Knee Problems

Question 1

5 acute knee injuries

Answer 1

• Fracture
• Acute on chronic degenerative joint disease
• Meniscal injury
• Ligament injury
• Tendon injury

Question 2

Hx for an acute knee injury

Answer 2

• Where did it happen (sport/recreation or work place)
• Activity (sports tackle, jumping)
• Energy (how fast + how heavy)
• Systemic symptoms
• Chronology (quick/slow onset, previous injury or event)
• Hear/feel pop/crack
• Swelling (early/late)

Question 3

Early swelling after an acute knee injury suggests what

Answer 3

Haemarthrosis

Question 4

Presentation of a meniscal injury

Answer 4

• Twisting movement on a loaded fixed knee
• Painful “squelch”
• Slow swelling (quicker in young)
• Painful to weight bear
• “Locked” knee

Question 5

Presentation of ACL tear

Answer 5

• Forward momentum, leg fixed +/- rotation
• “Pop”
• Quick swelling
• Often able to bear weight

Question 6

Collateral tears

Answer 6

• Lateralised pain
• Feel of “crack”, sharp pain
• No or minimal effusion
• Bruising to 1 side

Question 7

How to examine an acute knee injury

Answer 7

Look, feel, move

Look for:

• Scars, bruising, swelling
• Joint irregularity

Feel for:

• Effusion
• Crepitus
• Heat or tenderness
• Tissue lumps or defects

Move

• Passive + active
• Straight leg raise
• ROM
• Ligament testing
• Dynamic testing

Question 8

Investigations for acute knee injuries

Answer 8

• X-rays
• US
• MRI

Question 9

What 6 things can be seen on x-rays of acute knee injuries

Answer 9

• Fracture
• Loose bodies
• Ligament avulsion
• Lipohaemarthrosis
• Osteochondral defect
• Degenerative joint disease

Question 10

What 4 things can be seen on US of acute knee injuries

Answer 10

• Tendon rupture
• Some meniscal tears
• Swelling
• Cysts

Question 11

Indications for surgical Rx of acute knee problems

Answer 11

• Failure of conservative Rx
• Work/sport demands
• Problems with daily activities
• Prevention of falls or further joint injury

Question 12

Non-surgical Rx of acute knee injuries

Answer 12

• Physiotherapy
• Analgesia
• Swelling reduction

Question 13

Aims of non-surgical Rx of acute knee injuries

Answer 13

-Restoration of function, ROM swelling reduction

Question 14

Rx for meniscal tears

Answer 14

• Meniscal repair
• Partial meniscectomy
• Meniscal transplantation

Question 15

What decides whether meniscal repair will be open or arthroscopic

Answer 15

• How deep they are i.e. how accessible

- >3/4mm deep seems to be where open becomes arthroscopic

Question 16

Who gets meniscal tears

Answer 16

• Young
• Sporty
• Fresh tears (up to 3 months)
• Healthy meniscus
• Red or red/white

Question 17

4 meniscal repair techniques

Answer 17

• Open technique
• Outside - in
• Inside - out
• All inside (?arthroscopic?)

Question 18

Rx for ACL tear

Answer 18

• Full ACL rehabilitation

- ACL reconstruction

Question 19

Rx for Osteochondral injuries

Answer 19

• Debridement
• Reattachment of fragment
• Removal of loose bodies
• Microfracture chondroplasty