Knee disorders

Disorders of the Knee

Dr. Wahby Ghalib
FJMC, CABO, MRCS

Genu varum & valgum

Genu varum = bow leg

Genu valgum = knock knee

On standing

Genu varum : intercondylar distance > 6 cm

Genu valgum : intermalleolar distance > 8 cm

Causes

Physiologic : varum in 1 yr child
valgum in 4 yr child
Rickets


Trauma

Skeletal dysplasia

Blount`s disease

O.A.

R.A.
















Rx
Physiologic : follow up

Rickets : vit D

Hemiepiphysiodesis

Osteotomy

9

Meniscal injuries

Functions
Improve stability

Load distribution

Increase range of motion

Proprioception

Pathology

Medial meniscus is less mobile  more liable for injury

Most of the meniscus is avascular : tear not capable of healing except the lateral third

Meniscal tear  mechanical irritation  synovitis & later O.A.

Trauma

Axial loading + flexion + rotation

Types of meniscal tear

Vertical longitudinal

Bucket – handle

Transverse

Oblique

Horizontal cleavage : degenerative

C / F

Pain

Giving way

Locking

Swelling : 24 hrs after trauma

O / E
Tenderness

Fluid inside the joint

Mc Murray test

Dx
XR : normal


MRI

Arthroscopy

DDx
Locking : Loose bodies

Giving way : ACL injury

Patellar instability

Mx
Back slab 3-4 w

Cruches

Quadriceps exercises

Surgery : repair or partial meniscectomy

Total meniscectomy  O.A.

Chondromalacia patellae

C / F
Female

Knee pain

Friction test

Aetiology

Incongruence of patellofemoral joint

Malalignment of the extensor mechanism

Muscle weakness


Ligament laxity

Congruence: sulcus and congruence angles

Alignment: Q angle

Pathology

Articular cartilage : softening & fibrillation

Subchondral bone : congested

Rx
Analgesia


Physiotherapy

Surgery

Loose bodies
Trauma

O.A.

Osteochondritis dissecans

Charcot arthropathy

Synovial chondromatosis

Charcot arthropathy

Due to neuropathy

Joint swelling, deformity, instability, & loose bodies

Pain is unusual

Rx : splint , arthrodesis

Prepatellar bursitis (housemaid`s knee )Infrapatellar bursitis (clergyman`s knee)

Due to kneeling

Rx : avoid kneeling
firm bandaging
aspiration
excision

Semimembranosus bursa

Swelling in medial side of popliteal fossa


Rx : if painful : excision

Baker`s cyst

It is a bulge from posterior capsule with synovial herniation

R.A., O.A., T.B.

Rx : cause
aspiration & steroid injection
excision

Osgood - Schlatter disease

Tractional osteochondritis of tibial tubercle

Adolescent

Pain & swelling

XR : fragmentation

Rx : rest ± back slab


Thank you