⚕️FREE MSRA PODCAST –Posterior Cruciate Ligament (PCL) Tear

🎧 Your high-yield revision audio for mastering PCLtears — for the MSRA, exams, or on the go.

🧠Key Learning Points

📌Definition

• Posterior cruciate ligament (PCL) tear = injuryto the main ligament that stabilises the back of the knee, preventing the tibiafrom moving backwards relative to the femur

• PCL provides up to95% of posterior knee stability

📌Causes & RiskFactors

• Direct blow to the front of the knee (e.g.“dashboard injury” in car crashes)

• Hyperextension injuries

• Falling hard onto a bent knee

• High-impact/contact sports (football, rugby)

• Previous PCLinjury increases re-injury risk

Mnemonic: DHFSA — Dashboard, Hyperextension,Fall (bent knee), Sports, Accidents

📌Pathophysiology

• Force exceedsPCL’s tensile strength → partial or complete tear

• Posterior tibialdisplacement = loss of knee stability

• Hamstrings/gravitypull tibia backwards in absence of PCL

📌Symptoms &Clinical Features

• Knee pain, often with swelling and a sensation of instability(“knee might buckle”)

• Difficulty bearingweight

• Instability especially with walkingdownhill/stairs

• May be lessdramatic than ACL tears (often less “pop”)

📌DifferentialDiagnosis

• ACL tear

• Medial/Lateralcollateral ligament tears (MCL/LCL)

• Meniscal tear

• Patellardislocation

• General kneeinstability

• Osteoarthritis (inchronic cases)

📌Diagnosis

• Physical exam:

 – Posterior drawer test (most sensitive)

 – Posterior sag test (Godfrey’s test)

• MRI: gold standard for assessingligament/tissue injuries and grading severity

• X-ray: rules out fractures (especially tibialplateau avulsion)

📌Management

• Conservative for most isolated, mild/moderatetears:

 – PRICE/PRICER: Pain relief, Rest, Ice,Compression, Elevation, early Rehabilitation

 – Physiotherapy: emphasise quadriceps strengthening (quads = key fordynamic stability)

 – Bracing orcrutches for some injuries

• Surgical:

 – Reserved forsevere/complete tears, multi-ligament injuries, avulsion fractures, orpersistent instability

 – Procedure = PCLreconstruction (using tendon grafts)

Mnemonic: "Quadsfor PCL" — quad strength is vital in rehab!

📌Prognosis &Complications

• Good prognosis with early, focused rehab — manyregain full function

• Untreated/unstableknees risk chronic pain, instability, and earlyosteoarthritis

• Complications: Patellofemoral/medial arthrosis,chronic knee pain

• Commitment torehab is crucial for long-term outcome

📎MSRA Resources forPosterior Cruciate Ligament Tear

📝 Revision Notes: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-revision-notes/

💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-accordion-qa-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-flashcards/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-rapid-quiz/

🎓 Full Quiz: https://www.passthemsra.com/quizzes/posterior-cruciate-ligament-tear/

#MSRA #PCLTear#PosteriorCruciateLigament #MSRARevisionNotes #MSRAQuiz #MSRAFlashcards#MSRAQandANotes #MSRAAccordions #MSK #KneeInjury #Orthopaedics#MSRAOnlineRevision

🎙️Deep Dive:Prepatellar Bursitis (Housemaid’s Knee)– MSRA Essentials

Knee pain right overthe front of the patella? Swelling like a little water balloon? In thisepisode, we break down Prepatellar Bursitis,a deceptively simple but clinically important condition — especially for MSRA revision. Whether it’s from kneeling,trauma, or infection, we walk you through whatmatters and why.

🧠Key Concepts Covered

• 📍 Definition: Inflammation of the prepatellar bursa,a fluid-filled sac sitting just in front of the kneecap

• 💥 Causes: Repetitive kneeling (👷‍♂️ carpet layers, cleaners), direct trauma,infection, or associated inflammatory conditions (RA, gout)

• ⚠️Septic vs Non-septic: ~30% are infected – often Staph aureus

• 👩‍⚕️ Risk Factors: Manual occupations, contact sports,immunosuppression, skin breaks

• 🔍 Pathophysiology: Inflammation or bacterial colonisation of the bursa→ swelling, fluid accumulation, tenderness

🔄DifferentialDiagnosis

📌Don't assume it’sbursitis — rule out:

• Septic arthritis – red flag: systemic symptoms,joint pain with all movement

• Patellar tendonitis – pain below the patella

• Meniscal tear – twisting injury,locking/clicking

• Patellofemoral pain syndrome – ache behindkneecap, worse on stairs

• Cellulitis, infrapatellarbursitis, gout/pseudogout

🔬Diagnosis – What YouNeed to Know

✅Aspiration is key – gold standard to rule out infection or crystals

 • Send fluid for:

  – WCC, Gram stain& culture

  – Crystal analysis:

   • ⬆️MSU = gout

   • Rhomboid CPP =pseudogout

✅ Imaging:

 • Not routinely needed unless complicationssuspected

 • 🩻 X-ray: rule out trauma

 • 🧲 MRI/ultrasound: only if persistent or uncertain

💊Treatment Pathways

Type

First-line Management

Second-line

Non-septic

PRICE: rest, ice, NSAIDs, knee pads 🧊

Aspiration ± steroid (if no sepsis)

Septic

Empirical IV antibiotics 🚨

Repeated aspiration or surgical drainage

➡️ Consider bursectomy forchronic/recurrent cases

➡️ Patient education on knee protection is crucialfor prevention 🔁

📈Epidemiology &Prognosis

• 🧍‍♂️ More common in men aged 40–60

• 💼 Linked to manual jobs (e.g. cleaners, roofers, gardeners)

• ~1 in 10,000incidence/year in UK

• 🤒 ~30% are septic – more likely in children or immunocompromised

• 🩹 Non-septic cases usually resolve with conservative care

• 🔁 Recurrence possible if aggravating factors not addressed

📝Rapid MSRA Recap

• Swelling directly over kneecap = think prepatellar bursitis

• Always ask:occupation, trauma, systemic signs

• Aspiration rules in/out: sepsis, gout,inflammation

• Treatment:conservative for non-septic, antibiotics &drainage for septic

• Preventrecurrence: avoid kneeling, use knee pads

📚MSRA Resources forPrepatellar Bursitis

• 🧾 Revision Notes:

https://www.passthemsra.com/topic/prepatellar-bursitis-revision-notes/

• 🃏 Flashcards:

https://www.passthemsra.com/topic/prepatellar-bursitis-flashcards/

• ❓Accordion Q&A Notes:

https://www.passthemsra.com/topic/prepatellar-bursitis-accordion-qa-notes/

• ⏱️Rapid Quiz:

https://www.passthemsra.com/topic/prepatellar-bursitis-rapid-quiz/

• 🔍 Full Quiz:

https://www.passthemsra.com/quizzes/prepatellar-bursitis/

📎For More RevisionSupport

🎓 Full course: https://www.passthemsra.com

🆓 Free resources: https://www.freemsra.com

💡Final Thought

Prepatellar bursitismight seem simple, but missing a septic casecan be serious. Know how to spot it, aspirate safely, and treat it effectively— it's a small joint space, but a big examfavourite.

🔖 #MSRA #PrepatellarBursitis #HousemaidsKnee#MSRARevision #MSRAQuestionBank #MSKRevision #KneePain #MSRAMusculoskeletal#MSRAFlashcards #FreeMSRA #PassTheMSRA #Bursitis

🎧Deep Dive:Infrapatellar Bursitis (Clergyman’s Knee)

Welcome back to The Deep Dive, your go-to MSRA revisioncompanion. In this high-yield episode, we unpack InfrapatellarBursitis, sometimes known as Clergyman’sKnee, helping you master the key facts for your MSK section prep —without the fluff.

Whether you’retackling SBA questions or consolidating core knowledge, this episode willsharpen your understanding of what sets infrapatellarbursitis apart from other knee pathologies.

🦴What Is InfrapatellarBursitis?

• Inflammation of the infrapatellar bursa, located below the kneecap
• Acts as a cushion to reduce friction in the anterior knee
• Key symptom: pain and swelling just below the patella

💥Causes & RiskFactors

🔁Repetitive kneeling (e.g. gardeners, plumbers, carpet layers)

⚽️Direct trauma to the front of the knee

🦠Septic bursitis from bacterial infection

🧬Underlyinginflammatory conditions like gout or RA

🛠️ Immunocompromised individuals are at increasedrisk of septic bursitis

📍Mnemonic for Causes:

“Knocks, Kneels & Nasties”

• Knocks = trauma

• Kneels =repetitive pressure

• Nasties =infection/inflammation

📋Symptoms and ClinicalFeatures

• Localised anterior knee pain, worse withkneeling, stairs, or bending

• Swelling and tenderness below the patella

• Pain on palpationover the bursa

• May feel boggy or fluctuant swelling

• In septic cases: redness, warmth, systemic features like fever

🔎DifferentialDiagnoses

• Prepatellar bursitis (above the patella)

• Patellar tendonitis

• Patellofemoral pain syndrome

• Knee osteoarthritis

📍Location is key: Infra = below the kneecap

🧪Investigations

✅ Often a clinical diagnosis

🖼️X-ray or MRI may be used to exclude fracture or tendonpathology

💉Aspiration of thebursa if septic bursitis is suspected (for culture and microscopy)

🧊Management (UKApproach)

💡Mnemonic: B-RICE +NSAIDs

• Bursitis-specific care

• Rest

• Ice

• Compression (if needed)

• Elevation

• NSAIDs for inflammation and pain

💊Antibiotics for septic bursitis

🩺Aspiration ±corticosteroid injection in resistantcases

🔪Surgery = rare, only for chronic/recurrent or severeinfections

📈Prognosis

✅ Most cases resolve within a few weeks

⚠️ Chronic pain or limited mobility if not treatedearly

🚨 Septic bursitis = serious → needs urgentantibiotics to prevent joint damage

🧠Top Tip for MSRA

Always distinguish infrapatellar vs prepatellarbursitis — it’s a common SBA trap!

And if there’s systemic illness, redness, or rapid swelling,think septic bursitis and act fast.

🧪Quick Summary

• Definition: Inflammation of the bursa below the kneecap

• Causes: Kneeling, trauma, infection, orsystemic inflammation

• Symptoms: Pain + swelling just under thepatella

• Diagnosis: Clinical ± aspiration for infection

• Treatment: Rest, NSAIDs, ice, physio —antibiotics if septic

• Complications: Chronic bursitis, infection,mobility loss

📚MSRA Resources

📝 Revision Notes:

https://www.passthemsra.com/topic/infrapatellar-bursitis-revision-notes/

🃏 Flashcards:

https://www.passthemsra.com/topic/infrapatellar-bursitis-flashcards/

📚 Accordion Q&A Notes:

https://www.passthemsra.com/topic/infrapatellar-bursitis-accordion-qa-notes/

🎯 Rapid Quiz:

https://www.passthemsra.com/topic/infrapatellar-bursitis-rapid-quiz/

💡 Quiz Portal:

https://www.passthemsra.com/quizzes/infrapatellar-bursitis/

🌐More Free MSRA Help

• https://www.passthemsra.com

• https://www.freemsra.com

#MSRA#InfrapatellarBursitis #KneePain #MSRAQuiz #Orthopaedics #MSK #SepticBursitis#MSRAFlashcards #MSRARevisionNotes #PassTheMSRA #FreeMSRA #ClergymansKnee