OWL: OCOSH Classification/Joint Diseases/Knee Pain

Adolescent Knee Pain The Bone School

Andrew Birchley et al — 2009-12-23 21:00:38 GMT

Remember hip pain as a cause from SUFE / Perthes
Aetiology
Hip - Perthes / SUFE / Infection
PFJ - malalignment, chondromalacia, tendonitis
Cartilage - OCD
Meniscus (+/- discoid)
Ligament injury
OSD
Synovial Plica
Trauma
Tumor
Infection
Inflammatory

Anatomy and Kinematics of the Knee Joint Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

- bones forming the knee joint are femur, tibia, & patella;
- both the left and right femurs converge toward the knee and each tibia is nearly vertical, femur and tibia meet angle of some 5-12 deg;
- greater angle results in genu valgum;
- lesser angle results in genu varum;
- patello-femoral function:
- condyles:
- tibial plateau:
Roll Back and Sliding of the Knee Joint:
- Knee Rotation:
Wheeless' Textbook of Orthopaedics

Blood Supply to the Knee Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

- blood supply to skin around the knee is random (as opposed to axial)
- there are multiple small overlapping vessels that are interrupted by multiple small incisions;
- random supply is sustained by both intrinsic and extrinsic sources;
- intrinsic contributors to skin overlying knee are perforationg branches of the superior and inferior genicular systems;
- extrinsic supply: 3 sources;
- descending genicular (supreme genicular artery) branch of superficial femoral artery
- recurrent branch of anterior tibial artery;
- descending branch of the lateral femoral circumflex artery
Wheeless' Textbook of Orthopaedics

Diagnosis and Initial Management of Acute Knee Swelling Recommendations Issued Medscape

Not Available — 2010-02-08 21:00:38 GMT

Report on consensus recommendations for the diagnosis and initial treatment of patients with acute or recent onset of swelling of the knee. These guidelines are reported in the January 2010 issue of the Annals of the Rheumatic Diseases.

Examination of Knee Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

- serial diagnostic exam should take into consideration static deformities of the lower extremities, gait, ROM, tenderness, and knee stability;
- in the child w/ a painful knee, it is essential to closely examine the hip as hip pathology can refer pain to the hip;
Wheeless' Textbook of Orthopaedics

Knee joint Menu Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

Physical Exam Radiographs ACL Anteromedial Instability Anterolateral Rotatory Instability Arcuate Ligament Complex Arthrofibrosis Arthroscopy of the Knee Arthrodesis Articular Cartilage Baker's Cyst Bipartite Patella Blood Supply Blount's Disease Bursitis Capsule Chondral Injuries of the Knee Chondromalacia Diff Dx Discoid Meniscus Dislocations of the Knee Extensor Mechanism Injuries of the Knee Flexion Contracture Genu Varum Hemarthrosis High Tibial Osteotomy Intercondylar Eminence Fracture Jumper's Knee Kinematics of the Knee Joint Lachman Exam Lateral Anatomy Lateral Collateral Ligament Lateral Retinacular Release Ligaments of Humphrey and Wrisberg Medial Collateral Ligament Medial Compartment of the Knee Medial Synovial Plica Meniscii Meniscal Repair Menisco-Femoral Ligaments MRI-Knee Oblique Popliteal Ligament Osgood Schlatter Lesion Osteoarthritis Osteochondral Defects Osteochondritis Dissecans Osteonecrosis of the Knee Osteotomy, Tibial Osteotomy, Distal Femoral Patella bipartite patella chondromalacia patella patella alta patella infera prepatellar bursitis subluxation patellar tendon injury Physical Exam Pivot Shift Popliteal Cysts Posterior Oblique Ligament Posterior Cruciate Ligament Postero-lateral Instability Puncture of the Knee Joint Q angle of the Knee Radiograhpic Evaluation of the Knee Running Injuries Rupture of the Quadriceps Septic Knee Sindig-Larsen-Johanssen disease Subluxation of the Patella Surgical Approach Approach for TKR Posterior Approach Synovium Synovial Plica Total Knee Arthroplasty Tibial Tubercle Frx Tibial-Fibular Dislocation Unicondylar Replacement Valgus Stress Testing Varus Stress Testing
Wheeless' Textbook of Orthopaedics

Natural course of intra-articular shifting bone marrow edema syndrome of the knee

Aigner et al — 2008-04-13 21:00:38 GMT

Nicolas Aigner , Roland Meizer , Gert Petje , Elisabeth Meizer , Ashraf Abdelkafy and Franz Landsiedl BMC Musculoskeletal Disorders 2008, 9:45 Abstract & link to free full text
Background Intra-articular shift (migration) of bone marrow edema syndrome (BMES) is a very rare disease. Only a few cases have been reported thus far. The condition may cause the clinician to suspect an aggressive disease.
Results MR imaging showed complete restitution in 6 cases and a small residual edema in one case. A final control MR could not be obtained for one patient, who had no pain. A further patient had an avascular necrosis of the contralateral hip after 16 months. Improvement on MR imaging was correlated with the clinical outcome in all cases. All patients became asymptomatic after a mean period of 9 months (6-11). Interpretation: Intra-articular shifting BMES is a very rare condition. As the disease is self-limiting, conservative therapy may be recommended.

Pain in Both Knees Predicts Higher Risk of Impaired Function Medscape CME

Not Available — 2010-03-30 21:00:38 GMT

March 12, 2010 � Not surprisingly, people with pain in both knees are more likely to develop functional problems compared to those with pain in one knee only, according to a report in the February 26th online issue of Arthritis Care & Research.

Radiographic Evaluation of the Knee Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

- complete knee series should include an anteroposterior, lateral, & axilla view as well as a tunnel view in skeletally immature pts;
Wheeless' Textbook of Orthopaedics

Sindig-Larsen-Johanssen Disease Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

- cause of discomfort in anterior aspect of the knee;
- caused by persistent traction at the cartilaginous junction of patella & patellar ligament, usually at inferior patellar pole;
- usually seen in an active preteen boy who complains of activity-related pain;
- differential diagnosis:
- pediatric patella avulsion fractures
- patellar stress fracture;
- bipartite patella (type I)
- Osgood Schlatter's disease)
- calcification is present at the inferior pole of the patella (where as tenderness or calcification along the tibial tubercle;
- jumper's knee is considered in older adolescents;
Wheeless' Textbook of Orthopaedics

Synovium of the Knee Wheeless

C.R.Wheeless — 2002-02-04 21:00:38 GMT

- synovial cavity is deepest layer of joint capsule & it often has several embryological invaginations called plica that persist into adult life;
- these may cause anterior knee symptoms,
- although synovium membrane is attached all around, above to articular margins of femur and below to articular margins of tibia, it is not everywhere coextensive w/ capsule or ligament and tendons;
Wheeless' Textbook of Orthopaedics