Common MSK Knee Injuries

Question 1

ACL - Characteristics (3)

Answer 1

Prevents anterior tibial translation.
Assisted actively by hamstrings.
Contains mechanoreceptors -> ACL injury: altered neuromuscular control (proprioception).

Question 2

ACL Rupture - Mechanism of Injury

Answer 2

Approximately 30° knee flexion and valgus stress

Question 3

ACL Rupture - Risk Factors

Answer 3

Female, 15-40 years old.
Cutting, non-contact (78%) sport: handball, football, volleyball.

Question 4

ACL Rupture - Subjective Assessment (4)

Answer 4

Sudden onset
Rapid moderate to severe swelling
Instability
Pain that decreases quite quickly (rupture)

Question 5

ACL Rupture - Objective Assessment (5)

Answer 5

Swelling
Positive Lachman’s
Positive anterior drawer
Positive lever sign
Can have associated MCL and medial menisci tests (terrible triad).

Question 6

PCL Rupture - Characteristics and Mechanism of Injury

Answer 6

Quads help prevent posterior tibial translation.
Usually direct blow to tibia in posterior direction with knee flexed.

Question 7

PCL Rupture - Clinical Tests (2)

Answer 7

Positive posterior sag test
Positive posterior drawer test

Question 8

MCL Tear - Mechanism of Injury

Answer 8

Rapid valgus motion with flexed knee (like ACL), cutting, landing, jumping.
Often occur with ACL and medial menisci (MCL attaches to it) Terrible triad.

Question 9

MCL Tear - Clinical Tests (3)

Answer 9

Valgus stress test (0° & 30°): pain and/or laxity.
Palpation medial joint line: pain on MCL.
Instability: episodes of giving way.
Check also ACL.

Question 10

LCL Tear - Characteristics and Mechanism of Injury

Answer 10

Less common, more stable.
Usually direct trauma/force to medial knee -> varus force.

Question 11

LCL Tear - Clinical Tests (2)

Answer 11

Pain over lateral knee joint.
Positive varus stress test.

Question 12

Meniscal Tear - Characteristic and Mechanism of Injury

Answer 12

Long healing process due to poor blood supply.
Young athletes or old, degenerative.
Twisting/pivoting motion. Knee flexion, compression and femoral rotation.

Question 13

Meniscal Tear - Signs and Symptoms (4)

Answer 13

Possible tearing feeling at time of injury.
Pain and swelling increasing over 24h.
Intermittent locking.
Joint line tenderness.

Question 14

Meniscal Tear - Clinical Tests (6)

Answer 14

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.

Question 15

Patellofemoral Pain Syndrome - Characteristics

Answer 15

Gradual onset.
Mild to moderate pain over PFJ, can be diffused or vague.
From chronic overload, poor knee biomechanics, abnormal anatomical alignment.

Question 16

Patellofemoral Pain Syndrome - Risk Factors (2)

Answer 16

Female
Runners with a combo of increased:
- Hip add, IR, extension.
- Knee valgus, IR.
- Ankle DF, foot pronation.

Question 17

Patellofemoral Pain Syndrome - Clinical Tests (3)

Answer 17

Squat, stairs, run, jog, hop: anterior knee pain.
Patella palpation: pain.
Knee extension strength: <1,5 BW in 1RM and pain.

Question 18

Patella Tendinopathy (Jumper’s Knee) - Characteristics

Answer 18

Localized pain on patella tendon.
Repetitive jumping sport.

Question 19

Patella Tendinopathy (Jumper’s Knee) - Clinical Tests (4)

Answer 19

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.

Question 20

PFPS vs Patella tendinopathy (5)

Answer 20

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.

Question 21

Knee OA - Characteristics

Answer 21

More frequent in medial compartment.
Higher risk with prior ACL and/or meniscal injury.

Question 22

Knee OA - Clinical Tests (6)

Answer 22

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.