This week on PA Study Sesh, we will be covering disorders of the knee and proximal tibia.

  • Medial and lateral collateral ligament injuries (MCL & LCL)

  • MCL=valgus stress LCL= varus stress

  • MCL more common than LCL injury

  • Grade I & II (sprain & incomplete tear)= conservative

  • Grade III (complete) = surgical

  • ACL (anterior cruciate ligament) injury

  • 1 knee ligament injury

  • MOI: pivoting injury, may also be hyperextension

  • Females > Males

  • May have associated meniscus injury

  • Unhappy (O’Donoghue’s) triad: ACL, MCL, medial meniscus tear

  • May also have associated lateral tibial condyle avulsion= Segond fx

  • Pathognomonic for ACL tear

  • Symptoms: swelling +/- hemarthrosis, “buckling”

  • Lachman’s test= most sensitive

  • Patient supine

  • Knee flexed 20-30 degrees

  • Stabilize femur and pull tibia forward

  • Lack of firm endpoint is positive

  • Compare both sides

  • Patient needs to be fully relaxed

  • Anterior Drawer

  • Hip & knee bent to 90

  • Stabilize foot (sit on it)

  • Thumbs on joint line & pull forward

    • translates anterior without a firm endpoint

  • Diagnosis MRI. May consider Xray

  • PT vs Surgery (primarily surgical for younger patients)

  • PCL (posterior cruciate ligament)

  • Dashboard injury

  • Anterior force while knees are flexed

  • Typically not seen in athletes

  • Posterior Drawer Test

  • Posterior Sag Sign

  • Elevate leg and will see the leg “sag”

  • Tx: surgical

  • Meniscal Tears

  • Medial 3x>>> lateral (lateral is injured less)

  • Less mobile & more stress is able to be applied medially

  • Degenerative or traumatic (twisting or hyperflexion)

  • Joint line pain

  • “locking”, popping, giving way

  • Difficulty with stairs (up or down) & squats

  • McMurray’s Test

  • Lots of ways to describe

  • Grab heel with one hand and joint line with another

  • Medial= externally rotate heel, flex knee, extend while providing valgus stress

  • Lateral= internally rotate heel, flex knee, extend while providing varus stress

  • Tx: Conservative vs Surgical

  • PFPS (patellofemoral pain syndrome) aka chondromalacia

  • 1 knee complaint in primary care

  • Injury to patellar cartilage

  • Commonly seen in runners

  • Pain “under” or “behind” patella

  • crepitation

    • Long car ride or theatre sign

  • Difficulty with stairs

  • Look for malignment and improper patellar tracking

    • patellar glide, patellar grind, patellar apprehension. Used to assess mobility and associated pain with patellar movement

  • Tx: conservative, NSAIDS, rest, PT

  • Patellar Tendonitis

  • “jumpers knee”

  • Pain of patellar tendon

  • Conservative tx

  • IT Band Syndrome

  • 1 cause of knee pain in runners

  • Lateral knee pain

    • Ober Test

  • Conservative tx

  • Baker’s Cyst

  • Pain & swelling with prolonged standing

  • May be asymptomatic

  • Tx: NSAIDS, Aspiration/Injection, Compression Brace. Surgery rare

  • Patellar Fracture

  • MOI: direct blow

  • extreme contraction of quads [kiddos (patellar sleeve)]

  • X-ray: AP, lateral & Sunrise views

  • Tx: immobilized in extension. Refer to ortho for cast vs surgery

  • Patellar Dislocation

  • MOI: Twisting on a flexed knee

See All 22 Episodes of "PA Study Sesh"