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Objectives

Discuss the common forces that produce acute

Chapter 6
Assessment of Acute
Knee Injuries

injuries
Identify and discuss the common acute injuries to the

knee
Review the following components of injury

assessment related to the acute knee injuries

Forces Acting on the Knee to Produce


Acute Injuries
Compressive

Mechanism of injury

Signs

Symptoms

Stress tests

Special tests

Common Acute Knee Injuries


Sprain
Strain

Tensile

Meniscal injury
Chondral lesion

Shear

Fracture
Dislocation

Rotational

Common Chronic Knee Injuries


Tendinitis

History
Location of pain

Bursitis

Patellofemoral syndrome

Osgood-Schlatter disease

Patellar/quadriceps tendinitis

Sinding-Larsen-Johansson disease
Iliotibial band syndrome
Bakers cyst
Osteoarthritis

Differential Diagnosis

Osgood-Schlatter disease

Anterior

Sinding-Larsen-Johansson
disease
Degenerative joint disease
(OA)
Osteochondral defect (OCD)

History

History

Location of pain

Differential Diagnosis

Location of pain

MCL sprain

LCL sprain

Medial meniscus tear

Lateral meniscus tear

Pes anserine

Medial

bursitis/tendinitis
OA

History

Iliotibial band syndrome

Lateral

History

Location of pain

Differential Diagnosis

Meniscal tears in the

Posterior

Differential Diagnosis

posterior horns
PCL tear
Bakers cyst
Popliteus tendinitis

History

Mechanism of injury

Direct blows fx, dislocation,


MCL/LCL/ACL/PCP tears
Pivot injury patellar dislocation, ACL tear,
meniscus injury
Non-contact deceleration injury ACL tear

Observation

Acute vs. chronic

Deformity

Locking?

Effusion

Instability?
Recent treatment
Previous injury/previous treatment

Large effusion ACL tear, intraarticular fx,


peripheral meniscal tear
4-12 hours: ACL tear
12-36 hours: meniscal tear

Observation

Observation

Observation

Palpation

Knee alignment

Genu valgum
Genu varum
Genu recurvatum

Muscle asymmetry or atrophy

Palpation
Medial

MCL
Meniscus
Pes anserine tendons
Pes anserine bursa
Medial femoral condyle
Medial facet of patella
Medial retinaculum

Anterior

Patella
Patellar tendon
Quadriceps tendon
Joint line
Tibial tubercle

Palpation
Lateral

LCL
Lateral meniscus
Iliotibial band
Gerdys tubercle
Lateral femoral condyle
Lateral retinaculum

Palpation
Posterior

Hamstring tendons
Posterior joint line (posterior horns of menisci)
Popliteal fossa

Stress Tests
Valgus

ROM
Flexion
Extension

Valgus Stress Test


30 flexion

Varus
Lachman

Full extension

Anterior drawer
Posterior drawer
Slocum rotary drawer

Varus Stress Test

Lachman & Anterior Drawer

30 flexion
Full extension

Anterior Drawer
Lachman

Slocum Rotary Drawer

Posterior Drawer

Foot in internal rotation

Posterior lateral instability

Foot in external rotation

Posterior medial instability

Special Test

Posterior Sag (Godfreys)

Posterior sag (Godfreys)


Pivot shift
McMurray
Apleys compression & distraction

Specific Knee Injuries


Acute Ligamentous Injuries
Meniscal Injuries

MCL Sprains
History

MOI

Signs

Symptoms

MCL Sprains

MCL Sprains

Observation

Stress tests

Palpation

Special tests

MCL Sprains
Stress tests

MCL Sprains
Management

Special tests

1st degree

MCL Sprains
Management
2nd degree

PRICE
NSAIDs
Hinged brace
Crutches w/PWB when
necessary
Early ROM
Strengthening (closed chain)
Usually out for 3-4 wks
Should be protected when returned to play

PRICE
NSAIDs
Early ambulation is recommended (use crutches
if patient walks with limp)
Early ROM
Strengthening (closed chain)
Usually out for 1-2 wks
Should be protected when returned to play

MCL Sprains
Management
3rd degree

PRICE
Knee
immobilizer
Crutches - NWB
NSAIDs
Usually out for
6 wks or longer
Must be protected when
returned to play

LCL Sprains

LCL Sprains

History
MOI

Signs

Stress Tests

Arcuate Ligament
Complex

Special Tests

Symptoms

LCL Sprains

ACL Sprains

Management

Similar to MCL sprains


May heal slower to different collagen structure
of ligament

ACL Sprains
Females are 2-8 times more likely to

tear their ACL than their male


counterparts.
72% are non-contact
mechanisms

ACL Sprains
MOI

Foot strike with knee


near full extension
Sudden deceleration
Landing
Rapid change in
direction

What sports are associated with a high


frequency of landing, deceleration, and
rapid change of direction?

ACL Sprains

The position of no return

MOI

Ireland, M. L. (1999). Anterior cruciate ligament injury in female athletes:


Epidemiology. J Athl Train, 34(2), 150-154.

Predisposing Factors
Intrinsic

Anatomical
Arthrokinematic
Hormonal factors

Predisposing Factors
Extrinsic
Position

of no return
Muscle strength & conditioning
(quad to ham ratios)
Neuromuscular factors
Recruitment
Less joint stiffness
Longer electromechanical delay

ACL Research: Landing & Cutting


Mechanics
Females tend to

land with less


knee flexion and
less internal
rotation.

ACL Research: Landing & Cutting


Mechanics
Females take less

time to reach full


knee flexion.
Not attenuating
force

ACL Research: Landing and


Cutting Mechanics
Females land with

more knee valgus


(knocked knees)
in vertical and
backward stopjump tasks.

ACL Sprains
Stress Tests

ACL Sprains
Signs

Hemarthrosis (within 4-12 hours)

Symptoms

Patient reports a pop


Pain (extreme at first)
Patient may report giving
way of knee

ACL Sprains
Management
Initial
PRICE
NSAIDs
Crutches PWB
Hinge brace

Special Tests

ACL Sprains
Management
Surgical options

PCL Sprains
Anatomy

Autografts (taken from the patients


body)
Bone-patellar tendon-bone
Semitendinosus/gracilis tendons

Allograft (taken from cadaver)


Patellar tendon
Achilles tendon

PCL Sprains
MOI

PCL Sprains
Stress Tests

PCL Sprains
Signs and Symptoms

PCL Sprains
Management

Special Tests

Knee Sprains in Adolescents


Remember that epiphyseal fxs may mimic

Meniscal Injuries
Function of menisci?

knee ligament sprains

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Meniscal Injuries

Meniscal Injuries

MOI
Signs
Symptoms
Stress tests
Special tests

Meniscal Injuries

Meniscal Injuries
Other types of tears

Flap tear

Meniscal Injuries

Meniscal Injuries

Management?

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Meniscal Injuries

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