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Locked Knee
- 1. KNEE LOCKED Mini Presentation Axler JEAN PAUL, Intern December 2020 Hospital of the State University of Haiti Orthopedics and Traumatology Department
- 2. • Locked knee is considered a relative emergency. • A disabling condition characterized by the inability to achieve full knee extension. • It must be treated quickly and accordingly, as a prolonged locked knee position could lead to contractures complicating a flexion deformity, thus promoting premature cartilage degeneration. Axler JEAN PAUL, HUEH 2020 2
- 3. • Identify the main causes of knee blockage • Able to diagnose and manage knee blockage Axler JEAN PAUL, HUEH 2020 3
- 4. •Definition •Anatomical reminder •Classification •Cause •Clinic •PEC Axler JEAN PAUL, HUEH 2020 4
- 5. •Locked knee is a condition in which the affected person is unable to fully extend the knee. • Hussin P, Mawardi M, Nizlan NM. The 'Chalky Culprit' of acute locked knee. G Chir. 2014 Sep-Oct;35(9- 10):239-40. PMID: 25419591; PMCID: PMC4321498. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321498/citedby/ Axler JEAN PAUL, HUEH 2020 5
- 6. Axler JEAN PAUL, HUEH 2020 6
- 7. • Structures providing support and stability: Lateral and medial menisci in disc form. Anterior and posterior cruciate ligaments. Medial and lateral collateral ligaments. Axler JEAN PAUL, HUEH 2020 7
- 8. Axler JEAN PAUL, HUEH 2020 8
- 9. • Two main categories: True knee Locked: Pseudo-locking of the knee: Axler JEAN PAUL, HUEH 2020 9
- 10. • True locking: A) Meniscus tear: the most common one B) Another cause: a small fragment of bone detaches from the knee joint, known as the loose body. The bone fragment may have become detached from: Knee injury: e.g. patella fracture Underlying knee condition: e.g. knee arthritis or osteochondritis dissecans. Axler JEAN PAUL, HUEH 2020 10
- 11. • Pseudo-locking: is always accompanied by pain causing muscle spasms, keeping the leg in position. • The difference is that there is nothing really stuck inside the joint. Axler JEAN PAUL, HUEH 2020 11
- 12. • The most common causes of pseudo locking : Swelling. Inflammation. Patellar Maltracking: a problem with the movement of the patella in front of the knee. Plica syndrome: the synovial plica is a shelf-shaped membrane between the synovium of the patella and the tibiofemoral joint. Knee injury. Axler JEAN PAUL, HUEH 2020 12
- 13. • Symptoms of the real locked knee chronic knee stiffness. Difficulty to completely straighten the knee. Snapping sensation in the knee. Feel a bump at the site of the loose body. intermittent pain and swelling. • The main symptom of pseudo- locked is pain, other: a brief feeling of blockage in the knee a feeling that the knee catches a feeling of slackness or instability in the knee Axler JEAN PAUL, HUEH 2020 13
- 14. • Clinic: • Paraclinic: Imaging • Ultrasound • Scanner • MRI Axler JEAN PAUL, HUEH 2020 14
- 15. • Symptomatic Axler JEAN PAUL, HUEH 2020 15
- 16. • Knee exercises: to improve knee strength and flexibility. • Corticosteroid injections: to reduce knee pain and inflammation • Arthroscopic knee surgery: to remove any fragments of cartilage and bone trapped in the knee joint. Axler JEAN PAUL, HUEH 2020 16
- 17. • Knee locked is a painful condition that requires immediate management, in order to relieve the patient and avoid complications such as joint degeneration. Axler JEAN PAUL, HUEH 2020 17
- 18. • Hussin P, Mawardi M, Nizlan NM. The 'Chalky Culprit' of acute locked knee. G Chir. 2014 Sep-Oct;35(9-10):239-40. PMID: 25419591; PMCID: PMC4321498. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321498/citedby/ • https://www.uptodate.com/contents/meniscal-injury-of-the- knee?search=locked%20Knee§ionRank=1&usage_type=default&anchor= H27376205&source=machineLearning&selectedTitle=1~150&display_rank=1 #H27376205 • https://www.knee-pain-explained.com/knee-locking.html • Bansal P, Deehan DJ, Gregory RJ. Diagnosing the acutely locked knee. Injury. 2002 Jul;33(6):495-8. doi: 10.1016/s0020- 1383(02)00081-5. PMID: 12098545. https://pubmed.ncbi.nlm.nih.gov/12098545/ Axler JEAN PAUL, HUEH 2020 18
Editor's Notes
- Usually caused by a mechanical impediment to knee extension, such as meniscus tears, loose osteochondrial fragments, or the stump of a ruptured anterior cruciate ligament.
- The knee joint contains four bones - femur, tibia, patella, and fibula - and consists of three compartments - medial tibiofemoral, lateral tibiofemoral, and patellofemoral - all sharing a common synovial cavity. The knee has three joints: medial and lateral tibiofemoral and patellofemoral.
- The disc-shaped lateral and medial menisci provide additional shock absorption and distribute forces throughout the joint. The anterior and posterior cruciate ligaments provide stability with anterior and posterior movements and with flexion and extension; the medial and lateral collateral ligaments provide support in their respective planes (photo 3). Other structures that contribute to knee stability include the ilio-tibial band (Figure 3) and parts of the posterolateral corner (Figure 4).
- True knee blockage: where the knee gets physically jammed, caused by a mechanical block where something gets stuck inside the joint, preventing movement. Pseudo knee lock: much more common than the real lock. Here, the movement of the knee is temporarily limited by muscle spasms.
- Acute meniscal tears generally occur when a person changes direction in a way that involves rotating or "twisting" the knee while the knee is bent and the corresponding foot is planted. As with a meniscus tear, if it moves to the wrong place, it can get stuck and cause the joint to lock in a specific position.
- Swelling: Excess fluid in the joint capsule can limit movement due to increased tension, preventing full flexion and extension. Inflammation: Inflammation of the structures in and around the knee can also limit movement. Patellar Maltracking: a problem with the movement of the patella in the groove at the front of the knee can cause a pseudo lock. This is usually very painful Plica syndrome: irritation of the medial plica, a fold in the synovial tissue lining the joint can cause a pseudo lock. Knee Injury: Injury to a knee structure that is severe enough to cause severe pain can cause a muscle spasm that can resemble a locked knee, e.g. ligament sprain.