Evaluation of Knee Injuries Dr. Alan A. Zakaria, D.O., M.S. 1080 - - PowerPoint PPT Presentation

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Evaluation of Knee Injuries Dr. Alan A. Zakaria, D.O., M.S. 1080 - - PowerPoint PPT Presentation

May 27, 2023 129 likes •467 views

Evaluation of Knee Injuries Dr. Alan A. Zakaria, D.O., M.S. 1080 Kirts Blvd., Suite 400 Troy, Mi., 48084 Team Physician United States Soccer Federation University of Michigan Mens and Womens Soccer Objective Identify main anatomic

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Evaluation of Knee Injuries

  • Dr. Alan A. Zakaria, D.O., M.S.

1080 Kirts Blvd., Suite 400 Troy, Mi., 48084 Team Physician United States Soccer Federation University of Michigan Men’s and Women’s Soccer

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Objective

Identify main anatomic components of the knee Perform basic knee exam along with special tests Identify common knee injury patterns and their physical exam findings.

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Anatomy

  • Bony Anatomy
  • Ligaments
  • Cartilage
  • Musculature
  • Other Soft Tissue
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Knee Anatomy

Two functional joints

– Femorotibial – Femoropatellar

Femoral condyles

– Flex/extend

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Knee Anatomy

Patella

– Sesamoid with two concave surfaces and vertical ridge – Increases efficiency of extension

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Knee Anatomy: Anterior Cruciate Ligament (ACL)

Run inferior, anterior, and medially Arises from medial aspect lateral femoral condyle Insert lateral to medial tibial eminence Restrains anterior subluxation of tibia on femur

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Knee Anatomy: Posterior Cruciate Ligament (PCL)

Arises from the posterior intercondylar area of the tibia Inserts at the medial condyle of the femur Restrains posterior subluxation of the tibia on the femur

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Knee Anatomy: Medial Collateral Ligament (MCL)

Postero-superior medial femoral condyle to proximal end of tibia Maximum tension at full extension Restraint to valgus stress

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Knee Anatomy: Lateral Collateral Ligament (LCL)

Posterosuperior lateral femoral condyle to lateral head of fibula Restraint to varus stress

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Knee Anatomy: Meniscus

Load bearing, joint stability, shock absorption Peripheral third vascularized

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Knee Anatomy: Articular Cartilage

Hyaline cartilage that covers the femoral condyles, tibial plateau, and undersurface of the patella Shock absorbing structure that can withstand compression, tension, and shearing forces and dissipate load

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Knee Anatomy: Muscles

Quadriceps Hamstrings Iliotibial tract Pes Anserine

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Knee Anatomy: Pes Anserine

Composed of the conjoined tendons of the semitendinosus, gracilis, and sartorius muscles Inserts onto the anteromedial proximal tibial bone

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Knee Anatomy: Patellar and Pes Anserine Bursa

Synovial fluid-filled sacs that provide a cushion between bones and tendons and/or muscles around a joint Prepatellar bursa located superior to the patella

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Patient History.

  • Nature of symptoms
  • Location
  • Timing/Duration
  • Quality and Quantity
  • Trauma or preceding

event

  • Exacerbating or

relieving factors

  • Past History
  • Age
  • Occupation or

recreational activities

  • Clicking or popping
  • Locking or catching
  • Giving Way
  • Swelling
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Physical Exam

  • Observation
  • Range of Motion
  • Palpation
  • Strength Testing
  • Special Testing
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Observation

Anterior view standing

  • Genu valgum/varum, patella position, foot architecture

Posterior view standing

  • Genu valgum/varum, foot architecture

Anterior and lateral views sitting

  • Patella position/tracking, osgood schlatter’s changes

Gait

  • General changes, motion of patella, foot architecture
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Palpation

Anterior with knee extended

  • Swelling or effusion
  • Prepatellar bursa, patellar

tendon, plica

  • Quad and tendon
  • Pes Anserine

Lateral

  • Lateral meniscus
  • LCL
  • IT Band

Medial

  • Medial meniscus
  • Medial collateral ligament
  • Pes Anserine

Posterior

  • Hamstrings
  • Gastrocnemius
  • Popliteal fossa
  • Baker’s Cyst
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Range of Motion

  • Flexion – 135 -140 degrees
  • Extension – 0 degrees
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Strength Testing (5 point scale)

Flexion

  • Hamstring
  • Gracilis, sartorius
  • Popliteus
  • Gastrocnemius

Extension

  • Quadriceps
  • Tensor Fasciae Latae
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Collateral Ligaments

MCL

  • Valgus stress at 0

and 30 degrees LCL

  • Varus stress at 0 and

30 degrees

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ACL

  • Lachman
  • Anterior Drawer
  • Pivot Shift
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PCL

  • Posterior Sag
  • Posterior Drawer
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Meniscus

  • McMurray
  • Apley’s
  • Bounce Home
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Patellofemoral

  • Active patellar

grind/crepitus

  • Apprehension/hyper

mobility

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Others

Ober’s Test

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Diagnostic Imaging

X-rays:

  • AP
  • Lateral
  • Sunrise
  • Notch
  • Weight bearing
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Diagnostic Imaging

  • CT – More detailed bony evaluation
  • MRI – More detailed bony evaluation and

good evaluation of soft tissue structures

  • Ultrasound – Good, detailed evaluation of

more superficial soft tissue structures

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Summary

Knee Anatomy Basic physical exam Special tests

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Thank You!