Topic 10 knee disorders.pdf

University of Jordan Orthopaedics The Knee Dr. Bashar Al Qaroot BSc (Hons), MSc by research, PhD Dr. Bashar Al Qaroot Slide 1 University of...

University of Jordan Orthopaedics The Knee Dr. Bashar Al Qaroot BSc (Hons), MSc by research, PhD Dr. Bashar Al Qaroot Slide 1 University of Jordan Learning outcomes Learn how to clinically assess knee joint Understand genu varum/valgum conditions Differentiate different types of menisci lesions Explicitly identify the OA and RA presentation at the knee joint and its effect on patient’s life Get an insight into the way by which knee disease are orthotically treated Dr. Bashar Al Qaroot Slide 2 University of Jordan The knee Clinical assessment/History Pain is very common at the knee joint Frankly, the term “anterior knee pain” has become a diagnostic term by itself Pain is diffused with inflammatory or degenerative diseases Pain is localised with mechanical injuries The mechanism of injury is always very helpful for proper diagnose Dr. Bashar Al Qaroot Slide 3 University of Jordan The knee Clinical assessment/signs with pt upright Look from front and then back (knees=valgus) Valgus and varus deformities (Knock- knees and bow-legs) Unilateral deformities are more significant RA = valgus and OA = varus Unilateral involvement indicate a pathology (Paget's disease) Dr. Bashar Al Qaroot Slide 4 University of Jordan The knee Clinical assessment/signs with pt supine Notice valgus or varus deformities Notice flexion or extension contracture Notice quadriceps wasting Look for lumps Test for ligaments’ stability  McMurray’s test  Lanchman’s test/Posterior drawer test  Valgus/varus stress Dr. Bashar Al Qaroot Slide 5 University of Jordan The knee Dr. Bashar Al Qaroot Slide 6 University of Jordan The knee Clinical assessment/Examination Look at the skin for scars Look for the resting position Look at the shape and compare to the other limb Feel any abnormalities Move full ROM Dr. Bashar Al Qaroot Slide 7 University of Jordan The knee Bow legs and knock knees By the end of the growth 5-7° valgus Below or above this range it is called deformity Unilateral, recent or progressive Tested: weight bearing standing In genu-valgum the distance between the medial malleolus > 8cm In genu varum, the distance between the knees >6cm Dr. Bashar Al Qaroot Slide 8 University of Jordan The knee Bow legs and knock knees In children, they are normal variations and usually self-correcting by the age of 10 years-old Routine check up every 6months If persist after 10 years, surgical intervention is needed !Bone dysplasia (blount’s disease) and rickets! Dr. Bashar Al Qaroot Slide 9 University of Jordan The knee Bow legs and knock knees/Blount’s disease Progressive bow legs once a child walks Abnormal growth of the posteriomedial part of the tibia Dr. Bashar Al Qaroot Slide 10 University of Jordan The knee Bow legs and knock knees In adults, usually secondary to other conditions (e.g. RA, OA) Small degrees are well tolerated Large degrees are put in an orthoses or admitted to surgical intervention Dr. Bashar Al Qaroot Slide 11 University of Jordan The knee Meniscal tears Menisci are important for their role in: 1. Stability of the knee 2. Controlling the gliding and rolling 3. Distributing load during movement Common in young adults (footballers) Flexion and twisting is the common mechanism of injury (menisci/condyles/stress) Dr. Bashar Al Qaroot Slide 12 University of Jordan The knee Meniscal tears Medial menisci is more affected Apart from the outer third, menisci are avascular and self repair is not possible May develop secondary OA The condition leads to extremely sever pain (!locked knee in flexion!) Locking (inability to fully extend the knee) is an indication of meniscal tear Dr. Bashar Al Qaroot Slide 13 University of Jordan The knee Meniscal tears Dr. Bashar Al Qaroot Slide 14 University of Jordan The knee Osteochondritis dissecans (OCD or OD) A separated small avascular fragment of the femoral condyles and overlaying cartridge The fragment is loose in the joint Trauma is the most likely cause (patella/tibial ridge vs femoral condyle) 80% of the times the fragment is from the lateral aspect of the medial condyle Dr. Bashar Al Qaroot Slide 15 University of Jordan The knee Osteochondritis dissecans (OCD or OD) Usually affect young (15-20) Patients suffer pain, swelling, quadriceps is wasted, knee lock and giving way Local tenderness at one condyle Positive Wilson’s sign  (90° flexion with IR then ER) Dr. Bashar Al Qaroot Slide 16 University of Jordan The knee Osteochondritis dissecans (OCD or OD) Treatment is based on the severity  Stable lesion requires bracing for reducing activity for 6-12 months  Unstable lesion requires surgical intervention and then bracing for 6 week and weight-bearing is avoided thereafter until healing Dr. Bashar Al Qaroot Slide 17 University of Jordan The knee TB Usually children Fever, swollen, wasted thigh muscles and painful Resting the knee in a brace for 3-6 months until infection fade away Dr. Bashar Al Qaroot Slide 18 University of Jordan The knee RA It may start at the knees before spreading to other body joints During stage 1: pain, wasting, swelling, effusion and thickened synovium During stage 2: joint instability, marked muscles wasting, restricted movement During stage 3: develop deformity (either no movement or unstable joint) Dr. Bashar Al Qaroot Slide 19 University of Jordan The knee RA Bracing! Usually, in sever cases, no treatment would be helpful for the patient except joint replacement! Dr. Bashar Al Qaroot Slide 20 University of Jordan The knee OA Common site Usually secondary to other condition (e.g. trauma to the joint) Knee OA is associated with heberden’s nodes Dr. Bashar Al Qaroot Slide 21 University of Jordan The knee OA Affects elderly (usually) Over weight (usually) Bowleg deformity (usually) Pain is worse after activity (stairs in patellofemoral involvement) After rest, the joint is stiff and hard to get going again Giving way or locking Dr. Bashar Al Qaroot Slide 22 University of Jordan The knee OA grade 0: no radiographic features of OA are present grade 1: doubtful joint space narrowing (JSN) and possible osteophytic lipping grade 2: definite osteophytes and possible JSN on anteroposterior weight-bearing radiograph grade 3: multiple osteophytes, definite JSN, sclerosis, possible bony deformity grade 4: large osteophytes, marked JSN, severe sclerosis and definite bony deformity Dr. Bashar Al Qaroot Slide 23 University of Jordan The knee OA Dr. Bashar Al Qaroot Slide 24 University of Jordan The knee OA PFJ Vs TFJ Treatment Dr. Bashar Al Qaroot Slide 25 University of Jordan The knee Recurrent dislocation of the patella Causes are: 1. Ligament laxity 2. Under development of the medial femoral condyle 3. Maldevelopment of the patella 4. Valgus deformity of the knee 5. Muscle defect Dr. Bashar Al Qaroot Slide 26 University of Jordan The knee Recurrent dislocation of the patella Recurrent dislocation causes further flattening of the femoral groove and thus.. Secondary OA may develop Dr. Bashar Al Qaroot Slide 27 University of Jordan The knee Recurrent dislocation of the patella Females more Often bilateral Knee stuck in flexion (patient may fall) Lateral dislocation (felt as medial!) Orthosis for 2-3 weeks then walking with crutches Dr. Bashar Al Qaroot Slide 28