Orthopaedic Knee Conditions

Question 1

Meniscal tear causes

Answer 1

• Acute
  
  • Twisting especially in deep flexion
• Degenerative
  
  • Osteoarthritis
• Medial meniscal tears more common
  
  • More fixed structure
• Unlikely to heal
  
  • Poor blood supply

Question 2

Meniscal Tear Presentation

Answer 2

• Pain
• Clicking
• Locking
• Intermittent swelling

Question 3

Meniscal tear examination look

Answer 3

effusion

Question 4

Meniscal tear examination feel

Answer 4

tender joint line at point of tear

Question 5

Meniscal tear examination move

Answer 5

• mechanical block to movement
• McMurrays test positive
• fail deep squat
• Thessalays test positive

Question 6

Meniscal tear investigations

Answer 6

• X-Ray
  
  • arthritis
  • fractures
• MRI
  
  • more sensitive test
  • high false positive rate

Question 7

Meniscal tear non-operative treatment

Answer 7

• Rest
• NSAIDs
• Physiotherapy
• Hamstring and Quadriceps strengthening

Question 8

Meniscal tear operative treatment

Answer 8

• arthroscopy
  
  • repair
  • resection

Question 9

ACL position

Answer 9

runs from between tibial eminences to lateral wall of intercondylar notch of femur

Question 10

ACL blood supply

Answer 10

middle geniculate artery

Question 11

ACL innervation

Answer 11

• posterior articulate nerve
  
  • branch of tibial nerve

Question 12

ACL function

Answer 12

primary restraint to anterior translation of the tibia relative to femur

Question 13

ACL tear cause and female:male ratio

Answer 13

• non-contact pivot injury
• females:male 4.5:1

Question 14

ACL tear presentation

Answer 14

• heard a ‘pop’
• immediate swelling
  
  • haemarthrosis
• unable to continue playing
  
  • can walk in a straight line
• deep pain

Question 15

ACL tear examination look

Answer 15

effusion (if recent injury)

Question 16

ACL tear examination move

Answer 16

• Anterior draw
• Lachmann’s test
• Pivot shift
  
  • Best done under anaesthetic

Question 17

ACL tear investigations

Answer 17

• X-ray
  
  • Segond fracture
  • Avulsion # of anterolateral ligament
• MRI
  
  • ACL
  • Meniscii
    
    • Lateral – simultaneous with acl tear (48%)
    • Medial – secondary to shear from chronic instability
  • MCL

Question 18

ACL tear non-operative treatment

Answer 18

focussed quadriceps programme

Question 19

ACL tear operative treatment

Answer 19

• ACL reconstruction
  
  • +/- partial menisectomy +/- ligament repair or augmentation
  • hamstring graft

Question 20

Superficial and deep MCL function

Answer 20

• superficial - primary restraint to valgus stress
• deep - contributes to full knee extension

Question 21

MCL tear pathology and associated injuries

Answer 21

• severe valgus stress
  
  • usually contact related
• associated injuries
  
  • ACL tear
  • Meniscal tear

Question 22

MCL tear examination look

Answer 22

• medial swelling
• bruising

Question 23

MCL tear examination feel

Answer 23

• tender medial joint line
• tender femoral insertion of MCL

Question 24

MCL tear examination move

Answer 24

• painful in full extension
• opening on valgus stress

Question 25

MCL tear investigations

Answer 25

* X-Ray * may be normal * calcification at femoral insertion - chronic injury * MRI * modality of choice * assess location and severity of injury * identify other pathologies

Question 26

MCL tear non-operative treatment

Answer 26

* Majority * Rest, NSAIDs * Physiotherapy * Brace for comfort

Question 27

MCL tear operative treatment

Answer 27

* severe tears * failed non-operative management * repair or reconstruction * repair: avulsions * reconstruction: damaged tissue

Question 28

Osteochondritis dissicans

Answer 28

* pathological lesion affecting articular cartilage and subchondral bone * 2 forms * juvenile -10-15 years - while growth plates still open * adult

Question 29

Osteochondritis dissicans cause

Answer 29

* hereditary * traumatic * vascular * adult form

Question 30

Osteochondritis dissicans presentation

Answer 30

* Activity-related Pain * Poorly localised * Recurrent effusions * Mechanical symptoms * Locking * block to full movement

Question 31

Osteochondritis dissicans examination look

Answer 31

effusion

Question 32

Osteochondritis dissicans examination feel

Answer 32

localised tenderness

Question 33

Osteochondritis dissicans examination move

Answer 33

* stiffness * block to movement * Wilson’s test

Question 34

Osteochondritis dissicans investigations

Answer 34

* X-Ray * Add in tunnel view (flexed 30-50 deg) * MRI * Lesion size * Status of cartilage and subchondral bone * Signal intensity * Oedema suggests instability of fragment

Question 35

Osteochondritis dissicans non-operative treatment

Answer 35

* restricted weight bearing * rom brace

Question 36

Osteochondritis dissicans operative treatment

Answer 36

* Arthroscopy * Subchondral drilling * Fixation of loose fragment * Open fixation