Soft tissue knee injuries Flashcards Preview

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Flashcards in Soft tissue knee injuries Deck (81):
1

What are the two collateral ligaments of the knee?

Lateral collateral ligament
Medial collateral ligament

2

What are the two cruciate ligaments of the knee?

Anterior cruciate ligament
Posterior cruciate ligament

3

What are the two meniscus of the knee?

Medial meniscus
Lateral meniscus

4

Which bones are involved in the knee joint?

Femur
Tibia
Fibula
Patella

5

What are the two fibres which compose the meniscus?

Longitudinal fibres
Radial fibres

6

Describe the blood supply to the meniscus

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

7

Are medial or lateral meniscal tears more common? Why?

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

8

What is the function of the menisci?

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

9

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

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

10

Which is more mobile the lateral or medial meniscus?

Lateral meniscus (medial is fixed)

11

How does the tibia move during flexion and extension?

Flexion - internal rotation
Extension - external rotation

12

Which forces do the collateral ligaments resist?

Medial - valgus stress
Lateral - varus stress

13

Which forces do the cruciate ligaments resist?

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)

14

Which structures resist external rotation of the tibia in flexion?

Posterolateral corner - posterior cruciate, lateral collateral and popliteus

15

Describe the anatomy of the medial collateral ligament

Broad and thin
Excellent blood supply

16

Describe the anatomy of the lateral collateral ligament

Thick and cord like
Poor blood supply

17

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

Medial

18

What type of instability does medial collateral ligament rupture cause?

Valgus

19

What type of instability does anterior cruciate ligament rupture cause?

Rotatory instability

20

What type of instability does posterior cruciate ligament rupture cause?

Recurrent hyperextension
Difficulty descending stairs

21

What type of instability does posterolateral corner rupture cause?

Varus
Rotatory

22

What are the types of meniscal tears?

Longitudinal
Radial
Bucket handle
Parrot beak

23

Which type of meniscal tear can cause knee locking?

Bucket handle

24

Which type of meniscal tear may heal on its own?

Longitudinal (if very peripheral)

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

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