Knee injuries
Dr Abir Naguib
•Knee pain is the most common
musculoskeletal complaint (1/3)
•Source of significant disability
•Most prevalent in physically active
individuals
Differential diagnosis of knee pain is extensive
Accurate diagnosis can be achieved by localizing the
anatomic site of pain & patient’s age
Trauma
•Fracture
•Ligament sprain
•Tendon rupture
•Meniscal tear
•Patellar dislocation
History
1.Pain characteristics:
Onset- location- duration- severity- qualityaggravating and relieving factors
2. Mechanical symptoms:
Pop
Locking
Giving way
3. Effusion:
Timing and amount
4. Ability to continue playing
5. History of previous injury
Exclude referred pain (hip injury)
6. Mechanism of injury
Contact
(Direction of blow)
Non-contact
(position of knee)
Twisting
Hyperextension
Deceleration
Non-contact injury
Hyperextension injury
Examination:
Inspection:
Swelling (location)
Ecchymosis
Atrophy
Palpation:
Tenderness
Active
ROM
passive
Stability tests
Joint line
Ligament course
Investigations
•Radiological
X-ray, CT, MRI
•Aspiration
(painful swollen joint)
Clear yellow
Blood
Blood + fat droplets
•Arthroscopy
MCL injury
•CO:
Pop at time of injury
Pain , swelling (medial)
•OE:
Tenderness, swelling along ligament course
Valgus stress test
LCL injury
Uncommon
Mechanism: blow to medial aspect knee
Varus force
Similar: (lateral)
Varus stress test
ACL injury
Pop
Immediate swelling
Giving way
Anterior drawer test
Lachman test
ACL
PCL injury
• CO: insecurity of knee
• OE: abrasion on proximal tibia (anterior)
mild swelling
posterior drawer test
Posterior sag sign
PCL
Meniscal tear
CO: Pain after quick twisting or squatting
Locking
OE: Swelling
Joint line tenderness
McMurray test
Meniscal tear
Extensor mechanism injury
Quadriceps tendon rupture
Patellar tendon rupture
Patellar instability
Quadriceps tendon rupture
Aged, poorly conditioned (descending,jumping)
CO: severe anterior knee pain
snap
fall suddenly
OE: swelling, tenderness (local)
Palpable gap proximal to patella
inability to extend knee
Quadriceps tendon rupture
Patellar tendon rupture
young athletic patients
eccentric loading of quadriceps
OE: Swelling, tenderness
palpable defect at distal pole patella
Impaired knee extension
Patellar instability
Subluxation – Dislocation
Young adults
Mechanism: direct blow, forceful Q contraction
CO: Buckling
Anterior knee pain
Difficulty extending knee
OE: Swelling (effusion-hemarthrosis)
Tenderness medial patella
Apprehension sign
DD: history & X-ray
In almost 90% of knee injuries an
accurate diagnosis can be reached
through thorough history taking and
careful clinical examination.
Thank you