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42 Cards in this Set
- Front
- Back
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what are the 4 etiologies of meniscus tears?
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twisting injury
femur of tibia trauma degenerative standing up from a chair or walking (elderly) |
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what percentage of meniscal tears will heal as bone heals?
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50%
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T/F
In elderly, meniscus tear is more important than how much joint cartilage is present. |
FALSE
Meniscus tear is WAAAY less important than how much joint cartilage is left |
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how do you tx a young pt with a meniscal tear? elderly pts?
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young: surgery or debridement
elderly: pain meds (cortisome), debridement. |
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what are the four types of meniscus tears?
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radial, oblique, longitudinal, and degenerative fraying
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what type of meniscus tear must have the edges removed? why?
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radial--> it doesn't heal and keeps tearing. it can cause degenerative arthritis w/o removal
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what type of meniscus tear must be removed completely? why?
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oblique otherwise tear can flip into and out of joint will make pt think they don’t have a tear anymore when it flips out--> no symptoms
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what type of meniscus tear is sutured to repair?
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longitudinal
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what type of meniscus tear undergoes debridement to repair?
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degenerative
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what are the four meniscal tear symptoms?
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locking
catching popping pain on medial/lateral side (particular w/ twisting or squatting) |
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how do you diagnose meniscus tears? what imaging study is the best for meniscal tears?
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History
PE: tenderness over medial/lateral joint line Decreased ROM d/t pain or effusion MRI |
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which ligament can be confused for a tear?
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tranverse meniscal ligament
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what will an MRI miss in the diagnosis of knee injuries?
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cartilage lesions
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what is the gold standard for cartilage tears?
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arthroscopy
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which meniscus does not need surgery because it will heal on its own?
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lateral meniscus
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what causes a medial collateral ligament tear?
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valgus (abduction) stress (full extension and 30 degrees flexion)
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how does a MCL tear present w/?
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medial joint pain
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what is the unhappy triad?
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medial collateral ligament, medial meniscus, anterior cruciate ligament (ACL)
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what 4 ligaments provide primary stabilization of the knee? what do they stabilize against?
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-Medial and lateral collateral ligaments outside joint and stabilize knee against varus/valgus stress.
-ACL + PCL inside join stabilize knee against anterior/posterior stress |
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what are the 3 grades of MCL tears? what does each grade mean?
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Grade 1: valgus stress 5mm --> no surgery necessary (use hinged knee brace)
Grade 2: valgus stress 10mm--> no surgery Grade 3: valgus stress >14 mm --> brace if isolated injury, if not surgery is needed. |
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what two knee injuries are graded in the same manner?
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MCL, LCL/PLC
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what type of rotational instability would you be looking for in a suspected PLC injury? when does it suggest a tear?
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at 30 degrees and 90 degress.
>10 degrees suggest a tear |
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how do you tx the grades in a LCL/PCL tear?
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1) Brace
2) limit weight baring for 3 weeks + brace 3) surgery indicated |
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how do you get an ACL tear?
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form a valgus stress on the knee as well as from rotational or hyperextension force applied to the knee. COmmonly non-contact injury.
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what ligament is the primary stabilzer of the knee?
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ACL
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50% of ACL injuries occur w/ what other kind of injury?
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meniscal injury
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what do pts present with when they have an ACL tear?
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instability +pain to the degree of inhibiting further athletic activities
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How does the instability in ACL differ from the instability in PCL?
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ACL has less instability but more pain
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what is the segond sign?
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small avulsions of lateral tibial condyle just below joint line (avulsion off tibial plateau). associated with ACL tear.
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what will happen if you don't fix the ACL early?
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premature athritis
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how do you tx ACL tear for athletes/ weeknend warrior and elderly?
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atheletes: surgery
elder: brace |
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what is the lachman test? what ligament is this test sensitive for?
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hold femur and translate tibia. Sensitive for ACL.
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which test missed 50% of ACL tears?
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anterior drawer test
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what is a false positive in the anterior drawer test?
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pt contracts hamstring b/c test is uncomfortable.
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what is the best test to do in the OR to test for ACL? why is it down in the OR?
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pivot sift because it is painful and its best done under anesthesia.
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what is the empty notch sign?
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obliteration of ACL fibers on MRI. ACL gone, can see PCL fibers that should be touching the ACL.
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90% of the surgeries for ACL are done _______
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arthroscopically
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what is the MC source of autograft tissue for ACL repair?
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hamstring
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which tendon shows better results when used to surgically correct a torn ACL? what is the problem with the other tendon?
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hamstring: greater stability and function.
other tendon: patellar--> problems are fractures, anterior knee pain for >1 year, arthritis, harder to rehab, osteoarthritis 5 years after surgery. |
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why do you have to wait before returning to sports after fixing a ACL tear?
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because the ligament once placed into knee becomes liquefied early on in the healing process.
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what is the post-op protocol for a torn ACL?
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non weight bearing 3-5 days
no brace ROM start on day 1 gradually begin strengthening |
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when can you return to sports after an ACL tear?
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4-6 months
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