FemurFemur

Patellar surface femurPatellar surface femur

Lateral condyle & epicondyleLateral condyle & epicondyle

Head fibulaHead fibulaTibial tuberosityTibial tuberosity

FibulaFibula

Knee Boney AnatomyKnee Boney Anatomy

Medial condyle & epicondyleMedial condyle & epicondyle

Medial condyle of tibiaMedial condyle of tibia

Medial Collateral LigamentMedial Collateral Ligament

1st Degree 2nd Degree 3rd Degree1st Degree 2nd Degree 3rd Degree

MCL SprainMCL Sprain

MCL Mechanism of Injury Valgus StressMCL Mechanism of Injury Valgus Stress

Valgus Stress TestValgus Stress TestStresses MCLStresses MCL

Valgus Stress at 0 - 5ºValgus Stress at 0 - 5º

Valgus Stress at 25 - 30 Valgus Stress at 25 - 30 ºº

Lateral Collateral LigamentLateral Collateral Ligament

LCL-

Varus Stress TestVarus Stress Test

Stresses lateral structuresStresses lateral structures

Varus Stress at 0 Varus Stress at 0 ºº and 25 º to 30º of flexion and 25 º to 30º of flexion

Varus Varus StressStress

MOI of LCL InjuryMOI of LCL Injury

Anterior Cruciate LigamentAnterior Cruciate Ligament

ACL TearACL Tear• Anterior instabilityAnterior instability• MechanismMechanism

– Deceleration injuryDeceleration injury– IR of femur with knee flexed and IR of femur with knee flexed and

foot plantedfoot planted– Hyperextension of kneeHyperextension of knee

Signs Signs and and

SymptomsSymptoms

• SwellingSwelling

• Pop at time of injuryPop at time of injury

• Pain with Pain with – AROMAROM

– PROMPROM

• Anterior instabilityAnterior instability

• Decreased strengthDecreased strength

• Giving way or bucklingGiving way or buckling

Anterior Drawer TestAnterior Drawer Test

• Stabilize FootStabilize Foot• Check for hamstrings relaxationCheck for hamstrings relaxation• Thumbs either side patellar tendonThumbs either side patellar tendon• Apply anterior forceApply anterior force• Grade amount of translationGrade amount of translation

Grading Grading

Anterior InstabilityAnterior Instability

Medial viewMedial view

Right kneeRight knee

Lachman’s Test Lachman’s Test

• Better test than Anterior DrawerBetter test than Anterior Drawer• Takes opposition of hamstrings out of playTakes opposition of hamstrings out of play• Knee flexed 15 º - 30ºKnee flexed 15 º - 30º• Stabilize femurStabilize femur• Apply anterior force to tibiaApply anterior force to tibia

Pivot Shift Test Pivot Shift Test

• Gold standard test for ACLGold standard test for ACL• Leg is externally rotatedLeg is externally rotated• Valgus force is applied as leg is flexedValgus force is applied as leg is flexed• Positive test indicated by clunk sensationPositive test indicated by clunk sensation

Posterior Posterior CruciateCruciateLigamentLigament

Posterior cruciatePosterior cruciate

Posterior Sag TestPosterior Sag Test• Posterior Cruciate vs Anterior CruciatePosterior Cruciate vs Anterior Cruciate• Athlete supineAthlete supine• Both knees flexed 90’Both knees flexed 90’• Observe laterallyObserve laterally

Posterior Drawer TestPosterior Drawer Test

• Athlete supineAthlete supine• Knee flexed 90’Knee flexed 90’• Foot neutralFoot neutral• Sit on foot to stabilize itSit on foot to stabilize it• Posterior force applied at tibial plateauPosterior force applied at tibial plateau• Positive test indicates PCL injuryPositive test indicates PCL injury

PCLPCL ACLACL

Medial and Lateral MeniscusMedial and Lateral Meniscus

Medial meniscus “C” shapedMedial meniscus “C” shaped

Lateral meniscus more circular shapedLateral meniscus more circular shaped

• Mechanism of InjuryMechanism of Injury– Squat with rotationSquat with rotation– Internal rotation of femur Internal rotation of femur – on fixed tibiaon fixed tibia

Joint Space OrientationJoint Space Orientation

Medial Joint SpaceMedial Joint Space

Lateral MeniscusLateral Meniscus

Lateral Joint SpaceLateral Joint Space

Medial MeniscusMedial Meniscus

Mc Murray TestMc Murray Test

• Flex knee fullyFlex knee fully• Palpate medial & lateral joint spaces with one handPalpate medial & lateral joint spaces with one hand• Rotate tibia opposite to femur as knee is extendedRotate tibia opposite to femur as knee is extended• Palpable pop and/or pain indicate a positive testPalpable pop and/or pain indicate a positive test

Apley’s Compression TestApley’s Compression Test

External rotation of tibia tests medial meniscus External rotation of tibia tests medial meniscus

Internal rotation of tibia tests lateral meniscusInternal rotation of tibia tests lateral meniscus

Apley’s Distraction TestApley’s Distraction Test

Unloads the meniscus Unloads the meniscus

Stressess MCL and LCLStressess MCL and LCL