Soft Tissue Knee Injury - 24/10/18

Question 1

What are four modes of failure in the knee?

Answer 1

Extensor mechanism injuries
Meniscal tears
Ligament injuries
Knee and patellar dislocation

Question 2

What is pseudolock?

Answer 2

Patient’s standing up and experiencing pain and discomfort in their knees due to lack of synovial fluid in the joint for a short period after standing

Question 3

How is pseudolock treated?

Answer 3

Physiotherapy

Weight loss

Question 4

Which gender are more likely to tear ACL?

Answer 4

Women

Question 5

Why are females more likely to tear their ACL?

Answer 5

Women’s hamstring torque doesn’t come on as quickly from rest as it does from males

Question 6

What causes extensor mechanism rupture?

Answer 6

Fall on flexed knee with quad contraction

Quads tendon or patellar fracture, or patellar tendon

Question 7

What are risk factors for extensor mechanism rupture?

Answer 7

Previous tendonitis
Steroids
CKD
Ciprofloxacin

Question 8

What is seen on examination extensor mechanism rupture?

Answer 8

Unable to straight leg raise

Palpable gap

Question 9

How is extensor mechanism rupture treated?

Answer 9

Surgery

Question 10

Should you inject steroids into a tendon?

Answer 10

NO

Question 11

What is seen on xray in extensor mechanism rupture?

Answer 11

Large gap between patella and femur

Question 12

What is a non-traumatic cause of extensor mechanism rupture?

Answer 12

Femoral nerve palsy?

Question 13

What are 4 causes of extensor mechanism rupture?

Answer 13

Rectus femoris tear
quadriceps tendon rupture
Patellar fracture
Patellar tendonrupture

Question 14

What is the function of the meniscus?

Answer 14

Carry load

Transmit load equally throughout bone

Question 15

Which menisci is fixed?

Answer 15

Medial

Question 16

What are 4 types of meniscal tear?

Answer 16

Radial
Longitudinal
Parrot beak
Bucket handle

Question 17

How can meniscal tears occur?

Answer 17

Sporting injuries
Spontaneous (over 40)
ACL rupture

Question 18

How are meniscal tears investigated?

Answer 18

MRI

Question 19

Which side of meniscal tear is much more common?

Answer 19

Medial

Question 20

How are meniscal tears treated?

Answer 20

Radial tears wont heal
Limited repair potential
Acute peripheral tears can be repaired in younger patients
Only peripheral 1/3 has a blood supply
Surgery

Question 21

what signifies displaced bucket handle tear?

Answer 21

Acute locked knee

15 degree springy block to extension

Question 22

How are bucket handle tears treated?

Answer 22

Emergency surgery

Question 23

Why do meniscal tears struggle to repair?

Answer 23

Environment
Low blood supply
Not exposed
Lots of movement

Question 24

What do degenerate meniscal tears probably suggest?

Answer 24

Osteoarthritis

Question 25

How are degenerative meniscal tears treated?

Answer 25

Initial swelling will settle Flares may occur Results of surgery are lower in patients with evidence of osteoarthritis

Question 26

When should surgery NOT be done for meniscal tears?

Answer 26

Advanced structural Osteoarthritis

Question 27

When should urgent arthroscopic surgery be done for meniscal tears?

Answer 27

Locked Knee

Question 28

When should surgery be considered for meniscal tears?

Answer 28

Acute injury with MRI proven meniscal tear | Meniscal tear and corresponding symptoms

Question 29

What does MCL resist?

Answer 29

Valgus stress

Question 30

What does LCL resist?

Answer 30

Varus stress

Question 31

What does ACL resist?

Answer 31

ANterior subluxation | Internal rotation of tibia

Question 32

What does PCL resisit?

Answer 32

Posterior subluxation | External rotation of tibia?

Question 33

What is a grade 1 knee ligament injury?

Answer 33

Sprain | Torn fibres

Question 34

What is a grade 2 knee ligament injury?

Answer 34

Partial tear | Some fasicles affected

Question 35

What is a grade 3 knee ligament injury?

Answer 35

Complete tear

Question 36

What is a grade 4 knee ligament injury?

Answer 36

Knee dislocation

Question 37

What happens if the MCL ruptures?

Answer 37

Valgus instability

Question 38

What happens if the ACL ruptures?

Answer 38

Rotatory instability

Question 39

What happens if the PCL ruptures?

Answer 39

Recurrent hyperextension and instability

Question 40

What happens when the posterolateral corner ruptures?

Answer 40

Varus and rotatory instability

Question 41

What occurs with multiligament injury?

Answer 41

Gross instability

Question 42

What causes an increase in signal on an MRI?

Answer 42

Bone bruising | bleeding inside of bone

Question 43

How is a bone bleed treated?

Answer 43

No treatment | Will repair over 12-14 months

Question 44

Does the MCL heal?

Answer 44

Yes

Question 45

How is MCL treated?

Answer 45

Physio Bracing Early motion Rarely requires surgery

Question 46

What causes ACl rupture?

Answer 46

Sports injury

Question 47

Does ACL repair usually work?

Answer 47

No

Question 48

What does ACL repair entail?

Answer 48

Autograft of hamstring or patellar tendon Allograft of Achilles ACL can stick to PCL to give stability

Question 49

How can ACL be stabilised?

Answer 49

Physiotherapy

Question 50

Is full repair possible in ACL tears?

Answer 50

Nope

Question 51

Can range of movement be restored in ACL tears and how long does it take?

Answer 51

Yes | 10-12 months

Question 52

How do patients cope after ACL ruptire?

Answer 52

1/3 compensate and can function well 1/3 can avoid instability by avoiding activities 1/3 do not compensate and have frequent instability and cant get back to high impact sport

Question 53

What % of ACL ruptures have surgery?

Answer 53

40%

Question 54

When should ACL surgery occur?

Answer 54

Rotatory instability not responsing to physion | Protect meniscal repair

Question 55

How long does ACL repair take?

Answer 55

up to 1 year | Some never repair

Question 56

What can occur with ACL repair?

Answer 56

Stiffness Infection Arthritis within 10 years

Question 57

What are the characteristics of LCL Injury?

Answer 57

Uncommon Varus and hyperextension LCL doesnt heal +

Question 58

What are the characteristics of PCL rupture?

Answer 58

``` Direct blow to anterior tibia Hyperextension Posterior sag Occurs in cyclists + ```

Question 59

What are the characteristics of Knee dislocation?

Answer 59

``` High energy injury Popliteal artery injury Nerve injury compartment syndrome Emergency reduction Vascular surgery Temporary stabilisation Multilagament reconstruction ```

Question 60

What can be a consequence of knee dislocation?

Answer 60

Dropped foot

Question 61

What is Homokawasakitis? (sp?)

Answer 61

``` Cut over front of tibia Tibia forced back Bruised over medial collateral Knee full of blood Haemarthrosis decompresses into calf Serious knee injury and swollen calf Capsule has ruptured and all of the blood in the knee has gone into the leg ```

Question 62

Which patients are more likely to have a knee dislocation?

Answer 62

Overweight patients | Slipping

Question 63

How are knee dislocations treated?

Answer 63

Surgery External fixator Don't open up compromised area

Question 64

What are the characteristics of Patellar dislocation?

Answer 64

``` Rapid Runs in families Females Adolescents Valgus knee Laxity Chondral or ostechondral problems ```

Question 65

What are some important history points?

Answer 65

``` Pop or crack Knee cap dislocation Temperature Giving way Pain Locking Clicking or catching Recurrent swelling Recurrent patellar dislocation ```

Question 66

What are the characteristics of OA?

Answer 66

Biomarkers needed Non uniform Pharmacological and non! surgical

Question 67

What is important to consider in the treatment of OA?

Answer 67

What function the patient has | Symptoms over X-ray

Question 68

What are the consequences of knee replacement?

Answer 68

Limited movement | stiffer than normal

Question 69

What are the symptoms of OA?

Answer 69

``` Holiday knee Pain Inflammatory flares Stiffness Loss of movement Loss of function ```