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University College Hospital

London

The Knee

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The Knee

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The Knee

Anatomy

complex joint

4 bones 3 joints

cartilage 2 menisci

ligaments

muscles

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The Knee

Anatomy

femur medial condyle >

trochlea: more proximal lateral

tibia medial plateau >

medial concave

patella sesamoid bone

lateral facet >

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The Knee

Anatomy

menisci+/- avascular

cartilageACL

PCL

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The Knee

Anatomy

cruciate ligaments

collateral ligaments

MCL LCL MM

ACL

LM

anterior

medialcondyle

ACL

PCL

lateralcondyle

posterior

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The Knee

Anatomy

muscles

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The Knee

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The Knee

Anatomy

muscles

Bursae and plica suprapatellar

medial

mucosum

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The Knee

Anatomy

muscles

bursae and plicae suprapatellar

medial

mucosum

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The Knee

History

pain

other symptoms: locking, giving way, effusion

function

past history

med condyle

plateau

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The Knee

Clinical examination

look: scars, swelling, alignment, redness,

muscle atrophy, limping

feel: effusion, cfr. anatomy

move: flexion-extension, active-passive, hip!!

special tests

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The Knee

Technical examination

radiographs: 4 views

ultrasound

CT (+/-arthrography)

MRI

bonescan

arthroscopy

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The Knee

Patello-femoral joint

chondropathy

malalignement

dyplasia

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The Knee

Patello-femoral joint

history: movie sign, stairs, grinding, giving

way

examination

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The Knee

Patello-femoral joint

XR

CT + arthrography

bone scan

MRI?

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The Knee

Patello-femoral joint

conservative: physiotherapy (quads+++),

NSAID, glucosamine?

arthroscopy: when in doubt dont operate,lateral release

open: medial reefing, tuberosity transfer

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The Knee

Extensor mechanism

tendonitis: patellar tendon, ITB

apophysitis: Osgood Schlatter, Sinding-

Larsen-Johanson

rupture

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The Knee

Extensor mechanism

history

examination: palpation, active straight leg

raise

technical: XR, ultrasound, MRI

treatment: stretching, immobilization?, NSAID,rest, brace, infiltration, surgery

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The Knee

Anterior cruciate ligament

history: torsion, valgus, hyperextension

examination: effusion, haemarthrosis, anterior

drawer, Lachman, pivot shift

diagnosis: MRI (XR segond)

treatment: ACL physio/surgery

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The Knee

Anterior cruciate ligament

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The Knee

Posterior cruciate ligament

history: varus, hyperflexion, dashboard

examination: effusion, haemarthrosis,

posterior drawer, reverse pivot shift, sagging,quadriceps active test

diagnosis: MRI

treatment: PCL carefully neglect

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The Knee

Collateral ligaments

history: MCL valgus, LCL varus

examination: stress test (+/-30 of flexion)

I = pain, II = opening at 30, III = opening at 0

diagnosis: ultrasound, MRI

treatment: rest, physio, nsaid, infiltration,brace, surgery?

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The Knee

Meniscal injuries

history: flexionrotation, effusion, locking

examination: effusion, pain with hyperflexion,

pain at joint line, McMurray, Apley, cysts

diagnosis: MRI

treatment: conservative, surgery (partialmeniscectomy, suture, transplant)

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The Knee

Meniscal injuries

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The Knee

Cysts

Lo:

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The Knee

Cartilage

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The Knee

Cartilage

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The Knee

Cartilage

conservative: glucosamine, quads, unloading

brace, NSAID, steroids

debridement and lavage

abrasion arthroplasty and microfracturing

osteochondral allografts

autologous chondrocyte implantation

Br ittb erg M et al. NEJM 1994; 331: 889-95

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The Knee

Conclusion

effusion

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The Knee

ACL/PCL meniscus

cartilage cartilage

fracture inflammatory

meniscus

Conclusion

immediately delayed

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The Knee

Conclusion

effusion

pain

locking or giving way

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The Knee

Conclusion

locking giving waymeniscus ACL

cartilage PF

ACL meniscus

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The Knee

Conclusion

effusion

pain

locking or giving way

always plain XR (exclude tumor, fracture)

orthopaedics = anatomy

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The Knee

Thank you