Orthopaedic knee conditions

Question 1

what is a classic manoeuvre which can cause a meniscal tear?

Answer 1

deep flexion with a twist

Question 2

what investigations would you carry out to diagnose a meniscal tear?

Answer 2

history and examination
x-ray
MRI - most sensitive but a lot of false positives

Question 3

what tests can be carried out on examination if you suspect meniscal tear?

Answer 3

McMurrays test
Fail deep squat - asymmetric
Thassaly’s test

Question 4

what is the treatment for meniscal tears?

Answer 4

non-operative:

• rest
• NSAIDS
• physiotherapy

operative:
- arthroscopy

Question 5

what is the presentation of a meniscal tear?

Answer 5

pain (localised)
clicking
locking
intermittent swelling

Question 6

what are the 2 types of meniscal tear?

Answer 6

acute:
- twisting in deep flexion

degenerative:
- osteoarthritis

Question 7

what meniscal tear is more common?

Answer 7

medial because it is a more fixed structure compared to the lateral menisci

Question 8

what is the function of the menisci?

Answer 8

shock absorption
aid in force transmission
stability
load distribution

Question 9

what its he blood and nerve supply of the ACL?

Answer 9

blood:
- middle geniculate artery

nerve:
- posterior articular nerve (branch of tibial nerve)

Question 10

how does ACL tears occur?

Answer 10

bad landing mechanics

non-contact pivot injury

Question 11

what is the presentation of an ACL tear?

Answer 11

heard a ‘pop’ or a ‘crack’
immediate swelling (haemarthrosis)
continue playing, they are able to walk in a straight line (off the pitch)
deep pain

Question 12

what tests are carried out during clinical examination if you suspect an ACL tear?

Answer 12

anterior draw
lachmann’s test
pivot shift (under anaesthetic)

Question 13

what accompanying pathologies usually occur with an ACL tear?

Answer 13

lateral meniscal tear (50%) - acute ACL tear

medial meniscal secondary to shear from chronic instability

Question 14

what is the treatment for ACL tear?

Answer 14

non-operative :
- focused quadricep programme to strengthen quads for compensation

operative:
- ACL reconstruction

Question 15

what investigations would you carry out to help with diagnosis of ACL tear and why?

Answer 15

x-ray:
- segond fracture (avulsion fracture of anterolateral ligament)
MRI; view the ACL and menisci

Question 16

how does a MCL tear occur?

Answer 16

severe valgus stress

usually contact related

Question 17

what are associated injuries with a MCL tear?

Answer 17

meniscal

ACL

Question 18

what is the presentation of a MCL tear?

Answer 18

heard a "pop" or a "crack"
extreme pain in medial side- very localised 
bruising of medial knee
localised swelling 
unable to continue playing

Question 19

what are the signs on examination of a patient with a MCL tear?

Answer 19

look:
- medial rotation
- bruising

feel:

• tender medial joint line
• tender femoral insertion MCL

move:

• painful in full extension
• opening on valgus stress

Question 20

what is Pellegrini-Stieda?

Answer 20

calcification at femoral insertion of the middle collateral ligament
it is found on x-ray which suggests chronic injury to the MCL

Question 21

what are the treatments for a MCL tear?

Answer 21

non operative:

• rest
• NSAIDS
• physiotherapy
• brace

operative:
- reapir or reconstruction

Question 22

what is osteochondritis dissecans?

Answer 22

pathological lesion affecting articular cartilage and subchondral bone

Question 23

what are the causes of osteochondritis dissecans?

Answer 23

hereditary
traumatic
vascular (adult form)

Question 24

what is the presentation of osteochondritis dissecans?

Answer 24

activity related pain - poorly localised
recurrent effusions
mechanical symptoms: locking, block to full movement

Question 25

what are the clinical features during examination of a patient with osteochondritis dissecans?

Answer 25

look: - effusion feel: - localised tenderness move: - stiffness - block to movement - wilsons test

Question 26

what type of view on x-ray do you require to view osteochondritis dissecans?

Answer 26

tunnel view

Question 27

what is the treatment for osteochondritis dissecans?

Answer 27

non-operative: - restricted weight bearing - range of motion brace operative: - arthroscopy - open fixation

Question 28

where does osteochondritis dissecans commonly affect?

Answer 28

knee is most common | - posterior aspect of femoral medial condyle

Question 29

what are the functions of the superficial and deep MCL's?

Answer 29

superficial: restrains from valgus stress deep: contributed to full extension

Question 30

what are the functions of the ACL?

Answer 30

primary restraint to anterior translation of the tibia relative to the femur secondary restraint to tibial rotation and various/valgus stress