Knee Flashcards Preview

Phase II: Musculoskeletal > Knee > Flashcards

Flashcards in Knee Deck (37):
1

What radiographic changes are seen with osteoarthritis?

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

2

Where is knee OA most commonly seen?

Posterior patella
Medial compartment ➔ varus deformity

3

List the signs of osteoarthritis of the knee

Joint swelling
Wasting of quadriceps and/or calfs
Deformity: most commonly varus deformity
Fixed flexion of knee: posterior patellar involvement
Joint line tenderness

4

Name 3 causes of secondary osteoarthritis

Post-traumatic: fracture, meniscus tear, ligament tear
Post-operative
Malposition
Mechanical instability
Osteochondritis dissecans

5

Name 5 predisposing factors for osteoarthritis

Increased BMI
Genetics
Increasing age
Occupation
Trauma
Inflammatory arthritis
Hyperparathyroidism
Haemochromatosis
Wilson's disease
Acromegaly

6

Outline the management options for knee osteoarthritis

Lifestyle: weight loss, knee support
Physiotherapy

NSAIDs
Steroid injection

Arthroscopy
Osteotomy
Knee replacement: total or unicondylar
-plus 6-8 weeks post-op rehab

7

What clinical features support surgical intervention for osteoarthritis?

Night pain
Increasing impact on QoL
Increasing deformity

8

What is the benefit of knee replacement?

Improves knee pain*
Returns some function: usually limited to 90 degrees of flexion

9

What is the average lifespan of a total knee replacement?

10-15 years
Younger patients tend to wear it out faster ➔ recommended for unicondylar replacement if only one compartment affected

10

Describe the Outerbridge classification of cartilage damage

0. normal cartilage
I. soft cartilage with swelling
II. partial-thickness defect with fissures that do not reach subchondral bone
III. fissuring to level of subchondral bone
IV. exposed subchondral bone

11

Name 3 causes of anterior knee pain +/- swelling

Patellofemoral pain syndrome
Recurrent patella subluxation
Patella tendinopathy
Iliotibial tract syndrome
Medial shelf syndrome
Hoffa's fat pad syndrome
Osgood-Schlatter disease

12

Define patellofemoral pain syndrome

Pain and crepitus around the patella. Often aggravated by climbing stairs and running.

13

How is patellofemoral pain syndrome treated?

NSAIDs and paracetamol
Physiotherapy: quadriceps strengthening*
-80% success rate

Injection, PFJ replacement or TFR

14

How should an acute traumatic knee be managed?

History
X-ray to rule out fracture/dislocation
Splint and repeat exam at 3 weeks
MRI

Physiotherapy
Knee arthroscopy/reconstruction

15

What are the symptoms of bone bruise?

Pain or tenderness
Swelling
Change in skin colour
Joint inflammation
Joint stiffness

16

Describe the types of bone bruise

Subperiosteal: after traumatic injury
Interosseous: repeated pressure
Subchondral: compression or rotation

17

Name 2 risk factors for bone bruising

High-impact sport
Physically demanding job
Not wearing protective equipment during sport/job
Osteoarthritis

18

What is the prognosis of bone bruising?

Tends to self-resolve within months, unlikely to progress

19

Name 3 complications of total knee replacement

Infection
Bleeding
Pain/tenderness around scar
DVT/PE

20

List the signs seen with injury to a collateral ligament

Effusion +/- tenderness over affected ligaments
Associated common perineal nerve injury

21

Describe the management of injury to a collateral ligament

Rest + firm support
Surgery
-rarely needed for isolated MCL
-required for LCL if joint instability present

22

What is the typically cause of an ACL tear?

Twisting injury to the knee with foot planted on ground

23

Describe the clinical features of an ACL tear

Sudden onset of swelling: haemarthrosis
Unable to continue at time of tear
Knee giving way, instability esp when twisting

Swelling or popping suggests 70% likelihood of ACL tear

24

Name 3 tests used to assess an ACL tear

Lachman test*: flexion at 30 degrees
Anterior draw test: flexion at 90 degrees
Pivot shift test: done under anaesthetic

25

What treatment options exist for ACL tear?

3 weeks rest
Physiotherapy
ACL reconstruction: young or knee instability

26

How are ACL injuries classified?

Grade I: fibres stretched, but no tear. Little tenderness and swelling. Joint does not feel unstable or give out.

Grade II: fibres partially torn. Little tenderness and moderate swelling. Joint may feel unstable or give out.

Grade III: ACL ruptured. Tenderness. Ligament cannot control knee movements.

27

What is the commonest cause of meniscal tears?

Medial: Twisting or hyperflexion injury
Lateral: Adduction + internal rotation

28

Describe the clinical features of meniscal tears

Knee locking: fragments lodge between femur and tibia
Tender joint line
Unable to continue
Delayed swelling of knee

29

What investigation is ideal for meniscal tears?

MRI: tear location, morphology, length, depth, stability

30

What management options are available for meniscal tears?

Conservative
Arthroscopic repair/excision: locked knee, cysts, or persistent symptoms

31

Name 3 types of bursitis affecting the knee

Pre-patellar bursitis: housemaid's knee
Infra-patellar bursitis: clergyman's knee
Semi-membraneous bursitis: popliteal cyst

32

Define osteochondritis dissecans of the knee

Defect in subchondral region with partial or complete separation of the bone fragment.

Caused by repetitive overloading.

33

Describe the clinical features of osteochondritis dissecans

Poorly localised pain, exacerbated by exercise
Intermittent effusion
Occasional locking
Crepitation
Tender affected femoral condyle

34

What is the treatment of osteochondritis dissecans?

Conservative if stable lesion
Arthroscopic stabilisation excision

35

Which patient group is most commonly affected by osteochondritis dissecans?

Males (2:1) aged 13-21

36

Define Osgood-Schlatter disease

A common self-limiting cause of pain below the knee in adolescents. Caused by inflammation where the patellar tendon inserts into the tibia.

Pain on active extension of the knee against resistance.

37

Describe one congenital knee problem

Discoid lateral meniscus (incomplete or complete).

Excess covering of tibia leads to the knee being more prone to mechanical symptoms (locking, catching, giving way) and tears.

Treatment: knee arthroscopy