Ucsf: Video E 48 Part 8 Msk Skeletal Trauma (Learning Radiology Knee)

Front 1

Can plain film be normal even when there is extensinve soft tissue injury to the knee

Back 1

yes

Front 2

What is the imaging modaility of choice for occult bone injuries and soft tissue injuries of the knee

Back 2

MRI

Front 3

What are 3 clues on MR that there is pathology involving a ligament

Back 3

non-visualization, disruption, increased signal.

Front 4

What are 6 possible views of the knee

Back 4

AP
Lat
Inter and external oblique
tunnel (AKA knotch)
Axial ( AKA; skyline, tangential, sunrise, merchant view)

Front 5

AP anatomy of the knee

Back 5

Front 6

Lateral anatomy of the knee

Back 6

Front 7

What is are two important landmarks that lay underneath the quadraceps femoris tendon

Back 7

suprapatellar fat body
suprapatellar bursa (underneath the fat pad)

Front 8

What does the quadriceps femoris tendon attach to

Back 8

the patella

Front 9

What is the ligment that inferiorly attaches to the patella

Back 9

the patellar ligament

Front 10

What fat pad is underneath the patellar ligament

Back 10

the infrapatellar fat pad.

Front 11

What is another name for the infrapatellar fat pad

Back 11

hoffas fat pad

Front 12

What does the patellar ligament insert on

Back 12

the tibial tuberosity

Front 13

What does the ACL arise from

Back 13

lateral femoral condyle (top)

Front 14

What does the ACL insert into

Back 14

anterior to the medial tibial spine

Front 15

Where does the PCL arise from

Back 15

the medial femoral condyle (top)

Front 16

Where does the PCL insert

Back 16

posterior to the lateral tibial spine

Front 17

Where does anterior an posterior part of the the name of ACL and PCL come from

Back 17

there location on the tibia

Front 18

What is another name for the medial collateral ligament

Back 18

tibial collateral ligament

Front 19

Where does the MCL arise from and insert

Back 19

the medial femoral condyle and inserts into the medial condyle of the tibia

Front 20

Are the deep fibers of the MCL bound to the articular capsule of the knee

Back 20

yes, (this is my MCL injuries are almost always associated with medial meniscus injuries)

Front 21

What is another name for the LCL

Back 21

the fibular collateral ligament

Note the the Lateral collateral ligament is part of the lateral capsular complex which is the LCL, iliotibial band and bicep femoris

Front 22

Where does the lateral collateral ligament insert and attach

Back 22

attach: lateral femoral condyle
insert: head of the fibula

Front 23

What are 2 ST clues to injury of the knee

Back 23

joint effusions
lipohemarthrosis

Front 24

Where do joint effusions of the knee occur

Back 24

above the patellar and posterior to the quadricepts tendon

Front 25

What happens when the suprapatellar effusion becomes large enough

Back 25

they will tilt the superior portion of the patella forward.

Front 26

What happens to the clear space above the patellar when there is a joint effusion

Back 26

the clear space (fat) becomes obliterated and is replaced with a soft tissue density area that fills it and bulges the adjacent ST outward

Front 27

What else besides an effusion will cause the patella to tilt forward

Back 27

rupture of the quadriceps femoris tendon

Front 28

What is the difference in appearance of a ruptured quadriceps tendon and effusion

Back 28

the fat pad will not be obliterated in a rupture of the tendon

Front 29

What is the cause of a lipohemarthrosis

Back 29

fat exiting the marrow cavity 2/2 a fx

Front 30

What is the most common cause of a lipohemarthrosis of the knee

Back 30

a tibial plateau fx

Front 31

Does fat float on the blood

Back 31

yes

Front 32

What is a important technical aspect of X-ray postioning to see a lipohemarthrosis

Back 32

requires a horizontal beam

Front 33

What does a fat fluid level look like

Back 33

there is soft tissue density with the more lucent fat density on top

Front 34

Can there be a triple level lipohemarthrosis

Back 34

yes from cells layering out

Front 35

What are the 3 categories of distal femur fx

Back 35

supracondylar, condylar, intercondylar

Front 36

What is the MCC of a distal femoral fx

Back 36

axial loads (MVA, falls)

Front 37

What are common associated injuries of distal femur fx

Back 37

ligament injuries, vascular, tibial plateau fx

Front 38

What is the MC ligament injured from a distal femur fx

Back 38

ACL

Front 39

Are dislocations of the knee common

Back 39

no

Front 40

How are tibiofemoral dislocations of the knee described

Back 40

by the resting place of the tibia

Front 41

What are two dislocations of the knee

Back 41

tibiofemoral/patellar femoral

Front 42

Which way is the patellar usually dislocated

Back 42

laterally

Front 43

Why is the patellar more commonly displaced lateral

Back 43

the lateral femoral condyle is more shallow

Front 44

What is more common a subluxation of the the knee or dislocaiton

Back 44

subluxation

Front 45

What is more common an anterior or posterior dislocation of the tibia

Back 45

anterior

Front 46

What are two diseases of the patella

Back 46

osgood schlatter and sinding-larsen-johannson disease

Front 47

What are some similarities between these diseases

Back 47

adolescents
repetitive trauma

Front 48

Where does Sinding-Larsen-Johansson disease occur

Back 48

proximal end of patellar tendon

Front 49

Where does OS disease occur

Back 49

the distal end of the patella tendodn ( tibial tuberosity)

Front 50

Are OS and SLJ diseases clinical diagnoses

Back 50

yes (local pain and tenderness)

Front 51

Is imaging needed to diagnose OS and SLJ diseases

Back 51

no

Front 52

What is the cause fo SLJ disease

Back 52

traction stress on the proximal end of the patellar ligament (inferior pole of the patella)

Front 53

What are the imaging findings of SLJ disease

Back 53

fragmentation, osteophytes and STS on inferior pole of the patellla

heterotopic calcification of the patella tendon

Front 54

What is Osgood-schlatter disease

Back 54

a traction apophysitis (osteochondritis) 2/2 repetitive stress injury at the site of the tibial tuberosity

Front 55

What percent of OS is bilateral

Back 55

25-50 %

Front 56

What are the imaging findings of OS disease

Back 56

fragmentation, STS

Front 57

If there are radiographic findings consistent with either SLJ and OS disease is it diagnostic

Back 57

no, if the pt doesnt have the symptoms

Front 58

What is the unhappy triad of athletes

Back 58

ACL
MCL
Medial meniscus

Front 59

Where is the seperate ossification center of a bipartite patella located

Back 59

superolateral pole

Front 60

What % of bipartite patellas are bilateral

Back 60

50%

Front 61

Describe the margins of a bipartite patella

Back 61

smooth and corticated

Front 62

What does a patella fx that occurs as a result of a direct blow generally look like

Back 62

comminuted with articular cartilage damage

Front 63

What does a patellar fx as a result of an indirect fx look like

Back 63

articular cartilage is spared and these are avulsion injuries

Front 64

What is the main cause of an indirect patellar fx

Back 64

avusion 2/2 jumping

Front 65

Are most patellar fx transverse or vertical

Back 65

transverse

Front 66

What additional finding do you expect to see in a pt with a patella fx

Back 66

an effusion

Front 67

What happens to the fragments of the patella following a complete transverse fx

Back 67

they become distracted

Front 68

What is the most common fx of the proximal tibia

Back 68

tibial plateau fxs

Front 69

What is more common the lateral or medial plateau

Back 69

lateral

Front 70

What is the MC mechanism of a tibial plateau fx

Back 70

a compressive force of the femoral condyles (fall from height) or can be from a car bumper

Front 71

What is the general rule of thumb with fractures of the tibial plateau and ligaments

Back 71

there is commonly injury to the opposite ligament

Front 72

What causes a depressed fx of the tibial plataue

Back 72

depressed fx are caused by downward force by the condyle of the femur

Front 73

What are 3 types of osteochondral injuries

Back 73

osteochondral fractures
osteochondral dissecans
spontaneous osteonecrosis

Front 74

Are osteochondral injuries usually acute and sports related

Back 74

yes

Front 75

What osteochondral areas are most often involved in osteochondral injuries

Back 75

the femoral condyles, tibial plateaus, patella

Front 76

What often occurs following an osteochondral fx

Back 76

a loose body fragment

Front 77

What is an osteochondral fx often confused with

Back 77

osteochondritis dissecans

Front 78

What is the clinical SS of an osteochondral fx

Back 78

sudden onset of severe pain

Front 79

What is the demographic of a pt with osteochondritis dissecans

Back 79

adolescent and young adult males

Front 80

Is osteochondritis dissecans a chronic condition

Back 80

yes

Front 81

Does osteochondritis dissecans always affect bone and cartilage

Back 81

no, it can be both or just cartilage

Front 82

Where is the classic location for osteochondritis dissecans

Back 82

lateral aspect of the medial condyle

Front 83

What is the MC cause of a loose body

Back 83

osteochondritis dissecans

Front 84

If there is an unstable fragment does it almost always require surgery

Back 84

yes

Front 85

Where is the lateral aspect of the medial femoral condyle

Back 85

centrally located

Front 86

What is SONK stand for

Back 86

spontaneous osteonecrosis

Front 87

What is the typical onset for SONK

Back 87

older adult with acute onset of pain

Front 88

Does osteochondritis dissecans occur on the weight bearing surface of the medial condyle

Back 88

no

Front 89

Does SONK occur on the weight bearing surface of the medial femoral condyle

Back 89

yes

Front 90

What type of fracture is SONK

Back 90

insufficiency fx (makes sense it happens in older people)

Front 91

Is SONK acute in onset

Back 91

yes

Front 92

What are bony clues to a ST injury of the knee

Back 92

avulsion of intercondylar eminence, segond fx, avulsion of the proximal posterior tibia

Front 93

What is avulsion of the intercondylar eminence associated with

Back 93

tear of the ACL

Front 94

What is a clue that there is a MCL ligament tear

Back 94

widening of the medial portion of the knee joint space

Front 95

What is a segund fx

Back 95

an avulsion fx of the lateral boder of the proximal tibia

Front 96

What are segond fx associated with

Back 96

ACL tears (100%)
medial mensiscus (75%)

Front 97

What is an avulsion fx of the posterior portion of the proximal tibia

Back 97

PCL tear