The Knee
- anatomy and movement
- history and physical exam
- injuries
The knee is the largest joint in the body.
It is very complex, hinge-like. It is subject to constant pounding and twisting
THe ligaments work together, along with the menisci and leg muscles, to stabilize joint and allow knee to generate and deliver large quantities of power required for activity.
Extension
Quadraceps, quad tendon, patella, tendon, tubercule
The menisci provide suspension
Knee Injuries are a serious problem
physical, emotional, and economic consequences
Common pathologies of the knee include:
Patello-femoral syndrome: misalignment in patello-femoral articulation with a dull aching over knee’s anterior surface and pain worse when going downstairs, squatting, or sitting up to a stand after watching a long hockey game! Quadriceps may be atrophic
Meniscal injury: look for a trauma, locking and clicking of knee, tenderness along joint line (tell tale sign!)
Ligamentous injury: look for a trauma, acute/severe pain, sudden effusion likely hemarthrosis if rapid onset. Also look for limited ROM (muscle spasm), bruising, instability.
O’Donoghue’s triad: ACL with MCL and medial meniscal injury
A single, very swollen, hot knee requires strong suspicion of septic arthritis. This presentation is almost always pathologic!
Swelling above the patella itself -> think prepatellar bursitis and not an effusion.
Soccer
plant and twist - typically ACL and meniscal damage
hyperextension