Lecture 4: Knee Flashcards
Ligaments of the knee
ACL
PCL
LCL
MCL
Transverse Ligament
Which meniscus is bigger
Medial
What does the ACL do
Limits anterior displacement of the tibia
Differentiate diagnosis between PFPS and Chondromalacia Patellae
CP: more localised pain under kneecap where cartilage is located (sharp or aching pain), Fragmented appearance of cartilage beneath kneecap on X-ray, cartilage damage on MRI
PFPS: Pain in anterior aspect of knee, around kneecap (dull, ache, burning), X-rays and MRI often inconclusive and normal signs
Diagnosis of PFPS
Insidious onset of poorly defined pain (anterior retropatellar pain/peripatellar pain).
Pain in anterior aspect of knee, around kneecap (dull, ache, burning)
Slow build up or rapid development
Worsening of pain in loading positions
o Squatting (Full ROM)
o Going up/downstairs
o Running
o Prolonged sitting (Cinema Sign)
o Jumping
o No single diagnostic
Tends to worsen with activities such as squatting, sitting, climbing stairs, and running (aggravating factors)
Exclusion of other conditions that may cause anterior knee pain
o Chondromalacia Patellae
o Patella tendinopathy
o ITBS
o Meniscus tear
o Ligament injuries
Differential diagnosis for PFPS
Chondromalacia Patellae: more localised pain under kneecap where cartilage is located (sharp or aching pain), Fragmented appearance of cartilage beneath kneecap on X-ray, cartilage damage on MRI
Patella tendinopathy: localised pain at inferior pole of patella tendon
ITBS: more lateral pain, pain in calf, band flicking knee cap
Meniscus tear: McMurray’s Test
Ligament injuries:
ACL: Lachman’s, Anterior Drawer, Pivot Shift
PCL: Posterior Drawer
LCL: Varus Stress Test
MCL: Valgus Stress Test
Meniscus: McMurray
Normal Knee Flexion and Extension
Flexion: 135
Extension: 0 to -5
Diagnosis of Patella Tendinopathy
Pain localised in the tendon (inferior pole of the patellar or distal patellar tendon)
Load-related pain with a dose response component
Pain free at rest
Pain in a few cases can decrease with loading (warm up phenomenon), but it’s often increased the day after
Reduced strength in hip abduction, ER and extension
Reduced strength calf muscles
Reduced flexibility
Excessive foot pronation
Test: Patella Tendon Palpation, and Royal London Hospital Test
Diagnosis of Knee OA
Knee pain
Gradual onset, worsening with activity
Stiffness and swelling
Crepitus
Loss of ROM
Pain after prolonged sitting/resting
Age (older)
Diagnosis of Fat Pad Impingement
Increase in pain involving passive/active knee extension
Palpation
Also pain with movements close to EOR flexion once fat pad is swollen (patella can’t glide down)
A patient’s history may help to differentiate patellar tendinopathy from typical fat pad irritation. The patient with PT must have a history of eccentric loading of the quadriceps muscle such as running downhill, whereas a patient with a fat pad irritation presents after forceful extension manoeuvre
Hoffa’s Test
What test would you use for a meniscus tear
McMurray’s Test
What tests would you use for an ACL sprain
Lachman’s Test
Anterior Drawer Test
Pivot Shift
What tests would you use for an LCL sprain
Varus Stress Test
(Adduction of Tibia)
What tests would you use for an MCL sprain
Valgus Stress Test
(Abduction of tibia)
What tests would you use for a PCL sprain
Posterior Drawer, Sag sign, Reverse pivot shift
