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Year 2 > Soft tissue knee injuries > Flashcards

Soft tissue knee injuries Flashcards

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1
Q

What are the two collateral ligaments of the knee?

A

Lateral collateral ligament

Medial collateral ligament

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2
Q

What are the two cruciate ligaments of the knee?

A

Anterior cruciate ligament

Posterior cruciate ligament

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3
Q

What are the two meniscus of the knee?

A

Medial meniscus

Lateral meniscus

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4
Q

Which bones are involved in the knee joint?

A

Femur
Tibia
Fibula
Patella

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5
Q

What are the two fibres which compose the meniscus?

A

Longitudinal fibres

Radial fibres

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6
Q

Describe the blood supply to the meniscus

A

Only the most peripheral 1/3 of the meniscus has a direct blood supply

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7
Q

Are medial or lateral meniscal tears more common? Why?

A

Medial. The medial meniscus is under a greater amount of sheer stress

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8
Q

What is the function of the menisci?

A

Distribute load from the convex femoral condyles to the relatively flat tibial plateaus

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9
Q

Why does the medial meniscus undergo a greater amount of sheer stress?

A

Knee pivots on medial compartment of the knee during flexion and extension

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10
Q

Which is more mobile the lateral or medial meniscus?

A

Lateral meniscus (medial is fixed)

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11
Q

How does the tibia move during flexion and extension?

A

Flexion - internal rotation

Extension - external rotation

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12
Q

Which forces do the collateral ligaments resist?

A

Medial - valgus stress

Lateral - varus stress

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13
Q

Which forces do the cruciate ligaments resist?

A

Anterior - anterior subluxation of tibia & internal rotation of the tibial in extension
Posterior - posterior subluxation of the tibia (i.e anterior subluxation of the femur and hyperextension of the knee)

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14
Q

Which structures resist external rotation of the tibia in flexion?

A

Posterolateral corner - posterior cruciate, lateral collateral and popliteus

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15
Q

Describe the anatomy of the medial collateral ligament

A

Broad and thin

Excellent blood supply

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16
Q

Describe the anatomy of the lateral collateral ligament

A

Thick and cord like

Poor blood supply

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17
Q

Which collateral ligament of the knee usually heals on its own?

A

Medial

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18
Q

What type of instability does medial collateral ligament rupture cause?

A

Valgus

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19
Q

What type of instability does anterior cruciate ligament rupture cause?

A

Rotatory instability

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20
Q

What type of instability does posterior cruciate ligament rupture cause?

A

Recurrent hyperextension

Difficulty descending stairs

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21
Q

What type of instability does posterolateral corner rupture cause?

A

Varus

Rotatory

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22
Q

What are the types of meniscal tears?

A

Longitudinal
Radial
Bucket handle
Parrot beak

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23
Q

Which type of meniscal tear can cause knee locking?

A

Bucket handle

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24
Q

Which type of meniscal tear may heal on its own?

A

Longitudinal (if very peripheral)

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25
What is the typical history of meniscal tears in younger patients?
Traumatic - sporting injury / getting up from squatting
26
What is the typical history of meniscal tears in older patients (>40)?
Atraumatic degenerative
27
What are meniscal tears associated with?
ACL rupture
28
How are meniscal tears investigated?
MRI
29
How can peripheral tears be managed?
Arthroscopic repair in younger patients with extensive rehab (often fails)
30
How does the pain progress with meniscal tears?
Initial pain may settle
31
When is an arthroscopic menisectomy considered for meniscal tears?
Mechanical symptoms (painful locking) Irreparable tears Failed repair
32
How do you know which menisci you're looking at on an MRI?
Look for the bones - if tibia then probably medial meniscus
33
What is the cause of an acute locked knee?
Displaced bucket handle meniscal tear
34
How does a displaced bucket handle meniscal tear present?
Springy 15 degree block to extension
35
How should a displaced bucket handle meniscal tear be managed? Why?
Surgery (arthroscopic repair or partial menisectomy) | Prevent further damage to knee joint and resolve locking
36
What may develop of a displaced bucket handle meniscal tear is not treated?
Fixed flexion deformity
37
What can be seen on an MRI that indicates meniscal tear?
Double PCL sign | Gap in meniscus
38
How common are degenerative meniscal tears?
Common
39
How do degenerative meniscal tears present?
Often asymptomatic
40
How should degenerative meniscal tears be managed?
Conservatively (pain will settle) Injection to help pain Surgery for mechanical symptoms (NOT PAIN)
41
Describe the grading system of ligament tears
Grade 1 - Sprain (macroscopic structure intact) Grade 2 - Fascicles disrupted Grade 3 - Complete tear
42
What is the typical history of a medial collateral ligament tear?
Valgus stress (sport tackles, etc)
43
How are MCL tears managed?
Bracing Early motion Physiotherapy Surgery if combined injury/unstable knee
44
What are the surgical options for MCL tears?
Advancement | Tendon graft
45
How does the pain progress with MCL tears? Why?
Can take several months to settle | MCL has good innervation
46
What is the typical history of an anterior cruciate ligament tear?
Sports (rugby, football, skiing) | Twisting injury
47
How are ACL tears managed?
``` Bracing and/or Physiotherapy (elderly) Surgical reconstruction (younger) ```
48
What are the different surgical approaches to ACL tears?
Autograft - hamsting or patellar | Allograft - achilles
49
How can the ACL self stabilise?
By sticking to the PCL
50
Describe the rule of 1/3rds as it relates to ACL tears
1/3 - compensate 1/3 - compensate if avoiding certain activities 1/3 - cannot compensate and cannot return to high impact sport
51
Which type of patient is more likely to compensate following and ACL rupture?
Older (+ more likely to avoid impact sport)
52
What are the indications for ACL surgery?
``` Younger High impact sport High demand Rotatory instability not responding to physiotherapy Protect meniscal repair Part of multi-ligament repair ```
53
What does ACL surgery not do?
Treat pain | Prevent arthritis
54
What are the possible consequences of ACL tear and surgery?
Stiffness Infection Donor site morbidity Post traumatic arthritis
55
How common is lateral collateral ligament tear?
Uncommon
56
What is the typical history of LCL tear?
Varus forces | Hyperextension injury
57
Does the LCL heal?
No
58
What are the consequences of a non-healing LCL?
Varus and rotatory instability
59
What is associated with LCL tear?
Common peroneal nerve injury ACL rupture PCL rupture
60
How is LCL tear managed?
``` Surgical repair (caught early) Surgical reconstruction (caught late) ```
61
What is the typical history of a posterior cruciate ligament rupture?
Direct blow to anterior tibia (dashboard, motorcycle) | Hyperextension injury
62
How might a PCL tear present?
Popliteal pain and bruising
63
How common is a PCL tear?
Uncommon in isolation
64
How is PCL tear managed?
Conservative if isolated | Surgical reconstruction if marked instability or as part of multi-ligament reconstruction
65
How does PCL instability present?
Instability when going down stairs | Recurrent hyperextension
66
Is knee dislocation a high or low energy injury?
High
67
Knee dislocation has a high incidence of complications. What are these?
Popliteal artery injury (intimal tear, thombosis) Common peroneal nerve injury Compartment syndrome
68
How should a knee dislocation be managed?
Emergency reduction Neurovascular status +/- vascular surgery Ex-fix for temporary stabilisation Multi-ligament reconstruction
69
What is the typical history of a patellar dislocation?
Sudden turn | Direct blow
70
Who is most at risk of patellar dislocation?
``` Females Ligament laxity Valgus deformity Adolescents Torsional abnormalities ```
71
What is the risk of recurrent dislocation of the patella?
Low (10%)
72
Patellar dislocation can cause chondral or osteochondral damage. T/F
True
73
How is patellar dislocation treated?
Conservatively | Rarely surgical stabilisation
74
What is the typical history of a extensor mechanism rupture?
Fall onto flexed knee with quadriceps contraction
75
Who is at highest risk of extensor mechanism rupture?
``` Steroids Chronic renal failure Ciprfloxacin Previous tendonitis Rheumatoid arthritis ```
76
What should be found on examination of a patient with extensor mechanism rupture?
Unable to straight leg raise Palpable gap High or low riding patella depending on injury site
77
How is extensor mechanism rupture treated?
Surgical repair
78
Which ligament rupture will commonly cause a pop or crack?
ACL
79
Which injuries will produce a haemarthrosis?
ACL | Fracture
80
Which injuries will produce an effusion?
Meniscal | Chondral
81
How will a haemarthrosis be described in the history?
Sensation of filling up

Year 2 (72 decks)

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