1. 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

2. 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.

3. Anatomy
Bony Anatomy
Ligaments
Cartilage
Musculature
Other Soft Tissue

4. Knee Anatomy Two functional joints Femoral condyles Femorotibial
Femoropatellar
Femoral condyles
Flex/extend

5. Knee Anatomy
Patella
Sesamoid with two concave surfaces and vertical ridge
Increases efficiency of extension

6. 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

7. 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

8. 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

9. Knee Anatomy: Lateral Collateral Ligament (LCL)
Posterosuperior lateral femoral condyle to lateral head of fibula
Restraint to varus stress

10. Knee Anatomy: Meniscus
Load bearing, joint stability, shock absorption
Peripheral third vascularized

11. 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

12. Knee Anatomy: Muscles Quadriceps Hamstrings Iliotibial tract
Pes Anserine

14. Knee Anatomy: Pes Anserine
Composed of the conjoined tendons of the semitendinosus, gracilis, and sartorius muscles
Inserts onto the anteromedial proximal tibial bone

15. 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

16. Patient History. Nature of symptoms Location Timing/Duration
Quality and Quantity
Trauma or preceding event
Exacerbating or relieving factors
Past History
Age
Occupation or recreational activities
Clicking or popping
Locking or catching
Giving Way
Swelling

17. Physical Exam Observation Range of Motion Palpation Strength Testing
Special Testing

18. 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

20. Palpation Anterior with knee extended Swelling or effusion
Prepatellar bursa, patellar tendon, plica
Quad and tendon
Pes Anserine
Lateral
Lateral meniscus
LCL
IT Band
Medial
Medial meniscus
Medial collateral ligament
Pes Anserine
Posterior
Hamstrings
Gastrocnemius
Popliteal fossa
Baker’s Cyst

21. Range of Motion
Flexion – degrees
Extension – 0 degrees

22. Strength Testing (5 point scale)
Flexion
Hamstring
Gracilis, sartorius
Popliteus
Gastrocnemius
Extension
Quadriceps
Tensor Fasciae Latae

23. Collateral Ligaments MCL Valgus stress at 0 and 30 degrees LCL
Varus stress at 0 and 30 degrees

24. ACL
Lachman
Anterior Drawer
Pivot Shift

25. PCL
Posterior Sag
Posterior Drawer

26. Meniscus
McMurray
Apley’s
Bounce Home

27. Patellofemoral Active patellar grind/crepitus
Apprehension/hyper mobility

28. Others
Ober’s Test

29. Diagnostic Imaging
X-rays: AP
Lateral
Sunrise
Notch
Weight bearing

30. 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

31. Summary
Knee Anatomy
Basic physical exam
Special tests

32. Thank You!