knee

Postero-Medial Corner Injury

Anatomy

 

Layers of the medial knee

 

Layer 1

- sartorius and sartorius fascia

 

Layer 2

- superficial MCL

- posterior oblique ligament

 

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

 

MCL

 

Origin

- 3 mm proximal and 5 mm posterior to the epicondyle

 

Fat Pad Syndrome

Definition

 

Hoffa's syndrome

- impingement of the fat pad with knee ROM

 

Epidemiology

 

Rare

Diagnosis of exclusion

 

Theory

 

May be more prevalent in patients with intact ligamentum mucosum

 

Diagnosis

 

Hoffa's sign

- apply pressure to fat pad each side of patella tendon with knee in flexion

- extend knee

Knee

ApproachesPosterior approach knee

 

Medial Parapatellar

Medial

Lateral

Posterior

Modified Posterior

 

Medial Parapatellar Approach

 

Indications

 

Synovectomy 

Patellectomy 

TKR

 

Technique

 

Meniscal Repair

Indications for Repair

 

Only 20% repairable

 

1. Red / Red longitudinal tear

- outer 3mm / meniscocapsular junction

 

Meniscal Tear Red RedMensical Repair all inside

 

Mass Behind Knee

DDxPosterior knee mass

 

Baker's Cyst

Popliteal Anerysm

Soft tissue sarcoma

Osteosarcoma / Parosteal OS

Hemangioma / AVM

 

Note:

 

Always do xray for calcification

A Bakers cyst / aneurysm can be calcified

 

 

 

Loose Bodies

Knee Loose Bodies Fragments

 

Source

 

OCD

OA - Osteophytes

Meniscus

 

Symptoms

 

Pain

Locking

Clicking

Can cause chondral damage

 

Xray

 

OA Loose Bodies

Patellar tendonitis

Definition

 

Patellar Tendinitis

 

Epidemiology

 

Most common in athletes

- especially if involved in running, jumping and kicking

- over use injury

 

Basketball players

 

Aetiology

 

Chronic overload v inferior patella impingement

 

Schmidt et al Am J Sports Med

- dynamic MRI in patients with jumper's knee v controls

- no evidence of impingemnt

Knee & Foot

Principles

 

Foot

 

A little equinus is better than calcaneus

A little valgus is better than varus

A little varus is better than severe valgus

TA lengthening is most over used operation in CP

 

Knee

 

A little knee flexion is better than recurvatum

 

Knees

 

Problems

 

Tight hamstrings 

DDx Anterior Knee Pain

Plica 

 

Jumper's knee / Tendonitis

 

Bursitis

- prepatellar most common

- Pes anserinus 

 

Excessive Lateral Pressure Syndrome / Patella Tilt

 

Hoffa's Disease / Fat Pad Syndrome

 

ITB Syndrome

 

RSD

 

Others

- RA

Syndicate content