Knee Injuries
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Introduction
extensor mechanism:
- rupture of quad or patellar tendons
- tibial tuberosity avulsion
- patellar dislocation (risk of osteochondral fracture; often following twisting or direct blow); may reduce spontaneously; "did you see your kneecap over to the side?" - if you see it happen, reduce it by extending the leg; can bleed as retinaculum tears
locked knee lasting >10 min
- loose body
- bucket-handle tear of the meniscus
menisci
injury patterns:
- sudden twist
- associated with ligament tears
- age effects: meniscus softens and frays
history
- sharp, joint-line pain
- gradual swelling over a day or two
- +/- locking or catching lasting ~20 min
- inablity to fully straighten knee
- can hear sound "crunch"
physical exam
- loss of full extension
- effusion
- joint line tenderness
- McMurray's - external rotation and valgus
- Apley's test - pt prone, knee flexed, foot rotated
- squat test
treatments
- often conservative tx
- surgery to trim mensical edges
ligament injuries
ACL is one of most commonly injured ligaments in the knee. Usually sports; 70%are non-contact
Often planting and twisting
Can partially tear; can fully tear next time
symptoms
- hear or feel a pop
- intense pain
- immediate swelling
- unable to weight bear
- unsteadiness
physical exam
- joint effusion
- anterior/posterior drawer tests
- Lachman
- decreased ROM - lack of terminal extension
- possible joint line tenderness
- loss of muscle bulk; develops over days
definitive treatment with surgery
knee dislocation
physical exam
- vascular and neurological exam
- dorsiflexion and eversion
- ankle brachial ratio
Resources and References
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