Knee Disorders

PA Study Sesh

This week on PA Study Sesh, we will be covering disorders of the knee and proximal tibia.
* Medial and lateral collateral ligament injuries (MCL & LCL)
* MCL=valgus stress LCL= varus stress
* MCL more common than LCL injury
* Grade I & II (sprain & incomplete tear)= conservative
* Grade III (complete) = surgical
* ACL (anterior cruciate ligament) injury
* #1 knee ligament injury
* MOI: pivoting injury, may also be hyperextension
* Females > Males
* May have associated meniscus injury
* Unhappy (O’Donoghue’s) triad: ACL, MCL, medial meniscus tear
* May also have associated lateral tibial condyle avulsion= Segond fx
* Pathognomonic for ACL tear
* Symptoms: swelling +/- hemarthrosis, “buckling”
* Lachman’s test= most sensitive
* Patient supine
* Knee flexed 20-30 degrees
* Stabilize femur and pull tibia forward
* Lack of firm endpoint is positive
* Compare both sides
* Patient needs to be fully relaxed
* Anterior Drawer
* Hip & knee bent to 90
* Stabilize foot (sit on it)
* Thumbs on joint line & pull forward
* + translates anterior without a firm endpoint
* Diagnosis MRI. May consider Xray
* PT vs Surgery (primarily surgical for younger patients)
* PCL (posterior cruciate ligament)
* Dashboard injury
* Anterior force while knees are flexed
* Typically not seen in athletes
* Posterior Drawer Test
* Posterior Sag Sign
* Elevate leg and will see the leg “sag”
* Tx: surgical
* Meniscal Tears
* Medial 3x>>> lateral (lateral is injured less)
* Less mobile & more stress is able to be applied medially
* Degenerative or traumatic (twisting or hyperflexion)
* Joint line pain
* “locking”, popping, giving way
* Difficulty with stairs (up or down) & squats
* McMurray’s Test
* Lots of ways to describe
* Grab heel with one hand and joint line with another
* Medial= externally rotate heel, flex knee, extend while providing valgus stress
* Lateral= internally rotate heel, flex knee, extend while providing varus stress
* Tx: Conservative vs Surgical
* PFPS (patellofemoral pain syndrome) aka chondromalacia
* #1 knee complaint in primary care
* Injury to patellar cartilage
* Commonly seen in runners
* Pain “under” or “behind” patella
* crepitation
* + Long car ride or theatre sign
* Difficulty with stairs
* Look for malignment and improper patellar tracking
* + patellar glide, patellar grind, patellar apprehension. Used to assess mobility and associated pain with patellar movement
* Tx: conservative, NSAIDS, rest, PT
* Patellar Tendonitis
* “jumpers knee”
* Pain of patellar tendon
* Conservative tx
* IT Band Syndrome
* #1 cause of knee pain in runners
* Lateral knee pain
* + Ober Test
* Conservative tx
* Baker’s Cyst
* Pain & swelling with prolonged standing
* May be asymptomatic
* Tx: NSAIDS, Aspiration/Injection, Compression Brace. Surgery rare
* Patellar Fracture
* MOI: direct blow
* extreme contraction of quads [kiddos (patellar sleeve)]
* X-ray: AP, lateral & Sunrise views
* Tx: immobilized in extension. Refer to ortho for cast vs surgery
* Patellar Dislocation
* MOI: Twisting on a flexed knee