Knee injuries Dr Abir Naguib

Knee pain is the most common musculoskeletal complaint (1/3) Source of significant disability Most prevalent in physically active individuals

Differential diagnosis of knee pain is extensive Accurate diagnosis can be achieved by localizing the anatomic site of pain & patient’s age

Trauma Fracture Ligament sprain Tendon rupture Meniscal tear Patellar dislocation

History Pain characteristics: Onset- location- duration- severity- quality- aggravating and relieving factors 2. Mechanical symptoms: Pop Locking Giving way

Exclude referred pain (hip injury) 3. Effusion: Timing and amount 4. Ability to continue playing 5. History of previous injury Exclude referred pain (hip injury)

6. Mechanism of injury Contact (Direction of blow) Non-contact (position of knee) Twisting Hyperextension Deceleration

Non-contact injury

Hyperextension injury

Examination: Inspection: Swelling (location) Ecchymosis Atrophy Palpation: Tenderness ROM Stability tests Joint line Ligament course Active passive

Investigations Radiological Aspiration Arthroscopy X-ray, CT, MRI (painful swollen joint) Clear yellow Blood Blood + fat droplets Arthroscopy

MCL injury

CO: Pop at time of injury Pain , swelling (medial) OE: Tenderness, swelling along ligament course Valgus stress test

LCL injury Uncommon Mechanism: blow to medial aspect knee Varus force Similar: (lateral) Varus stress test

ACL injury Pop Immediate swelling Giving way

Anterior drawer test

Lachman test

ACL

PCL injury

CO: insecurity of knee OE: abrasion on proximal tibia (anterior) mild swelling posterior drawer test

Posterior sag sign

PCL

Meniscal tear CO: Pain after quick twisting or squatting Locking OE: Swelling Joint line tenderness McMurray test

Meniscal tear

Extensor mechanism injury Quadriceps tendon rupture Patellar tendon rupture Patellar instability

Quadriceps tendon rupture Aged, poorly conditioned (descending,jumping) CO: severe anterior knee pain snap fall suddenly OE: swelling, tenderness (local) Palpable gap proximal to patella inability to extend knee

Quadriceps tendon rupture

Patellar tendon rupture young athletic patients eccentric loading of quadriceps OE: Swelling, tenderness palpable defect at distal pole patella Impaired knee extension

Subluxation – Dislocation Patellar instability Subluxation – Dislocation Young adults Mechanism: direct blow, forceful Q contraction CO: Buckling Anterior knee pain Difficulty extending knee OE: Swelling (effusion-hemarthrosis) Tenderness medial patella Apprehension sign DD: history & X-ray

In almost 90% of knee injuries an accurate diagnosis can be reached through thorough history taking and careful clinical examination.

Thank you