Common MSK Knee Injuries Flashcards
ACL - Characteristics (3)
Prevents anterior tibial translation.
Assisted actively by hamstrings.
Contains mechanoreceptors -> ACL injury: altered neuromuscular control (proprioception).
ACL Rupture - Mechanism of Injury
Approximately 30° knee flexion and valgus stress
ACL Rupture - Risk Factors
Female, 15-40 years old.
Cutting, non-contact (78%) sport: handball, football, volleyball.
ACL Rupture - Subjective Assessment (4)
Sudden onset
Rapid moderate to severe swelling
Instability
Pain that decreases quite quickly (rupture)
ACL Rupture - Objective Assessment (5)
Swelling
Positive Lachman’s
Positive anterior drawer
Positive lever sign
Can have associated MCL and medial menisci tests (terrible triad).
PCL Rupture - Characteristics and Mechanism of Injury
Quads help prevent posterior tibial translation.
Usually direct blow to tibia in posterior direction with knee flexed.
PCL Rupture - Clinical Tests (2)
Positive posterior sag test
Positive posterior drawer test
MCL Tear - Mechanism of Injury
Rapid valgus motion with flexed knee (like ACL), cutting, landing, jumping.
Often occur with ACL and medial menisci (MCL attaches to it) Terrible triad.
MCL Tear - Clinical Tests (3)
Valgus stress test (0° & 30°): pain and/or laxity.
Palpation medial joint line: pain on MCL.
Instability: episodes of giving way.
Check also ACL.
LCL Tear - Characteristics and Mechanism of Injury
Less common, more stable.
Usually direct trauma/force to medial knee -> varus force.
LCL Tear - Clinical Tests (2)
Pain over lateral knee joint.
Positive varus stress test.
Meniscal Tear - Characteristic and Mechanism of Injury
Long healing process due to poor blood supply.
Young athletes or old, degenerative.
Twisting/pivoting motion. Knee flexion, compression and femoral rotation.
Meniscal Tear - Signs and Symptoms (4)
Possible tearing feeling at time of injury.
Pain and swelling increasing over 24h.
Intermittent locking.
Joint line tenderness.
Meniscal Tear - Clinical Tests (6)
Turning, change in direction, jumping: painful.
Clicking: may or may not.
McMurrays: pain and/or clicking.
Thessalys: pain and/or clicking.
Knee ROM: pain depending on location of injury, with overpressure.
Joint line palpation: Pain depending on location of injury.
Patellofemoral Pain Syndrome - Characteristics
Gradual onset.
Mild to moderate pain over PFJ, can be diffused or vague.
From chronic overload, poor knee biomechanics, abnormal anatomical alignment.
Patellofemoral Pain Syndrome - Risk Factors (2)
Female
Runners with a combo of increased:
- Hip add, IR, extension.
- Knee valgus, IR.
- Ankle DF, foot pronation.
Patellofemoral Pain Syndrome - Clinical Tests (3)
Squat, stairs, run, jog, hop: anterior knee pain.
Patella palpation: pain.
Knee extension strength: <1,5 BW in 1RM and pain.
Patella Tendinopathy (Jumper’s Knee) - Characteristics
Localized pain on patella tendon.
Repetitive jumping sport.
Patella Tendinopathy (Jumper’s Knee) - Clinical Tests (4)
Jump, run, jog, hop: pain on patella tendon.
Visa questionnaire: <80.
Ultrasound: positive changes on doppler imaging.
Knee extension strength: <1,5BW on 1RM / pain.
PFPS vs Patella tendinopathy (5)
Non-specific pain vs patella tendon pain.
Small swelling vs. increased thickness, no swelling.
Quad contraction normal vs painful.
Restricted medial direction vs normal
Taping might decrease pain vs no change.
Knee OA - Characteristics
More frequent in medial compartment.
Higher risk with prior ACL and/or meniscal injury.
Knee OA - Clinical Tests (6)
STS, walking, stairs: pain and difficulty (later stages).
Stiffness in AM: may or may not.
Palpation: cold, hard feeling.
Swelling after aggravation.
Knee ROM: decreased flexion, extension and pain with overpressure.
x-ray: joint space changes.
