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11 December 2019
The Evaluation and Management of
Common Disorders of the Knee
Joseph P. DeAngelis, MD, MBA
Assistant Professor, Orthopaedic Surgery
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MACOPYRIGHT
Disclosures
Appointments
AAOS Evidence-Based Quality & Valued Committee
Performance Measures
Consultancies
Forensis, GLG Group, Health Transformation Institute, KOL Groups,
Lumelian, Scope Medical
Research Support
Arthrex, Ceterix, DePuy Synthes, Major League Baseball, Smith &
Nephew
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Objectives
1. To understand the applied pathoanatomy of the knee as it
relates to common injuries and clinical complaints.
2. To recognize the critical elements within the history and
physical examination that warrant advanced imaging.
3. To appreciate the rationale for surgical treatment within
the continuum of patient care.COPYRIGHT
Plan of Attack
• Anatomy
• Function
• Common Injuries & Conditions
• Treatment
• Non-Operative & Surgical
• What Will Keep Your Knees Healthy
• StretchCOPYRIGHT
Secrets to Success
1.Stretch / Flexibility
2.Balance / Proprioception
3.Lateral-based movement
4.Core strength
5.Variety
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Knee Anatomy
• Bones
• Cartilage
• Ligaments
• Tendons
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Anatomy
Anterior Posterior (AP) View of Both Knees – Weight Bearing
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AP View of Both Knees – Weight BearingLateral View of Right Knee
Sunrise View of Right KneeCOPYRIGHT
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AP View of Right Knee AP View of Right Knee
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Knee Anatomy
• Bones
• Femur, Tibia, Patella
• Cartilage
• Articular & Meniscal
• Ligaments
• Tendons
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Knee Anatomy
• Bones
• Femur, Tibia, Patella
• Cartilage
• Articular & Meniscal
• Ligaments
• Collateral: Medial (MCL) & Lateral (LCL)
• Cruciate: Anterior (ACL) & Posterior (PCL)
• TendonsCOPYRIGHT
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Knee Anatomy
• Bones
• Femur, Tibia, Patella
• Cartilage
• Articular & Meniscal
• Ligaments
• Collateral: Medial (MCL) & Lateral (LCL)
• Cruciate: Anterior (ACL) & Posterior (PCL)
• Tendons
• Quadriceps -> Patellar
• Hamstring
• Iliotibial Band
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Knee Anatomy
• Bones
• Femur, Tibia, Patella -> Fractures
• Cartilage
• Articular & Meniscal
• Ligaments
• Collateral: Medial (MCL) & Lateral (LCL)
• Cruciate: Anterior (ACL) & Posterior (PCL)
• Tendons
• Quadriceps -> Patellar
• Hamstring
• Iliotibial Band
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Knee Injuries
• Bones
• Femur, Tibia, Patella
• Cartilage
• Articular & Meniscal -> Torn vs. Worn Out
• Ligaments
• Collateral: Medial (MCL) & Lateral (LCL)
• Cruciate: Anterior (ACL) & Posterior (PCL)
• Tendons
• Quadriceps -> Patellar
• Hamstring
• Iliotibial Band
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• Pot hole vs. worn shoe/tire
• Pebble in shoe vs. frayed pants
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Knee Injuries
• Bones
• Femur, Tibia, Patella
• Cartilage
• Articular & Meniscal
• Ligaments -> Sprained or or Torn
• Collateral: Medial (MCL) & Lateral (LCL)
• Cruciate: Anterior (ACL) & Posterior (PCL)
• Tendons
• Quadriceps -> Patellar
• Hamstring
• Iliotibial Band
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Knee Injuries
• Bones
• Femur, Tibia, Patella
• Cartilage
• Articular & Meniscal
• Ligaments
• Collateral: Medial (MCL) & Lateral (LCL)
• Cruciate: Anterior (ACL) & Posterior (PCL)
• Tendons -> Sprained vs. Torn
• Quadriceps -> Patellar
• Hamstring
• Iliotibial Band
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Secrets to Success
1.Stretch / Flexibility
2.Balance / Proprioception
3.Lateral-based movement
4.Core strength
5.VarietyCOPYRIGHT
bidmc.org/sports
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Bibliography
• Covey CJ, Hawks MK. Nontraumatic knee pain: a diagnostic & treatment
guide.
• J Fam Pract. 2014 Dec;63(12):720-8.
• Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N
Engl J Med. 2008 Nov 13;359(20):2135-42. doi: 10.1056/NEJMcp0804745.
• Schraeder TL, Terek RM, Smith CC. Clinical evaluation of the knee. N Engl J
Med. 2010 Jul 22;363(4):e5. doi: 10.1056/NEJMvcm0803821.COPYRIGHT