Lower Extremity

Question 1

athlete with anterior knee pain

Answer 1

patellofemoral arthralgia

patellar tracking disorder

Question 2

elderly patient with knee pain

Answer 2

osteoarthritis

usually affects the medial portion of the joint (weight bearing)

Question 3

young athlete with tibial tuberosity pain

Answer 3

osgood schaltet disease

Question 4

complaint of instability

Answer 4

chronic ACL damage

Question 5

complaint of painful locking

Answer 5

meniscus tear

Question 6

hyperextension

Answer 6

ACL tear

patellar dislocation

Question 7

hyperflexion

Answer 7

PCL tear and/or associated ACL tear

Question 8

sudden deceleration

Answer 8

ACL tear

Question 9

valgus force

Answer 9

medial collateral ligament tear

Question 10

valgus force with rotation

Answer 10

ACL
MCL
Menisci

Question 11

blow to flexed knee

Answer 11

contusion
patellar fracture
PCL tear

Question 12

ACL Testing

Answer 12

challenging posterior to anterior stability of the knee
lachman’s test
anterior drawer test
pivot shift test

Question 13

Meniscus Testing

Answer 13

compressive challenge
McMurrays test
Apley’s Compression and Distraction

Question 14

Collateral Ligament Testing

Answer 14

Varus Stress Test

Valgus Stress Test

Question 15

Patellofemoral Disorders

Answer 15

Compression
Stability
Tracking

Question 16

Ottawa Knee Rules for Acute Trauma

Answer 16

patient over 55 years old
isolated tenderness at the patella
isolated tenderness of the fibula head
patient is unable to flex knee to 90 degrees
patient is unable to bear weight immediately after the injury or take four steps

Question 17

Classic presentation of ACL tear

Answer 17

acute or chronic onset

Question 18

Acute onset ACL tear

Answer 18

• sudden onset of pain following hyperextension maneuver,
sudden stopping or cutting, or contact injury with the knee being hit from the side
• may hear pop
• joint swelling appears quickly
• patient is unable to bear weight

Question 19

Chronic presentation of ACL tear

Answer 19

Patient will have a past history of the acute onset type with a gradual resolution of joint swelling and pain, with the complaint usually being instability

Question 20

O’Donaghue’s Triad

Answer 20

aka unhappy triad
ACL
Medial Meniscus
MCL

Question 21

What type of fracture is associated with ACL tear?

Answer 21

Segond’s Fx or potential tibial spine fracture, or head of fibula

Question 22

Segond’s Fx

Answer 22

type of avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur

Mechanism of injury: internal rotation and varus stress which causes abnormal tension on the central portion of the lateral capsular ligament

ACL is most common injury with Segond’s Fx, other injury includes Medial Meniscus or Lateral Meniscus

First image with a knee injury is plain film, if Segond’s is found then do an MRI

Question 23

Complete ACL Tear

Answer 23

focal discrete complete disruption of all visible fibers

Question 24

Partial / Intrasubstance Tear

Answer 24

abnormal signal intensity within substance of ligament with some intact and some discontinuous fibers

Question 25

What color should ligaments/tendons be on MRI

Answer 25

``` low signal (black) if damaged it will be a higher signal (gray) ```

Question 26

Where does the ACL lie

Answer 26

The ACL lies in a plane 10-15 degrees externally rotated to the sagittal plan

Question 27

Posterior Cruciate Injury

Answer 27

* knee pain following a blow to the front of his tibia with the knee in a flexed position or by forced hyper flexion * less common than an ACL tear * posterior drawer sign * SAG sign * X-ray reveals increased signal and thickening

Question 28

Where does the PCL attach

Answer 28

attaches proximally on the internal aspect of the medial femoral condyle and runs distally to where it attaches to the posterior eminence of the tibia

Question 29

Where does the ACL attach

Answer 29

It attaches proximally at the internal aspect of the lateral femoral condyle and runs distally to its broad attachment to the anterior tibia and the anterior aspect of the tibial spine

Question 30

Where does the PCL lie

Answer 30

It lies in the sagittal place and can usually be seen in its entirety on a single sagittal MR slice

Question 31

Where do avulsion fx mostly occur

Answer 31

they occur at the insertion of the ACL (most common) and PCL. Most commonly seen in adolescents.