KNEE OA risk factors?
- genetic factors - specific genes unknown
- constitutional factors - eg? x4
- local factors - prev joint injury, occupational or recreational stresses on the joint, reduced surrounding muscle strength or any joint laxity or misalignment
KNEE OA clinical features?
- pain - where is this typically felt? where can it radiate to? exacerbating & relieving factors?
- often bilateral disease w associated joint stiffness - this can result in reduced function and even joint swelling.
KNEE OA on examination?
- reduced ROM
- evidence of muscle wasting
- crepitus in severe cases
KNEE OA differential diagnoses?
main DDs for someone presenting w joint pain and stiffness are:
- any meniscal or ligament injury
- referred pain from another joint or back
- crystal arthropathies - eg gout
- patellofemoral arthritis
KNEE OA imaging & investigations?
- plain film x ray (lateral & AP views) you will be able to see diagnostic features on it - LOSS (what is this?)
- skyline view can further assess for any ? involvement
- additional investigations only required when alternative differentials suspected eg blood tests for infective cause or MRI in ligamentous injury
KNEE OA classification?
by the Kellgren & Lawrence system - TMS has more detail
KNEE OA initial management?
- lifestyle modifications - eg??
- adequate pain control to ensure ongoing mobility & QOL
- PT to slow disease progression & improve joint mechanics
- conservative management doesn’t work? surgical management is now warranted
KNEE OA surgical management?
- TKR - functions for at least 10 yrs & pts have significant reduction in knee pain
- 10% of pts only require partial (unicondylar) knee replacement - pts w disease localised to either the medial or lateral compartment so the affected compartment will be replaced and the healthy compartment left intact. PKR are more conservative so faster recovery time but maybe need a TKR at a later date
KNEE OA what is patellofemoral oa?
patella rests in the trochlear groove on top of the femur - this is where the patella moves back & forth during knee flexion and extension. PF OA is OA affecting the articular cartilage along the trochlear groove & on the underside of the patella.
KNEE OA - PF OA risk factors?
- patella dysplasia - so the patella doesn’t properly fit into ? groove
- previous patella fracture - leading to damage to the ? cartilage
KNEE OA - PF OA clinical features?
- anterior knee pain - worse w activities that put pressure on the patella eg??
- associated w joint stiffness & swelling
- diagnosis mainly made from Hx then confirmed w x rays (mainly skyline view)
KNEE OA - PF OA management?
- conservative - same as knee oa
- surgery: PF replacement -> if OA in other parts of the knee then TKR
ACL TEAR typical hx?
- athlete w a hx of twisting the knee whilst weight bearing
- occurs w/o contact and result from a sudden change of direction twisting the flexed knee
- pt won’t be able to weight bear
- pt says there was a ‘popping’ sound and immediate swelling (why so quick?) as well as significant pain
- delayed presentation? pt describes leg as ‘giving way’
ACL TEAR specific clinical tests which can identify potential ACL damage?
- lachman test - what is this?
- anterior draw test - what is this?
ACL TEAR differential diagnoses?
- prox tibial or distal femur fracture
- meniscal tear
- collateral ligament tear
- quadriceps tendon tear
- patellar ligament tear
ACL TEAR imaging?
- x ray of knee (AP & lateral) to exclude ?? x3
- MRI - gold standard & also picks up meniscal tears (50% ACL tears also include medial meniscus tears)
ACL TEAR immediate management?
RICE - what is this?
ACL TEAR conservative management?
- rehab - which utilises strength training of the quadriceps to stabilise the knee. in an emergency setting inpatient admission is rarely required - pt can often partially weight bear & a cricket pad knee splint can be applied for comfort
ACL TEAR surgical management?
- surgical reconstruction involves the use of a tendon or an artificial graft. this is performed following a period of ‘prehabilitation’ - pt w a PT for some months before surgery
- acute surgical repair of ACL is possible in some cases dependent on the location of the tear within the ligament. if imaging on MRI is favourable pt can be further assessed under GA knee arthroscopy & acute repair involves resuturing the ends of the torn ligament together
ACL TEAR complications?
post traumatic OA - complication of ACL injury & surgery
MENISCAL TEARS menisci anatomy info
the menisci rest on the tibial plateau and have 2 main functions: - shock absorbers of the knee joint & - inc articulating SA
- the medial meniscus is less circular than the lateral and is attached to the medial collateral ligament, whilst the lateral isnt attached to the lateral collateral ligament
MENISCAL TEARS pathophysiology?
- most common cause: trauma related injury & degenerative disease
- trauma? young pt who has twisted their knee whilst it is flexed and weight bearing w the onset of sx soon after
MENISCAL TEARS types? pics on TMS
- vertical
- longitudinal (bucket handle)
- transverse (parrot beak)
- degenerative
MENISCAL TEARS clinical features?
pts report: a tearing sensation in knee, intense sudden onset pain, swelling over 6-12 hrs.
bucket handle tear? knee locked in ??
