Do we need to fix quad and patella ruptures?
Unless you surgically fix this they will become disabled Delay in tx is makes the outcome much worse
83
What do quad and patella ruptures get? (he never gives these to anyone else)
Knee immobilizer
84
Clinical triad for quad and patella rupture?
1. Inability to actively extend knee 2. Patella alta/baja 3. Palpable defect
85
How fast do they need surgery?
With in 1 week
86
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P-2 Ortho 3 (6 decks)

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