The Knee

Question 1

S&S of Ottawa Knee Rules

Answer 1

Age > 55

• Tenderness at head of fibula
• Isolated tenderness of patella
• Inability to flex knee to 90º
• Inability to walk 4 total weight-bearing steps (limping ok)

Question 2

S&S of Pittsburgh Decision Rules

Answer 2

Blunt trauma of a fall as mechanism of injury plus any of the following

• Age <12 or >50 years old
• Inability to walk 4 total weight-bearing steps

Question 3

S&S of Distal Femur Fractures

Answer 3

NWB x6 weeks

Very slow to heal (bony union at 4-6 months)

Question 4

S&S of Knee Osteoarthritis

Answer 4

May have antalgic gait

Pain with weight-bearing/compression

May have history of previous knee trauma/overuse

Question 5

S&S of MCL Tear

Answer 5

Swelling on medial side of the knee

Pain with extension

Tenderness to palpation

Question 6

S&S of LCL Tear

Answer 6

Swelling on lateral side of the knee

Tenderness to palpation

Question 7

S&S of ACL Tear

Answer 7

History of a ‘pop’ or giving way

Immediate swelling

Question 8

S&S of PCL Tear

Answer 8

Limited swelling

Question 9

S&S of Meniscal Injuries

Answer 9

Pain worse with movement, better with rest

Swelling appears ~24 post injury

Question 10

S&S of PFPS

Answer 10

Pain with stairs

Pain with prolonged sitting

Sudden increase in activity/training

Tender to palpation under patella

Question 11

S&S of Bursitis at the Knee

Answer 11

Due to excessive pressures or sudden incrase in activity level

Tightness in certain muscle groups

Question 12

S&S of Patellar Tendinopathy

Answer 12

Palpation tenderness

Pain with knee extension AROM and resistance

Question 13

S&S of a Plica

Answer 13

Can present similar to PFPS

May report snapping/popping sensation

Can be irritated during flexion or extension

AROM extension may be painful

Pain with medial glide of patella

Question 14

S&S of ITB Syndrome

Answer 14

May complain of popping or crepitus

Sudden increase in activity level

AROM knee flexion may be painful

Tender to palpation

Weak glut. med.

Question 15

Special Test for Distal Femur Fractures

Answer 15

Sign of the buttock

Question 16

Special Test for Patellar Fractures

Answer 16

Sun-rise X-ray view

Question 17

Special Tests for Segund Fractures

Answer 17

ACL tests

Hughston’s Drawer Sign

Question 18

Special Tests for Knee Osteoarthritis

Answer 18

Compression and Distraction

Accessory motions

PROM/AROM

Question 19

Special Test for MCL Tear

Answer 19

Valgus accessory motion in 20º knee flexion and full extension

Question 20

Special Tests for ACL Tear

Answer 20

Anterior Drawer

• Also try with tibia IR, should have less movement if ACL is intact

Pivot-shift

Reverse Pivot-shift

Lachman’s

Question 21

Special Tests for PCL Tear

Answer 21

Sag sign

Posterior Drawer

External Rotation Recurvatum test

Dial test

Question 22

Special Tests for Meniscal Injuries

Answer 22

Four hallmark findings (better than MRI is all are positive)

• Joint line tenderness
• Mild to moderate effusion over 1-2 days
• Quad atrophy
• Positive entrapent test:

1. Apley’s
2. McMurray’s
3. Thessaley’s
4. Squat

Question 23

Special Tests for PFPS

Answer 23

McConnell Test

Q-angle

Accessory motions

VMO coordination/activation test

Single leg squat, squat, & step down

Question 24

Special Tests for Plica

Answer 24

Stutter test

Hughston’s Plica Test

Question 25

Special Tests for ITB Syndrome

Answer 25

Ober’s test

Noble Compression test