Knee Injury Introduction Objectives Basic Anatomy More Basic Anatomy Range Of Motion. Function of Knee Structures Types of Knee Injuires a.) Acute Injury b.) Ligament Injury in lower leg. c.) Sprain ACL Injuires. ACL Injury Diagnosis Step wise Evaluation Various Tests Evaluation( PCL, Medial, Lateral ) Chronic Injuries Preferred Equipment . Thankyou

1. ALL ABOUT KNEE INJURY
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BY : PRIYANKA

2. Objectives
• To provide a review of common knee injuries,
• To describe the epidemiology of these injuries,
• To review the diagnostic examinations available for
further evaluation,
• To describe the preliminary management of knee
injuries,
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3. Basic Anatomy of the Knee
• Large Hinge Joint
• Major bones:
Femur
Tibia
Fibula
Patella
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4. More Basic Anatomy
• Ligaments
• Medial Collateral
Ligament (MCL)
• Lateral Collateral
Ligament (LCL)
• Anterior Cruciate
Ligament (ACL)
• Posterior Cruciate
Ligament (PCL)
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5. The 2 Cruciates
• ACL : passes from anterior intercondyloid fossa
of tibia to the back part of the medial surface of
the lateral condyle of the femur.
• PCL: This is shorter and stronger ligament
than the ACL, passing upward and forward from
the posterior intercondyloid fossa of the tibia to
the lateral and front part of the medial condyle
of the femur.
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6. Menisci
• The menisci are discs of fibro cartilage attached to tibial plateaus.
They are thicker along the periphery.

7. Range of Motion
• The knee should be able to range from
hyperextension to 135 degrees of flexion.
• Loss of active extension and inability to maintain
passive extension are indicative of quadriceps
and patellar tendon injuries.
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8. Functions of Knee Structures
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9. F
E
M
U
R
T
I
B
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A
PATELLA
The ACL prevents the
femur from sliding
posteriorly on the tibia or
the tibia from sliding
anteriorly on the femur.
The PCL prevents the femur
from sliding anteriorly on the
tibia or the tibia from sliding
posteriorly on the femur.

10. Menisci Function
• increases stability by
deepening tibial plateaus
• decreases friction by 20%
• increases contact area by
70%
• absorbs shock
• removal of menisci does NOT
preclude normal motion, but
.increase wear on
articulating surfaces
.increase chance of
developing degenerative
joint disease

11. Types of Knee Injuries
• Injuries to one or more of the ligaments of the
knee (ACL, PCL, MCL, and LCL)
• Injuries to the bony structures (Patellar
fractures, femur fractures, tibial fractures)
• Injuries to the meniscus and articulating surface
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12. Acute injuries
1.injuries to the ligaments
2.injuries to the cartilages
3. bone injuries
a. patella fracture
b. epiphysial fractures
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13. Ligamentous Injuries
• ACL injuries
• PCL injuries
• MCL injuries
• LCL injuries
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14. ACL injury
1) attempting a rapid cutting maneuver
with foot in contact with the ground and
knee flexed (problem exacerbated if an
external force applied to knee during
this movement)
2) knee hyperextension with internal
tibial rotation
Example
backward falling skier - boot and
skis accelerate forward creating an
anterior drawer mechanism

15. ACL injuries
• 50% of ACL injuries are associated with meniscal injuries
• Often associated with bleeding and thus immediate
swelling
• Grade I and II should be managed conservatively with
pain meds and range of motion exercises
• Patient should be made non weight bearing
• If possible, patient should not be placed in a knee
immobilizer if an isolated injury
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16. Torn Anterior Cruciate Ligament
• Signs and Sx
▫ Hear or feel a pop
▫ Rapid effusion
▫ Buckling of the knee
▫ Guarding will occur quickly so
special tests need to be done
within 5 minutes of injury
• Treatment
▫ Splinting, ice, compressive
wrap and crutches.
▫ Surgery for a ACL tear in
necessary
▫ Not typically seen with
grades, but they do occur
▫ MRI is confirmation for
diagnosis

17. ACL injuries also commonly occur with
hyperextension of the knee, deceleration and
valgus stress.

19. ACL Injury Diagnosis
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20. Stepwise evaluation of the injured
knee
• Palpate the knee and determine the areas of maximal
tenderness
• Examine and note the presence and location of any
effusion
• Evaluate the Range of Motion at the Knee
• Evaluate the movement and stability of the patella
• Perform specific ligamentous stability testing
• Perform Meniscal examination
• Examine for neurovascular compromise
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21. ACL Testing
Anterior Drawer sign
• Supine position.
• hip flexed 45 degrees, the
knee passively held in 90
degrees of flexion with the
tibia in neutral rotation.
• The examiner stabilizes the
lower extremity by gently
sitting on the foot.
• A gentle anterior force to the
proximal tibia is applied

22. Lachman Test
• Supine position.
• The knee is passively held in 30 degrees of flexion.
• With one hand, the distal femur is stabilized and with
the other hand a gentle anterior force to the proximal
tibia is applied.

23. PCL injuries
• Hyperflexion and Dashboard injuries when
isolated injury
• Generally managed non-operatively
• Treated long term with quadriceps
strengthening
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24. PCL Injuries
Most common mechanism for PCL alone to be injured is from a direct blow to
the front of the knee while the knee is bent.
Automobile accident
1. Automobile strikes another and stops suddenly
2. Front passenger or driver slides forward.
3. Bent knee hits the dashboard just below the knee cap forcing tibia
backwards on the femur tearing PCL.
The same force can occur during a fall on the bent knee, where
the force of the fall on the tibia pushes it back against the femur
and tears the posterior cruciate ligament (PCL).

25. PCL injury diagnosis
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26. PCL Testing
• Posterior Drawer sign
▫ Gold Standard
▫ Performed similarly to
Anterior drawer sign
Posterior Sag Sign
-Observe the lag at maximum
muscle relaxation
-Compare to unaffected leg
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27. Posterior Drawer Test
• Patient is in the supine position.
• The hip is flexed 45 degrees and the knee is passively
held in 90 degrees of flexion with the tibia in neutral
rotation.
• The examiner stabilizes the lower extremity by sitting on
the foot.
• A gentle posterior force to the proximal tibia is applied.
• When the tibia moves posterior with respect to the
femur, the test is positive and a PCL.
• Sensitivity 51% to 90%. Specificity 99%.

28. Medial Collateral
Ligament Sprain:
Cause:
most common mechanism
is a blow to the outside of
the knee followed by
planting of the foot and
twisting of the knee.

29. Medial Collateral Ligament Sprain
• Signs and Sx
▫ Limited ROM
▫ Tenderness at either
insertion of MCL or along
ligament length.
▫ Various levels of pain and
laxity to medial knee
Special Test
Valgus Stress Test
• Treatment
▫ RICE and protect
▫ Ice and Interferential
▫ Straight leg strengthening
initially.
▫ Immobilize if necessary

30. MCL Testing
• Valgus stressing of the
MCL at both 0 and 30
degrees
• Testing at 30 degrees
removes the stabilization
provided by the cruciate
ligaments
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31. Lateral Collateral Ligament Sprain
• Not as common as the MCL
sprain.
• Caused by a medial force to
the knee joint or a twisting.
• Classified with 3 grades like
any other sprain.

32. Lateral Collateral Ligament Sprain
• Signs and Sx
▫ Limited ROM
▫ Tenderness at either insertion of LCL or along
ligament length.
▫ Various levels of pain and laxity to lateral knee

33. Lateral Collateral Ligament Sprain
• Treatment
▫ RICE and protect
▫ Ice and Interferential
▫ Straight leg
strengthening initially.
▫ Immobilize if necessary

34. LCL Testing
• LCL testing similar to
MCL testing
• Varus stress testing
• Performed at 0 and 30
degrees
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35. Meniscal Injuries
• Crescent shaped semilunar
fibrocartilaginous structures
• Diagnosis via MRI after
clinical suspicion
• Unless locking, initial
management is NSAIDs, ice,
knee immobilization, non
weight bearing, and
orthopedic referral
• Ultimate management is
determined often secondary
to associate ligamentous
injury
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36. Meniscal Tear
. Mechanism
▫ Young: twisting or pivoting
▫ Older: minor trauma
• Signs and Sx
▫ Swelling
▫ Catching
▫ Giving way
▫ Locking

37. Meniscal Testing
• McMurray’s Test to
evaluate for Meniscal
injury
• Positive test is
“clicking” along joint
line along with pain
during internal and
external rotation
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38. McMurrays Test
• The lateral meniscus is tested by:
▫ Passive flexion, valgus stress, and internal
rotation of the lower leg. During slow
extension of the knee while maintaining valgus
stress and internal rotation.
▫ A snap on the lateral joint line may be
palpated, this indicates a positive test.
• Sensitivity 51% to 53%, Specificity 59% to 97%.
• Therefore, a negative test does not exclude a
meniscal tear.

39. McMurray Test
• Patient in supine
• The medial meniscus is tested by:
▫ Passive flexion, varus stress, and external
rotation of the lower leg. During slow
extension of the knee while maintaining the
varus stress and external rotation.
▫ A snap on the medial joint line may be
palpated; this indicates a positive test.

40. Patellar Fractures
• If extension is possible
without displacement
▫ non operative
management
▫ Initially treated in knee
immobilizer
▫ Treated long leg cast 4-
6 weeks
▫ Operative management
consists of ORIF
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41. Patellar Testing
• Examine the patella,
with ROM testing,
feeling for catches
and grinding
• Next test the
movement of the
patella testing for
lateral laxity (Patellar
Dislocation
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openmichigan, YouTube

42. Chronic Injuries
1. Patellar Tendonitis
2. Patellofemoral Pain Syndrome
3. Subluxation of Patella
4. Chondromalacia
5. Osgood-Schlatters Disease
6. IT Band Syndrome

43. Iliotibial Band Syndrome
• IT-band
▫ thick strong band of
ligamentous tissue
▫ connects tensor fascia
latae to the lateral
condyle of the femur and
the lateral tuberosity of
the tibia
• IT-band rubs against
the lateral femoral
condyle when there is
excessive tension

44. Iliotibial Band Syndrome
• Special Tests- ober’s
• Treatment
▫ Modification of gait or
footwear
▫ Icing of the area
▫ Massage of the area
▫ Reduce activity

45. Chondromalacia
• This is a Latin term meaning “bad cartilage” or breakdown or
softening of the articular cartilage of the patella
• The cartilage surface on the underside of the patella becomes soft.
Part of the cartilage can become stringy and flake off at times. Part
of the surface may become roughened.
• Causes
1. Training errors
 Increasing intensity too soon
1. Weak vastus medialis muscle
2. Large Q angle
 Greater than 25 for women and 20 for men
1. Pronation of the foot causing the tibia to medial rotate
2. Gender - more common in women
3. Poor footwear and/or surface

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47. Epidemiology of Knee Injuries
• All Knee injuries
• Subset of
Ligamentous injuries
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48. Imaging Modalities
• Plain X-Rays
• CT
• Ultrasound
• Bone Scan
• MRI
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49. Ultrasound
• Often used to examine the musculature of a joint
while in use
• Provides dynamic imaging for examining muscle
tears, tendon ruptures, and other soft tissue
injuries.
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50. Magnetic Resonance Imaging
• Most useful for
examination of meniscal
injuries
• Can be used for
evaluating for
ligamentous injury
▫ ACL has high
sensitivity but poor
sensitivity in
determining complete
versus partial tear
▫ Very sensitive in PCL
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51. Preferred Treatment
• Acute: Rest, Ice, Activity Modification, Surgery
▫ Meniscal tears will not normally heal without help
unless very young
• Chronic: Surgical excision

52. Preferred Treatment
• Non Surgical: Activity Modification, Pain
Medications, Injections
• Surgical:
• Arthroscopic debridement and removal of lose
fragments
• Procedures to restore weight bearing surface
▫ Resurfacing, Cartilage Transplant, Joint Replacement

53. THANKYOU
FOR WATCHING…
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