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Flashcards in Soft Tissue Knee injuries Deck (54):
1

If a patient reports an injury on twisting which ligament is likely to be affected?

ACL

2

If the injury was caused by a valgus force which ligament is likely to be affected?

MCL

3

If the injury was caused by a varus force which ligament is likely to be affected?

LCL

4

If an effusion is present what injury is likely?

Meniscal or cartilage

5

What is a haemarthrosis?

Blood in joint space caused by ACL injury or a fracture

6

What recurrent symptoms must you ask about?

Locking
Swelling
Clicking/catching
Patellar dislocation

7

At what angle of degrees do you do anterior drawer for?

90

8

At what angle of degrees is the Lachmans test done?

30

9

What kind of patients tend to get meniscal tears?

Sporting injury in young patients or spontaneous in >40

10

If a patient has an ACL injury what must you also keep in mind?

Half will have a meniscal tear

11

What are the 4 types of meniscal tear?

Longitudinal
Radial
Bucket handle
Parrot beak tear

12

Which type of meniscal tear will not heal?

Radial tears

13

Why do meniscal tears not heal well in general?

Only the peripheral third has a blood supply
High failure rate in arthroscopic repair

14

What would an acutely locked knee signify?

Displaced bucket handle meniscal tear

15

What needs to be kept in mind with a bucket handle tear?

It is potentially repairable and if the knee remains locked an FFD may develop

16

What would you do if you have a meniscal tear that hasn't healed or wont heal?

Arthroscopic menisectomy

17

What can degenerate tears be a sign of?

OA

18

How are knee ligament injuries graded?

1- sprain. Tears some fibres but total structure intact
2- partial tear with some fascicles disrupted
3- complete tear

19

Usualyly an MCL tear will heal well.
When might it be complicated?

If combined with ACL or PCL rupture.

20

What is the rule of thirds of ACL rupture?

1/3 will compensate and function well
1/3 will avoid instability by avoiding activities
1/3 will have frequent instability

21

What percent of ACL ruptures need reconstruction?

40%

22

What reconstruction is available for repair of ACL?

Autograft from patellar tendon or hamstrings
Allograft from the achilles
Synthetic graft

23

What is the rehab time for an ACL reconstruction?

3/12 to 12/12

24

How does an LCL affect the patient?

Relatively uncommon
Can cause varus and hyperextension
High incidence of fibular nerve palsy

25

What treatment is needed for an LCL?

Urgent (2-3 wk) repair then reconstruction

26

When does a PCL injury occur?

Direct blow to anterior tibia

27

What can occur with a knee dislocation?

Popliteal artery tear
Fibular nerve damage
Compartment syndrome

28

Who is more likely to get a patellar dislocation?

Females, adolescents with ligamentous laxity

29

How does a patellar dislocation occur?

Rapid turn or direct blow

30

What can be clinically seen with an extensor mechanism rupture?

Palpable gap
Unable to straight leg raise

31

What atraumatic cartilage defects exist?

Osteochondritis dissecans
OA

32

Why will only cartilage injuries which are full thickness heal?

Blood vessels are only after the tidemark. If the tear is above the tidemark it will not heal.

33

What kind of cartilage is present when healed?

Fibrocartilage.
Usual cartilige is hyaline

34

What is osteochondritis dissecans?

Where an area of knee loses its blood supply.
Bone can fragment off

35

What age group is osteochondritis most common in?

Adolescents

36

What surgical treatment can be given for osteochondritis?

If detached then can remove.
If detaching then can pin in place

37

What is cartilage regeneration?

Stem cells found within the bone and grown to produce new cartilage

38

How long will a cartilage regeneration last?

Around 5 years

39

What is the risk of multiple steroid injections with OA?

May accelerate the arthritic process

40

When would an osteotomy be a good idea for control of OA?

If heavy manual worker and needs 10 years to retire.

41

What is an osteotomy?

The arthritic bone is removed and replaced with another bit of bone

42

Why wouldn't a TKR be given in painful OA?

If young then will wear out the new joint too quickly and the second TKR is never as good.

43

How long can a TKR last in older patients?

20 years

44

What are common presentations to GP regarding knee?

Anterior, localised pain
Stiffness
Swelling
Giving way
Deformity
Loss of function

45

What must you always keep in mind regarding knee pain?

Could actually be pain from hip

46

What is Osgood-Schlatter's disease?

Inflammation of patellar ligament at tibial tuberosity.
Most common in adolesents

47

What are the most common knee problems?

Ligament strain- most commonly medial collateral
Bursitis
OA

48

What kind of cartilage tear are you thinking if you hear a pop and develop a haemoarthrosis?

ACL

49

What is a chronic complaint with an ACL rupture?

Rotatory instability with giving way on turning

50

When would a complete knee dislocation occur?

All 4 ligaments torn

51

What is an extensor mechanism injury?

Rupture of patellar tendon or quadriceps tendon

52

What are predisposing factors to an extensor mechanism injury?

Tendonitis
Chronic steroid (ab)use
DM
RA

53

What direct does the patella dislocate?

Laterally

54

A valgus misaligment predisposes to OA of which part of the knee?

Lateral since valgus misalignment puts a bigger stress on lateral bones