KNEE CONDITIONS PART 2

Flashcard #1
Term: COMPARTMENT SYNDROME
Definition:

Cross sections of the main compartment of the lower leg.
- Common on the lower leg but can happen in the upper extremity or hands.
- Tibia usually has trauma.
- Direct contact with many things (e.g., soccer ball hitting tibia).
Occurs due to increased pressure within a closed osteofascial compartment, leading to blood flow occlusion, nerve ischemia, and eventual necrosis.
Generally a clinical diagnosis; can measure intracompartmental pressure (>30 mmHg). Normal is <10, and over 10 requires observation.
Most common location: anterior compartment of the leg.
- Can also occur in the fascial compartment of the forearm, thigh, buttocks, shoulder, hand, and foot.

Flashcard #2
Term: ETIOLOGY & PATHOPHYSIOLOGY OF COMPARTMENT SYNDROME
Definition:

Increased fluid content in the compartment, such as bleeding due to trauma, burns, or muscle swelling from overexertion.
- Causes: direct trauma, fractures, crush injuries, or prolonged compression (e.g., tight dressings or casts).
More common in males than females, typically related to tibial shaft fractures.
Delayed treatment in non-traumatic cases can lead to complications.
Compartment syndrome is a surgical emergency.

Flashcard #3
Term: MOI AND PATHOPHYSIOLOGY OF COMPARTMENT SYNDROME
Definition:

Results from prolonged compression of the compartment, causing impaired vascular supply and venous outflow.
- Leads to muscle and nerve ischemia, ultimately causing tissue necrosis.
Early diagnosis is essential to restore blood flow and prevent ischemia.

Flashcard #4
Term: CLINICAL MANIFESTATIONS OF COMPARTMENT SYNDROME
Definition:

Presents as deep, unrelenting, and progressive pain that is disproportionate to the injury.
- Pain worsens with passive muscle stretching.
Usually affects one side (unilateral), with tight, shiny skin that feels "wood-like."
Physical assessments include checking for lesions, swelling, temperature, tension, tenderness, pulses, sensory, and motor functions.

Flashcard #5
Term: 6 P's OF COMPARTMENT SYNDROME
Definition:

Pain, Pallor, Paresthesia, Paralysis, Pulselessness, and Poikilothermia (inability to adjust temperature, cold to touch due to lack of blood flow).

Flashcard #6
Term: DIAGNOSTIC MODALITIES OF COMPARTMENT SYNDROME
Definition:

Acute setting:
- Radiographs for fractures, ultrasound for fluid accumulation, and manometer or slit catheter to measure intracompartmental pressure.
Diagnostic threshold for compartment syndrome is >30 mmHg; normal is <10 mmHg.

Flashcard #7
Term: TREATMENT OF COMPARTMENT SYNDROME
Definition:

Immediate surgical management is ideal within 6 hours of injury; fasciotomy not recommended after 36 hours.
Escharotomy should ideally be done within 6 hours.
If more than 36 hours, amputation may be necessary due to ischemia.
Removal of restrictive devices and prevention of hypoperfusion are critical.
Complications may include pain, contractures, rhabdomyolysis, renal failure, muscle weakness, sensory deficits, and infection.

Flashcard #8
Term: MYOSITIS OSSIFICANS
Definition:

A benign, self-limiting process where bone forms within skeletal muscle, commonly in quads, brachialis, and hip adductors.
Often follows large muscle trauma or hematomas; repetitive injury can also lead to it.
Lasts an average of 1.1 years.
Initial treatment includes stretching, range-of-motion exercises, and gentle muscle exercises.

Flashcard #9
Term: MOI AND PATHOPHYSIOLOGY OF MYOSITIS OSSIFICANS
Definition:

Occurs after muscle trauma or bone fractures.
Bone cells form between torn muscle fibers, causing a painful, tender mass with local inflammation and restricted motion.

Flashcard #10
Term: GENU VARUM (BOW-LEGGED)
Definition:

Normal in children from neonate to age 2, with outward knee and patella alignment and inward tibial alignment.
- Typically resolves with normal development.
Night bracing or osteotomy may be required if persistent beyond 15 degrees.
Causes may include Blount’s Disease, rickets, skeletal dysplasia, and trauma.
Can lead to gait abnormalities and muscle imbalances due to altered joint mechanics.

Flashcard #11
Term: BLOUNT DISEASE (TIBIA VARA)
Definition:

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

Flashcard #12
Term: MOI & PATHOPHYSIOLOGY OF TIBIA VARA
Definition:

Excessive compressive forces on the medial aspect of the medial tibial physis lead to altered endochondral bone formation and inhibition of growth on the medial side, causing a genu varus deformity.

Flashcard #13
Term: 3-DIMENSIONAL DEFORMITY OF TIBIA VARA
Definition:

Varus deformity, procurvatum, internal tibial rotation, and leg length discrepancy.

Flashcard #14
Term: TWO TYPES OF TIBIA VARA
Definition:

Infantile (Age 1-5): Commonly bilateral, worsens after starting to walk.
Adolescent: Presents later, usually unilateral, often painful, frequently found in obese children.

Flashcard #15
Term: FINDINGS SUGGESTIVE OF BLOUNT DISEASE (X-RAY)
Definition:

Medial breaking of epiphysis, widened/irregular medial physis, irregular ossification, medial slope of the epiphysis and metaphysis in varus deformity.

Flashcard #16
Term: TIBIOFEMORAL ANGLE
Definition:

Angle between the femoral and tibial shaft axes.
- Normal valgus angle: 5-7 degrees.
- 7 degrees indicates valgus; <5 degrees indicates varus.

Flashcard #17
Term: METAPHYSEAL-DIAPHYSEAL ANGLE
Definition:

Used to predict Blount Disease progression.
- 16 degrees suggests 95% chance of progression.
- <10 degrees likely physiologic; 11-16 degrees requires observation.

Flashcard #18
Term: LANGENSKIÖLD CLASSIFICATION
Definition:

Describes severity and metaphyseal collapse.
- Stage I: Irregular metaphyseal zone.
- Stage II: Medial metaphyseal beaking.
- Stage III: "Step" in metaphyseal beak.
- Stage IV: Epiphyseal beaking and pit in medial metaphysis.
- Stage V: Double epiphyseal plate.
- Stage VI: Bony bar formation.

Flashcard #19
Term: MANAGEMENT OF TIBIA VARA & GENU VARUM
Definition:

Orthotic Bracing: KAFO for children <4 years and in Langenskiöld stage 1 or 2.
Guided Growth: Via hemiepiphysiodesis with lateral growth plate pinning/plating.
Osteotomy: Last resort for leg length discrepancy correction.

Flashcard #20
Term: GENU VALGUM (KNOCK KNEES)
Definition:

Normal at ages 2-4, corrected with growth; normal adult valgus is 5-10 degrees.
Asymptomatic, may require surgery if persistent past age 10.
Etiology: Rickets, skeletal dysplasia, trauma.

Flashcard #21
Term: MOI & PATHOPHYSIOLOGY OF GENU VALGUM
Definition:

Increased weight bearing on the medial side, causing medial foot and knee pain.

Flashcard #22
Term: LIGAMENT TEARS
Definition:

Extracapsular Ligaments: Collateral ligaments.
Intracapsular Ligaments: Cruciate ligaments.
- Difficult to treat due to need for extensive surgical intervention.

Flashcard #23
Term: COLLATERAL LIGAMENT INJURIES
Definition:

MCL Sprain: Direct lateral impact causing valgus force without rotation.
LCL Sprain: Less common; caused by high-energy blow with excessive varus force to a hyperextended knee.

Flashcard #24
Term: CLINICAL PRESENTATION OF LIGAMENT INJURIES
Definition:

Acute pain, swelling, and ecchymosis; tenderness along the ligament, knee instability, positive varus/valgus stress tests.

Flashcard #25
Term: LIGAMENTOUS LAXITY GRADING
Definition:

Grade 1: 0-5 mm displacement.
Grade 2: 5-10 mm displacement.
Grade 3: >10 mm displacement, indicating a fully torn ligament.

Flashcard #26
Term: ACL TEARS
Definition:

Commonly injured ligament due to noncontact deceleration, pivoting sports, or direct lateral knee trauma.
- More common in females due to bone structure and ligament laxity.

Flashcard #27
Term: EPIDEMIOLOGY OF ACL INJURY
Definition:

Females are more prone due to anatomical and biomechanical differences, including increased Q-angle and valgus collapse.

Flashcard #28
Term: CLINICAL PRESENTATION OF ACL TEARS
Definition:

Acute pain, significant effusion, and instability.
- Audible "pop" often reported; positive Lachman and Anterior Drawer tests.

Flashcard #29
Term: POSTERIOR CRUCIATE LIGAMENT (PCL) TEARS
Definition:

Occurs with knee flexion or hyperextension injuries, commonly seen in car accidents (dashboard injury).

Flashcard #30
Term: DEGREES OF SEVERITY (ACL & PCL)
Definition:

Grade 1: Microscopic tears; ligament is still functional.
Grade 2: Partial tear with instability.
Grade 3: Complete tear with associated ligamentous injuries.

Flashcard #31
Term: GRADE 1 (DEGREE OF SEVERITY)
Definition:

Microscopic tears in the ligament, typically functional with mild tenderness and swelling.

Flashcard #32
Term: GRADE 2 (DEGREE OF SEVERITY)
Definition:

Partially torn ligament, leading to instability and increased translation during stress tests.

Flashcard #33
Term: GRADE 3 (DEGREE OF SEVERITY)
Definition:

Complete ligament rupture, often accompanied by sprain of outer cruciate/collateral ligaments.

Flashcard #34
Term: TREATMENT OF ACL
Definition:

Imaging for diagnosis: X-ray, MRI (gold standard).
Non-operative for Grade I and II injuries; operative if instability is severe or function is compromised.

Flashcard #35
Term: CHRONIC INSTABILITY (ACL)
Definition:

Can lead to early onset osteoarthritis (OA) due to articular cartilage degeneration.

Flashcard #36
Term: PCL TREATMENT
Definition:

Conservative: Posterior drawer <10 mm, stable internal rotation, minimal abnormal laxity.
Surgical Reconstruction: Necessary for chronic instability or high-grade injuries.

Flashcard #37
Term: RISKS OF ACL RECONSTRUCTION
Definition:

Permanent numbness (100%), nerve injuries (0.5%), patellofemoral pain (15%), stiffness (10%), reinjury (5-10%), infections (1%).

Flashcard #38
Term: RELATIVE CONTRAINDICATIONS TO ACL RECONSTRUCTION
Definition:

Inactive lifestyle, inability to cope with instability, advanced knee arthritis, poor compliance with rehabilitation.

Flashcard #39
Term: ADVANTAGES OF BONE-PATELLAR TENDON-BONE AUTOGRAFT
Definition:

High tensile strength, reliable fixation, rapid biological fixation, and safe return to high-demand activities.

Flashcard #40
Term: DISADVANTAGES OF BONE-PATELLAR TENDON-BONE AUTOGRAFT
Definition:

Anterior knee pain, discomfort while kneeling, quadriceps weakness, and rare patellar fractures.

Flashcard #41
Term: ADVANTAGES OF SEMITENDINOSUS GRACILIS AUTOGRAFT
Definition:

High tensile strength, no disturbance of the growth plate in young patients, regeneration of hamstring tendon, knee flexor strength recovered within 2 years post-op.

Flashcard #42
Term: DISADVANTAGES OF SEMITENDINOSUS GRACILIS AUTOGRAFT
Definition:

Tendon-to-bone fixation is less reliable than bone-to-bone, longer healing time (12 weeks), potential hamstring strain, and short- and long-term knee flexor weakness.

Flashcard #43
Term: GENERAL TREATMENT (ACL)
Definition:

Immobilization for 6 weeks, restricted weight bearing due to poor healing of ligament tissue; complications include post-immobilization contractures and muscle weakness.

Flashcard #44
Term: EXERCISE PRECAUTIONS AFTER ACL RECONSTRUCTION
Definition:

Avoid high stress on graft:
- Closed-chain training: avoid knee past toes in squats.
- Open-chain training: avoid resistance on distal tibia; keep knee extension exercises limited to 45°-30°.

Flashcard #45
Term: KNEE DISLOCATION
Definition:

Results from multiple ligament injuries (ACL, PCL, MCL/LCL), often due to high-energy trauma or sports.
Anterior dislocation is most common; posterior dislocation is dangerous due to popliteal artery risk.

Flashcard #46
Term: MENISCAL TEAR
Definition:

Common knee injury caused by rotational forces, often involving adjacent structures (e.g., ACL, MCL).
- More common in adolescent males and in the medial meniscus.

Flashcard #47
Term: CLINICAL MANIFESTATIONS OF MENISCAL TEAR
Definition:

Symptoms include swelling, pain at joint line, limited motion, difficulty weight-bearing, and knee locking.
- Positive McMurray and Apley's Compression tests.

Flashcard #48
Term: MENISCAL TEAR TREATMENT
Definition:

Partial Meniscectomy: Torn meniscus removed using small incisions and vacuum.
- Indicated for displaced tears in inactive older adults or avascular inner meniscus tears.
Meniscal Repair: Sutures used if tear is in vascular outer third, often in active patients under 40.

Flashcard #49
Term: DISCOID MENISCUS
Definition:

A rare congenital condition where the lateral meniscus remains round, causing instability in the lateral knee compartment.