11. Knee Problems

Question 1

What are the common Knee Problems?

Answer 1

1. Fracture
2. Acute on Chronic Degenerative Joint Disease
3. Meniscal Injury
4. Ligament Injury
5. Tendon Injury

Question 2

What should special focus be placed on, in the History of a Knee Problem?

Answer 2

1. Environment (Sport / Recreation vs Workplace)
2. Activity (Sport tackle vs jumping)
3. Energy (How fast and How heavy)
4. Systemic Symptoms
5. Chronology (Quick vs Slow, Previous Injury)
6. Hear / Feel a Pop/Crack
7. Swelling (Early (Haemarthrosis) vs Late)

Question 3

What causes a Meniscal Injury?

Answer 3

Twisting Movement on a Loaded, Fixed Knee

Question 4

What are the Features of a Meniscal Injury?

Answer 4

1. Painful “Squelch”
2. Slow Swelling
3. Painful to Weight Bear
4. “Locked” Knee

Question 5

What causes an Anterior Cruciate Ligament Tear?

Answer 5

1. Forward Momentum

2. Leg Fixed +/- Rotated

Question 6

What are the Features of an Anterior Cruciate Ligament Tear?

Answer 6

1. “Pop”
2. Quick Swelling
3. Often able to Weight Bear

Question 7

What are the Features of a Collateral Tear?

Answer 7

1. Lateralised Pain
2. Feel of “Crack” - Sharp Pain
3. No / Minimal Effusion
4. Bruising to one side

Question 8

What are the Principles of a Knee Musculoskeletal Examination?

Answer 8

1. Look
2. Feel
3. Move

Question 9

What are you Looking for in a Knee Musculoskeletal Examination?

Answer 9

1. Scars / Bruising / Swelling

2. Joint Line Irregularity

Question 10

What are you Feeling for in a Knee Musculoskeletal Examination?

Answer 10

1. Effusion
2. Crepitus
3. Heat
4. Tenderness
5. Tissue Lumps / Defects

Question 11

What are you looking for in Movement during a Knee Musculoskeletal Examination?

Answer 11

1. Passive and Active
2. Straight Leg Raise
3. Range of Movement
4. Ligament Testing
5. Dynamic Testing

Question 12

What Rradiological Investigations can be done on the Knee?

Answer 12

1. X-Ray
2. Ultrasound
3. MRI

Question 13

What is seen on an X-Ray of a Knee Joint?

Answer 13

1. Fracture
2. Loose Bodies
3. Ligament Avulsion
4. Osteochondral Defect
5. Degenerative Joint Disease
6. Lipohaemarthrosis

Question 14

What is seen on an Ultrasound of a Knee Joint?

Answer 14

1. Tendon Rupture
2. Some Meniscal Tears
3. Swelling
4. Cysts

Question 15

What is an MRI of a Knee Joint used for?

Answer 15

Clinical Confirmation

Note - This is not good for Degenerative Joint Disease or Mobile Pathology

Question 16

What are the Indications that Surgery may be needed?

Answer 16

1. Failure of Conservative Treatment
2. Demands of Work / Sport
3. Problems with Daily Activities
4. Prevention of Further Joint Injuries / Falls

Question 17

What forms of Non-Surgical Management are there?

Answer 17

1. Physiotherapy

2. Analgesia

Question 18

What can Non-Surgical Management lead to?

Answer 18

1. Restoration of Function
2. Swelling Reduction
3. Range of Motion
4. Normal Movement

Question 19

What surgeries are available for Meniscal Injuries?

Answer 19

1. Meniscal Repair
2. Partial Meniscectomy
3. Meniscal Transplantation

Question 20

Who is most likely to get Surgical Repair of a Meniscal Injury?

Answer 20

1. Young
2. Sporty
3. Fresh Tears - up to 3 months
4. Healthy Meniscus (Red/Red or Red/White)

Question 21

What are the Repair Techniques for a Meniscal Injury?

Answer 21

1. Open Technique
2. Outside - In
3. Inside - Out
4. All Inside
   Note - This has a 90% success rate

Question 22

What Procedures are there for Anterior Cruciate Ligament tears?

Answer 22

1. Full ACL Rehabilitation

2. ACL Reconstruction Surgery

Question 23

What would the reasons be for having ACL Reconstruction Surgery?

Answer 23

1. Prevention of further injury
2. To get back to work / sport
3. Prevention of Osteoarthritis

Question 24

What are the treatment options for Osteochondral Injuries?

Answer 24

1. Debridement
2. Reattachment of Fragment
3. Removal of Loose Bodies
4. Microfracture Chondroplasty
5. ACI