KNEE CONDITIONS PART 2

COMPARTMENT SYNDROME

Occurs due to increased pressure within a closed osteofascial compartment, leading to blood flow occlusion, nerve ischemia, and eventual necrosis.

ETIOLOGY OF COMPARTMENT SYNDROME

Increased fluid content in the compartment due to bleeding from trauma, burns, or muscle swelling.

MOI OF COMPARTMENT SYNDROME

Results from prolonged compression, impairing vascular supply and venous outflow.

CLINICAL MANIFESTATIONS OF COMPARTMENT SYNDROME

Deep, progressive pain disproportionate to injury; tight, shiny skin with one side affected.

6 P's OF COMPARTMENT SYNDROME

Pain, Pallor, Paresthesia, Paralysis, Pulselessness, Poikilothermia.

DIAGNOSTIC MODALITIES OF COMPARTMENT SYNDROME

Radiographs, ultrasound for fluid, and manometer for intracompartmental pressure measurement.

TREATMENT OF COMPARTMENT SYNDROME

Immediate surgical management; fasciotomy within 6 hours is ideal.

MYOSITIS OSSIFICANS

Bone forms within skeletal muscle following large muscle trauma; often self-limiting.

MOI OF MYOSITIS OSSIFICANS

Occurs after muscle trauma or fractures, causes a painful mass.

GENU VARUM

Normal in children; outward knee and patella alignment; resolves with growth.

BLOUNT DISEASE (TIBIA VARA)

Acquired genu varus deformity due to disrupted cartilage growth at the proximal medial tibia.

MOI OF TIBIA VARA

Compressive forces on the medial tibial physis lead to altered bone formation.

3-DIMENSIONAL DEFORMITY OF TIBIA VARA

Includes varus deformity, procurvatum, internal tibial rotation, and leg length discrepancy.

TWO TYPES OF TIBIA VARA

Infantile (1-5 years, bilateral) and Adolescent (unilateral, often painful).

FINDINGS SUGGESTIVE OF BLOUNT DISEASE (X-RAY)

Medial epiphyseal breaking, widened medial physis, irregular ossification.

TIBIOFEMORAL ANGLE

Angle between femoral and tibial shafts; normal is 5-7 degrees.

METAPHYSEAL-DIAPHYSEAL ANGLE

Predicts Blount Disease progression; >16 degrees suggests high chance.

LANGENSKIÖLD CLASSIFICATION

Describes severity and metaphyseal collapse stages, from irregularity to bony bar formation.

MANAGEMENT OF TIBIA VARA

Includes orthotic bracing, guided growth, and osteotomy as last resort.

GENU VALGUM

Normal at ages 2-4; may require surgery if persistence past age 10.

MOI OF GENU VALGUM

Increased weight bearing on medial side causes pain.

LIGAMENT TEARS

Injuries to either extracapsular (collateral) or intracapsular (cruciate) ligaments.

COLLATERAL LIGAMENT INJURIES

MCL sprain from lateral impact; LCL sprain from high-energy varus forces.

CLINICAL PRESENTATION OF LIGAMENT INJURIES

Acute pain, swelling, tenderness, knee instability, positive stress tests.

LIGAMENTOUS LAXITY GRADING

Grade 1: 0-5 mm, Grade 2: 5-10 mm, Grade 3: >10 mm displacement.

ACL TEARS

Common injury from noncontact deceleration or direct lateral trauma.

EPIDEMIOLOGY OF ACL INJURY

Higher incidence in females due to anatomical differences.

CLINICAL PRESENTATION OF ACL TEARS

Acute pain, significant effusion, instability, audible pop, positive tests.

PCL TEARS

Typical in knee flexion injuries; often seen in accidents.

DEGREES OF SEVERITY (ACL & PCL)

Grade 1: Microscopic tears; Grade 2: Partial tears; Grade 3: Complete rupture.

GRADE 1 (DEGREE OF SEVERITY)

Microscopic tears; functional with mild swelling.

GRADE 2 (DEGREE OF SEVERITY)

Partial tears causing instability and increased translation.

GRADE 3 (DEGREE OF SEVERITY)

Complete ligament rupture with potential other ligament involvement.

TREATMENT OF ACL

X-ray and MRI for diagnosis; non-operative for Grade I and II injuries.

CHRONIC INSTABILITY (ACL)

Risk of early-onset osteoarthritis due to cartilage degeneration.

PCL TREATMENT

Conservative for stable injuries; surgery for chronic instability.

RISKS OF ACL RECONSTRUCTION

Includes permanent numbness, nerve injuries, and reinjury.

RELATIVE CONTRAINDICATIONS TO ACL RECONSTRUCTION

Inactive lifestyle, significant arthritis, poor rehabilitation compliance.

ADVANTAGES OF BONE-PATELLAR TENDON-BONE AUTOGRAFT

Strength, reliable fixation, rapid recovery for high-demand activities.

DISADVANTAGES OF BONE-PATELLAR TENDON-BONE AUTOGRAFT

Anterior knee pain and discomfort kneeling post-surgery.

ADVANTAGES OF SEMITENDINOSUS GRACILIS AUTOGRAFT

Regeneration potential, no growth plate disturbance, good strength recovery.

DISADVANTAGES OF SEMITENDINOSUS GRACILIS AUTOGRAFT

Longer healing time, potential for hamstring strain.

GENERAL TREATMENT (ACL)

Immobilization for 6 weeks with weight bearing restrictions.

EXERCISE PRECAUTIONS AFTER ACL RECONSTRUCTION

Avoid high stress and certain movements during recovery.

KNEE DISLOCATION

Multiple ligament injuries from high-energy trauma; anterior is most common.

MENISCAL TEAR

Knee injury from rotational forces; often involves adjacent structures.

CLINICAL MANIFESTATIONS OF MENISCAL TEAR

Swelling, joint line pain, locking, limited motion.

MENISCAL TEAR TREATMENT

Partial meniscectomy or meniscal repair based on tear type.

DISCOID MENISCUS

Congenital condition where lateral meniscus remains round, causing instability.