soft tissue knee injuries

Question 1

What do menisci do?

Answer 1

distribute load from convex femoral condyles to relatively flat tibial articular surfaces

Question 2

Lateral an medial menisci are fixed T/F

Answer 2

F

Medial meniscus is fixed while lateral meniscus Is more mobile

Question 3

MCL resists valgus stress T/F

Answer 3

T (its rupture may lead to values instability)

Question 4

LCL resists valgus stress T/F

Answer 4

F- it resists varus stress

Question 5

ACL resists anterior _____ of the tibia and _____ rotation of the tibia in extension

Answer 5

subluxation
internal
(its rupture may lead to rotatory instability)

Question 6

PCL resists _____ subluxation of the tibia i.e. anterior subluxation of the femur and hyperextension of the knee

Answer 6

posterior

its rupture may lead to various and rotatory instability

Question 7

who are meniscal tears usually found in?

Answer 7

usually sporting injuries in younger patients or getting up from squatting position in younger patients
(can get atraumatic spontaneous degenerative tears in older patients -over 40)

Question 8

What should you investigate a meniscal tear with?

Answer 8

MRI

Question 9

Lateral meniscal tear is 10 times more common than medial T/F

Answer 9

F- medial meniscal tears approx 10 times more common than lateral meniscal tears

Question 10

Meniscal tears heal very well T/F

Answer 10

F
only peripheral 1/3 has a blood supply
radial tears won’t heal

Question 11

When should arthroscopic repair be considered?

Answer 11

In acute peripheral tears in younger patients 
Mechanical symptoms (painful catching or locking) for irreparable tears or failed meniscal repair

Question 12

What does acute locked knee signify

Answer 12

displaced bucket handle meniscal tear

Question 13

What is the management for acute locked knee?

Answer 13

urgent surgery required - may be repairable by arthroscopic repair
If knee remains locked- may develop FFD
If irreparable needs partial meniscectomy to unlock knee and prevent further damage

Question 14

Degenerate meniscal tears are common T/F

Answer 14

T- 20% over 50s , many asymptomatic (injection may help)

Question 15

What is the grading for knee ligament injuries

Answer 15

grade 1- sprain-tear some fibres but macroscopic structure intact

Grade 2-Partial tear-some fascicles disrupted

Grade 3-complete tear

some ligaments heal more than others and some stabilise over time

Question 16

What is the treatment for MCL injury

Answer 16

brace, early motion and physio
Pain can take several months to settle
rarely requires surgery

Question 17

What is the main stabiliser against IR of tibia

Answer 17

ACL

Question 18

The best way to treat ACL rupture is repair T/F

Answer 18

F
ACL repair does not work- reconstruction only
autograft-patellar tendon or hamstrings
allograft-achilles

Question 19

What is the ACL rupture rule of thirds?

Answer 19

1/3 compensate and are able to function well
1/3 can avoid instability by avoiding certain activities
1/3 do not compensate and have frequent instability or can’t get back to high impact sport

Question 20

What is the role of surgery in ACL rupture

Answer 20

when the rotatory instability is not responding to physio

Question 21

LCL injury is relatively uncommon. Where is it found?

Answer 21

varus and hyperextension

Question 22

What is the management of complete rupture of the LCL ligament

Answer 22

need urgent repair if early (within 2-3 wks)

later–> reconstruction (hamstring or other tendon)

Question 23

What causes a PCL rupture?

Answer 23

Direct blow to anterior tibia, or hyperextension injury

there will be popliteal knee pain and bruising

Question 24

In 90% of cases PCL rupture is isolated T/F

Answer 24

F- isolated PCL rupture rare

Question 25

A knee dislocation is a serious high energy injury. What are the high incidence complications?

Answer 25

Popliteal artery injury (tear, intimal tera and thrombosis) nerve injury-common perineal nerve compartment syndrome

Question 26

What is the treatment for a knee dislocation?

Answer 26

Emergency reduction | re check neuromuscular status

Question 27

What may cause a patellar dislocation

Answer 27

Rapid turn or direct blow

Question 28

Patellar dislocation is more common in...

Answer 28

``` females adolescents ligamentous laxity valgus knee torsional abnormalities ```

Question 29

What is the risk of recurrent dislocation in patellar dislocation?

Answer 29

10%

Question 30

What is the management for patellar dislocation?

Answer 30

Some may benefit from surgical stabilisation-bony or soft tissue procedures

Question 31

what is the likely soft tissue knee injury as a result of falling onto a flexed knee with quads contraction?

Answer 31

Extensor mechanism rupture

Question 32

What are the RF for extensor mechanism rupture

Answer 32

previous tendonitis steroids chronic renal failure,ciprofloxacin

Question 33

What does an extensor mechanism rupture practically look like?

Answer 33

Unable to straight leg raise | palpable gap

Question 34

Getting from squatting - what is the most likely injury?

Answer 34

meniscal tear

Question 35

Hypeextension- what is the most likely injury?

Answer 35

PCL

Question 36

Varus- what is the most likely injury?

Answer 36

LCL

Question 37

Valgus- what is the most likely injury?

Answer 37

MCL

Question 38

Twisting- what is the most likely injury?

Answer 38

ACL or meniscal injury

Question 39

Football injury, twist, pop, haemarthrosis, generalised pain, pain settles after a few days, rotatory instability. What is the most likely diagnosis?

Answer 39

ACL rupture

Question 40

Getting up from squatting, sudden sharp pain medial joint line, effusion, recurrent medial pain & catching +/- locking. What is the most likely diagnosis?

Answer 40

Meniscal tear