knee

• VALGUS


  MCL; pos:pain/excessive movement indicates MCL injury
• VARUS


  LCL; pos:pain/excessive movement indicates LCL injury
• ANT DRAWER TEST


  ACL; pos: forward movement of tibia indicates ACL injury
• POST DRAWER TEST


  PCL; pos: backward movement of tibia indicates PCL injury
• LACHMAN TEST


  ACL; pos: sig forward movement of the tibia indicates ACL injury
• BALLOTTEMENT TEST


  knee effusion; pos: tapping sens/visible fluid wave indicates knee effusion
• MENISCUS TEAR


  catching/locking and painful lateral, or twisting movements
• Meniscus tear findings


  • ROM full
  • Strength 5/5
  • Joint effusion +/-
  • Tender at medial or lateral joint line
  • Pos McMurray, all else neg
• PATELLOFEMORAL SYN (PFPS)


  most common knee prob (W); pt has probs w Lateral patellar tracking, Weakness at quadriceps (specifically vastus medialis), Hip abductor and gluteal group weakness, Repetitive stress/overuse injury
• PFPS findings


  • No injury
  • pt has popping, clicking, grinding, pain w knee extension activities
  • full ROM
  • 5/5 strength
  • peripatellar tenderness
  • special tests of patella7r apprehension, patellar grind/inhibition, patellar mobility
• PFPS imaging


  XR= patellar tilt/subluxation; normal
• PFPS management


  • PT
  • knee brace
  • patellar tapping
  • activity modification
  • orthotics
  • selective intra-articular injection
  • MRI??
  • arthroscopic intervention
• OSGOOD-SCHLATTER DISEASE


  Traction at tibial tuberosity apophysis from contraction of the quadriceps musculature/patellar tendon (M) post growth spurt, athletes, repetitive strain chronic avulsion of patellar tendon insertion new bone laid down prominent tibial tuberosity
• Osgood-Schlatter findings


  • pain at tibial tuberosity (w prominent tuberosity)
  • neg special tests
• Osgood-Schlatter imaging


  avulsion at tibial tuberosity
• Osgood-Schlatter management


  • activity modification
  • NSAIDS
  • ice
  • physical therapy
  • quadriceps and hamstring stretching
• PATELLAR DISLOCATION


  F; twist/pivot on flexed knee/direct patellar trauma, immediate pain, can't continue activity, spontaneously reduce, obvious deform, LATERAL dislocation
• Patellar dislocation findings


  • painful/stiff ROM
  • joint effusion
  • possible patellar hypermobility
  • Tender at medial patellar border and possibly lateral femoral condyle
  • Pos apprehension test
  • neg lachman/ant drawer, valgus/varus stress
• Patellar dislocation imaging


  normal if patellas been reduced, subluxation laterally, medical patellar facet avulsion
• Patellar dislocation management


  • Knee immobilizer/patellar stabilizing brace
  • crutches PRN
  • rest
  • ice
  • compression
  • Limit ROM/activities for 1st wk then gradually progress
  • Return to sports @ 4-6 weeks
  • PT
  • dislocations inc risk of reinjury
• ACL RUPTURE/TEAR


  F, most common ligament injury, Noncontact- pivoting on a flexed knee (i.e. cutting or decelerating and pivoting)//Contact- hyperextension or valgus blow to a planted leg, MVA; pt hears/feels a pop and complains of knee "giving out"
• ACL tear findings


  • dec/painful/stigg ROM
  • significant joint effusion
  • pos Lachman, Anterior Drawer, and/or Pivot Shift
  • May have another tear
• ACL tear imaging


  usually normal; Segond fracture (ALL avulsion) suggests ACL tear; MRI confirms dx
• ACL tear management


  • Rest
  • immobilization
  • crutches if needed
  • NSAIDs/OTC analgesia
  • ice
  • non-surgical: Extensive rehabilitation, bracing, and patient education regarding chronic ACL deficiency→Risk of osteoarthritis/degen meniscus tears
  • Surgical: Indicated for high-demand employment, sports participation/w sig knee instability; Arthroscopic/mini-open procedures to reconstruct ACL
• TIBIAL PLATEAU FRACTURE


  trauma, MVA, falls, hyperextension, twisting (if osteoporotic), stress fracture, varus/valgus load with or without axial load; normally very subtle; potential compartment syn
• Tibial plateau fracture findings

  • dec/painful ROM
  • maybe sig joint effusion
  • focal tenderness along tibial plateau
  • special tests hard due to pain
• Tibial plateau fracture imaging

  range from subtle to overt – AP, lateral, oblique; MRI/CT to evaluate extent of fx, articular surface depression or condylar separation, or to evaluate equivocal exam and x-ray findings
• Tibial plateau fracture management

  • Non-weight bearing 6-8 weeks
  • knee immobilizer/T-ROM in extension or limited ROM→As healing continues do progressive inc weight bearing/ROM/strengthening
  • ORIF for fracture with significant articular deformity
  • Staged procedures for concomitant injury
  • Emergent treatment if compartment syndrome/open fx
  • Pt may have post-traumatic OA
• OSTEOARTHRITIS


  degen disease of synovial joint→progressive loss of articular cartilage, risk from previous trauma, obesity, age, gender – females>males, occupation, genetic history; Kellgren & Lawrence Scale for severity.
• Osteoarthritis findings


  • gait abnormality
  • +/- palpable tenderness, effusion, flexion/extension stiffness, limb alignment (varus/valgus deformity)
  • normal/abnormal ligamentous stability
• Osteoarthritis imaging


  WEIGHT BEARING VIEWS essential. shows: loss of joint space, osteophytosis, sclerosis, subchdonral cysts. MRI no.
• Osteoarthritis management


  • NSAIDs/Tylenol/Tramadol
  • physical therapy/exercise
  • WL
  • corticosteroid/viscoelastic injection
  • unloader bracing
  • knee arthroplasty – UKA vs TKA