Knee

Question 1

Which meniscus in the knee is more fixed and less mobile?

Answer 1

Medial

Question 2

Which ligament resists valgus stress?

Answer 2

Medial collateral ligament

Question 3

Which ligament resists varus stress?

Answer 3

Lateral collateral ligament

Question 4

What movement does the ACL prevent?

Answer 4

Anterior subluxation of the tibia

Question 5

What movements does the PCL prevent?

Answer 5

Posterior subluxation of tibia
Hyperextension of knee

Question 6

Patient who has difficulty descending stairs may have ruptured which ligament in the knee?

Answer 6

PCL

Question 7

Which meniscal tear is most common?

Answer 7

Medial - undergoes more stress

Question 8

True/False: Meniscal tears heal easily

Answer 8

False - limited healing potential due to poor blood supply

Question 9

Define bucket handle tear (presentation)

Answer 9

Meniscus flap gets caught in intercondylar notch
Presents as locked knee

Question 10

How is a bucket handle tear treated?

Answer 10

Arthroscopic repair/menisectomy

Question 11

True/False: Meniscal tears due to degenerative damage is pointless to operate on

Answer 11

True
Little improvement, can somtimes make it worse

Question 12

Describe a grade 1 knee ligament tear.

Answer 12

Tear of some ligament fibres but macroscopically everything is intact (sprain)

Question 13

Describe grade 2 knee ligament tear.

Answer 13

Partial tear where some fascicles are disrupted

Question 14

Describe grade 3 knee ligament tear.

Answer 14

Complete tear of the ligament

Question 15

ACL rupture repair never really works - what is done instead?

Answer 15

Reconstruction (allograft, autograft or synthetic graft)

Question 16

If a patient presents with a knee injury after a sudden twisting motion, which ligaments are susceptible to tear?

Answer 16

ACL, meniscus

Question 17

True/False: Only a full thickness cartilage injury can heal

Answer 17

True

Question 18

When hyaline cartilage heals, what type of cartilage replaces it?

Answer 18

Fibrocartilage

Question 18

Define osteoarthritis dissecans.

Answer 18

Area of the surface of the knee loses its blood supply and cartilage, sometimes causing bone to fragment off

Question 19

List some cartilage regeneration techniques.

Answer 19

Microfracture
Grafting
Mosaicplasty
MACI

Question 20

Aetiology of patella dislocation.

Answer 20

Can occur with a direct blow or sudden quadriceps contraction with a flexing knee

Question 21

True/False: The patella can dislocate medially and laterally.

Answer 21

False - the patella always dislocates laterally

Question 22

List some risk factors for patella dislocation.

Answer 22

Hypermobility
Increased Q-angle
High riding patella
Hypoplastic lat. femoral condyle
Lat. quad insertion
Weak vastus medialis

Question 23

List clinical signs and symptoms of patella dislocation.

Answer 23

Clear history - often self relocation
Medial pain
Effusion
+ve patella apprehension test

Question 24

What would you see on X-ray of a patellar dislocation?

Answer 24

Lipo-haemarthrosis occurs with characteristic x-ray appearance Small opacification may suggest osteochondral fracture

Question 25

What imaging would you use in complete knee dislocation?

Answer 25

If concern over NV status - CT angiogram No concern over NV status - MRI

Question 26

Describe immediate management for total knee dislocation.

Answer 26

Emergency reduction under sedation May need emergency fix (stabilisation) Theatre reduction if button hole Vascular stenting or bypass in NV injury

Question 27

Describe the definitive management for total knee dislocation.

Answer 27

Sequential ligamentous repair

Question 28

Aetiology of loose bodies of the knee joint?

Answer 28

Trauma, oteochondritis dissecans and joint degeneration can cause a fragment of cartilage +/- bone to detach

Question 29

Define Baker's cyst

Answer 29

Ganglion cyst found in popliteal fossa Associated with OA of knee