Evaluation of Knee Injuries Dr. Alan A. Zakaria, D.O., M.S. 1080 Kirts Blvd., Suite 400 Troy, Mi., 48084 Team Physician United States Soccer Federation University of Michigan Men’s and Women’s Soccer
Objective Identify main anatomic components of the knee Perform basic knee exam along with special tests Identify common knee injury patterns and their physical exam findings.
Anatomy Bony Anatomy Ligaments Cartilage Musculature Other Soft Tissue
Knee Anatomy Two functional joints – Femorotibial – Femoropatellar Femoral condyles – Flex/extend
Knee Anatomy Patella – Sesamoid with two concave surfaces and vertical ridge – Increases efficiency of extension
Knee Anatomy: Anterior Cruciate Ligament (ACL) Run inferior, anterior, and medially Arises from medial aspect lateral femoral condyle Insert lateral to medial tibial eminence Restrains anterior subluxation of tibia on femur
Knee Anatomy: Posterior Cruciate Ligament (PCL) Arises from the posterior intercondylar area of the tibia Inserts at the medial condyle of the femur Restrains posterior subluxation of the tibia on the femur
Knee Anatomy: Medial Collateral Ligament (MCL) Postero-superior medial femoral condyle to proximal end of tibia Maximum tension at full extension Restraint to valgus stress
Knee Anatomy: Lateral Collateral Ligament (LCL) Posterosuperior lateral femoral condyle to lateral head of fibula Restraint to varus stress
Knee Anatomy: Meniscus Load bearing, joint stability, shock absorption Peripheral third vascularized
Knee Anatomy: Articular Cartilage Hyaline cartilage that covers the femoral condyles, tibial plateau, and undersurface of the patella Shock absorbing structure that can withstand compression, tension, and shearing forces and dissipate load
Knee Anatomy: Muscles Quadriceps Hamstrings Iliotibial tract Pes Anserine
Knee Anatomy: Pes Anserine Composed of the conjoined tendons of the semitendinosus, gracilis, and sartorius muscles Inserts onto the anteromedial proximal tibial bone
Knee Anatomy: Patellar and Pes Anserine Bursa Synovial fluid-filled sacs that provide a cushion between bones and tendons and/or muscles around a joint Prepatellar bursa located superior to the patella
Patient History. Nature of symptoms Age Location Occupation or recreational activities Timing/Duration Clicking or popping Quality and Quantity Locking or catching Trauma or preceding event Giving Way Exacerbating or Swelling relieving factors Past History
Physical Exam Observation Range of Motion Palpation Strength Testing Special Testing
Observation Anterior view standing Genu valgum/varum, patella position, foot architecture Posterior view standing Genu valgum/varum, foot architecture Anterior and lateral views sitting Patella position/tracking, osgood schlatter’s changes Gait General changes, motion of patella, foot architecture
Palpation Anterior with knee extended Medial Swelling or effusion Medial meniscus Prepatellar bursa, patellar Medial collateral ligament tendon, plica Pes Anserine Quad and tendon Pes Anserine Posterior Hamstrings Lateral Gastrocnemius Lateral meniscus Popliteal fossa LCL Baker’s Cyst IT Band
Range of Motion Flexion – 135 -140 degrees Extension – 0 degrees
Strength Testing (5 point scale) Flexion Hamstring Gracilis, sartorius Popliteus Gastrocnemius Extension Quadriceps Tensor Fasciae Latae
Collateral Ligaments MCL Valgus stress at 0 and 30 degrees LCL Varus stress at 0 and 30 degrees
ACL Lachman Anterior Drawer Pivot Shift
PCL Posterior Sag Posterior Drawer
Meniscus McMurray Apley’s Bounce Home
Patellofemoral Active patellar grind/crepitus Apprehension/hyper mobility
Others Ober’s Test
Diagnostic Imaging X-rays: AP Lateral Sunrise Notch Weight bearing
Diagnostic Imaging CT – More detailed bony evaluation MRI – More detailed bony evaluation and good evaluation of soft tissue structures Ultrasound – Good, detailed evaluation of more superficial soft tissue structures
Summary Knee Anatomy Basic physical exam Special tests
Thank You!
Recommend
More recommend