Transcript Evaluation of Knee Injuries

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
 Timing/Duration
recreational activities
 Clicking or popping
 Locking or catching
 Giving Way
 Swelling
 Quality and Quantity
 Trauma or preceding
event
 Exacerbating or
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
 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
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!