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The Knee
Anatomy
complex joint 4 bones 3 joints cartilage 2 menisci
ligaments
muscles
The Knee
Anatomy
femur
medial condyle > trochlea: more proximal lateral
tibia
medial plateau > medial concave
patella
sesamoid bone lateral facet >
The Knee
Anatomy
menisci
+/- avascular
PCL
cartilage
ACL
The Knee
Anatomy
cruciate ligaments collateral ligaments
lateral MCL condyle LCL
posterior LM ACL
anterior
ACL MM
medial condyle
PCL
The Knee
Anatomy
muscles
The Knee
The Knee
Anatomy
muscles
The Knee
Anatomy
muscles
The Knee
History
pain other symptoms: locking, giving way, effusion function
med condyle
past history
plateau
The Knee
Clinical examination
look: scars, swelling, alignment, redness, muscle atrophy, limping
The Knee
Technical examination
radiographs: 4 views ultrasound CT (+/-arthrography)
MRI
bonescan
arthroscopy
The Knee
Patello-femoral joint
chondropathy
dyplasia
malalignement
The Knee
Patello-femoral joint
history: movie sign, stairs, grinding, giving way
examination
The Knee
Patello-femoral joint
XR CT + arthrography bone scan
MRI?
The Knee
Patello-femoral joint
conservative: physiotherapy (quads+++), NSAID, glucosamine?
arthroscopy: when in doubt dont operate, lateral release open: medial reefing, tuberosity transfer
The Knee
Extensor mechanism
tendonitis: patellar tendon, ITB apophysitis: Osgood Schlatter, SindingLarsen-Johanson rupture
The Knee
Extensor mechanism
history examination: palpation, active straight leg raise technical: XR, ultrasound, MRI treatment: stretching, immobilization?, NSAID, rest, brace, infiltration, surgery
The Knee
The Knee
The Knee
diagnosis: MRI
treatment: PCL carefully neglect
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?
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 (partial meniscectomy, suture, transplant)
The Knee
Meniscal injuries
The Knee
Cysts
Lo:
The Knee
Cartilage
The Knee
Cartilage
The Knee
Cartilage
conservative: glucosamine, quads, unloading brace, NSAID, steroids
Conclusion
effusion
The Knee
Conclusion
immediately
ACL/PCL
cartilage fracture meniscus
delayed
meniscus
cartilage inflammatory
The Knee
Conclusion
effusion pain locking or giving way
The Knee
Conclusion
locking
meniscus
giving way
ACL
cartilage
PF
ACL
meniscus
The Knee
Conclusion
effusion pain locking or giving way
The Knee
Thank you
The Knee