INSPECTION

THE KNEE EXAMINATION1Anatomy of Knee3 Bones:- Tibia, Femur, Patella3 Compartments- Medial, Lateral, Patellofemoral 4 Ligaments- MCL, LCL, ACL, PCL2 MeniscusArticular Cartilage

2Anatomy & Physiology of Knee

CHIEF COMPLAINSPainSwelling Stiffness Mechanical disorder (locking, giving way, )DeformityLimpPosition of the ExaminationStandingSittingSupineProne INSPECTION-SIGNS WITH THE PATIENT UPRIGHTDeformity (valgus or varus or hyperextension)

Examination standing : Look at the general shape and posture, rst from in front and then from behind. Look for swelling of the joint or wasting of the thigh muscles.Blunt disease: kedaan varuspada anak2Gmbr ketiga: locking knee and valgus6INSPECTION-SIGNS WITH THE PATIENT LYING SUPINEExamination with the patient supine Wasting of the quadriceps occurs rapidly after any internal derangement of the knee. The girth is measured at the same level in both limbs, about a hands breadth above the patella.

PALPATIONTests for Intra-articular FluidCross Fluctuation :This test is applicable only if there is a large effusion. The left hand compresses and empties the suprapatellar pouch while the right hand straddles the front of the joint below the patella By Squeezing with each hand alternately, a uid impulse Is transmitted across the joint.

The Patellar Tap : Again the suprapatellar pouch is compressed with the left hand to squeeze any uid from The pouch into the joint. With the other hand the Patella is then tapped sharply backwards onto the Femoral condyles.

The Bulge Test :Compress or stroked medial sideof knee to proximally to move the fluid away.Positive Bulge appear at the medial of patella.

The Juxta-Patellar Hollow Test : Normally, when the knee is exed, a hollow appears lateral to the patellar ligament and disappears with further exion; If there Is Excess uid, the hollow lls and disappears at a lesser Angle of exion. Compare this in The two knees.

SPECIAL TESTSSpecial Test - ACL InjuryLachman Test :

Knee flexed to 20-30 degreesAnterior force on tibia.Laxicty indicates ACL injury.

Anterior drawer :

Knee flexed to 90 degreesAnterior force on tibia.Laxity/anterior translation : ACL Injury.

14Special Test - ACL InjuryPivot shift:Supine, extend knee,foot to flex hip 45, IR, Valgus force on proximal tibia, then flex kneeClunk with knee flexion indicates ACL injury.

15Special Test - PCL InjuryPosterior Drawer TestKnee flexed to 90 degreesPosterior force on tibia.Posterior translation : PCL Injury

Posterior Sag Sign :Supine, hip 45, knee 90, view lateralyPosterior translation of tibia (on femur ) indicates PCL Injury.

16Meniscal Injury : McMurray test Test Medial and Lateralmeniscus separately.MedialFlex/varus/ER knee,then extendLateralFlex/valgus/IR knee,then extendPositive : pop or pain

17Patient supineHeel of patients injured leg held while knee fully flexedFingers of other hand palpate medical joint line while thumb palpates lateral aspect of jointValgus stress appliedPatients knee extended with tibia held externally rotatedPain or palpable click over medial joint line indicates medical meniscal tearMeniscal Injury : Apleys Compression Prone, knee 90, compress and rotate.Positive : pop or pain

18Patient supineHeel of patients injured leg held while knee fully flexedFingers of other hand palpate medical joint line while thumb palpates lateral aspect of jointValgus stress appliedPatients knee extended with tibia held externally rotatedPain or palpable click over medial joint line indicates medical meniscal tearSpecial Test - MCL InjuryValgus Stress Testing :

Knee flexed to 30 degrees

Lateral force applied to knee

Look and feel for translation and endpoint

Compare to uninjured side

May repeat with knee in full extension

19Special Test - LCL InjuryVarus Stress Testing :

Same test as valgus stress testing

Except applying medial force to knee at 30

20Special Test - Meniscal InjuryThessaly Test :Patient stands on affected legKnee bent at 20Examiner holds pts hands and rotates pt to both sides.Meniscal grindPositive test: pain, painful click.

Radiologic Imaging

Anterior-Posterior (AP) and Lateral. In the context of trauma the Lateral view is acquired with the patient lying supine and with a horizontal X-ray beam. This allows effusions to be visualised in the suprapatellar pouch.Knee X-RayKnee X-Ray : Lateral

It looks like a sun floating above the horizon. This view demonstrates the patellofemoral joint space. When looking at the normal Sunrise view:There is space between the patella and the femur (patellofemoral joint space).The bones are more opaque than surrounding soft tissue.The patella is projected free of superimposition.

SUNRISE VIEWCT- ScanUseful for showing patello-femoral congruence at various angles of flexion

MRIMore helpful in identifying the knee disorder so we can make an early diagnosis