Hughston Laxity Classification Grade I – 1-4 mm laxity Grade II – 5-9 mm laxity Grade III – >10 mm laxity (soft endpoint) »Hughston JC, Andrews JR, Cross MJ, Moschi A: Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. »J Bone Joint Surg Am 58:159-172, 197
Two handed technique Trap ankle on Iliac crest Both hands on joint line –Palpate both joint lines
Collegiate football Severity vs. Return Grade I – 10.6 days Grade II – 19.5 days Derscheid, G.L. and J.G. Garrick. MCL injuries in football: Non-operative management of grade I and grade II sprains. Am J Sports Med, 1981. 9(6): p. 365-8.
Sideline estimate ( Crowley-Albright 30 consecutive FB cases) 1 mm = 1 week 2 mm = 2 weeks 3 mm = 3 weeks 6 mm = 6 weeks
Time Loss From Sport Severity of injury Compliance??
Exam Settings 1.Sideline Exam (on the field triage) 2.Training room (post game eval) 3.Office/clinic Exam
Office Exam What is important about the MCL exam? –Knee stability in full extension
Value of MRI? When should an MRI be done? –When knowledge of location of injury might influence treatment –When additional injury is suspected Instability at full extension should increase suspicion of cruciate injury »Mazzocca, A.D., et al., Valgus medial collateral ligament rupture causes concomitant loading and damage of the anterior cruciate ligament. »J Knee Surg, 2003. 16(3): p. 148-51.
Location MCL Tissue damage Proximal ruptures heal more quickly than distal but have more stiffness Complete ruptures can displace into the joint Damage over entire ligament associated with persistent laxity after non-operative treatment –Nakamura, N., S. Horibe, et al. (2003). "Acute grade III MCL injury of the knee associated with ACL tear. usefulness of MRI in determining treatment regimen." –Am J Sports Med 31(2): 261-7.
Grade III – Gross instability Laxity at full ext (no endpoint) Indicates complete rupture of MCL –Evaluate posteromedial capsule –Evaluate for cruciate injury ACL PCL –Evaluate for Patellar Dislocation
Meniscus tears Joint line tenderness –Most sensitive but least specific (Fu) Squat and duck walk test McMurray' s test –Modified McMurray' s test –Most sensitive but least sensitive Appley’s test –Modified Appley’s test Full Extension?? –Pain anterior joint line
Displaced Meniscus? (bucket-handle tear) Lacks full extension –No screw home –Pain anterior joint line –Rotation affects degree of pain Lacks full flexion –Rotation affects degree of pain Rotation OK in mid range flexion