Meniscus and ligament knee injuries: Difference between revisions
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**Provide restraint against varus (inward) stress | **Provide restraint against varus (inward) stress | ||
== | ==Clinical Features== | ||
===ACL=== | ===ACL=== | ||
*Healing/feeling a "pop" during injury is pathognomonic | *Healing/feeling a "pop" during injury is pathognomonic | ||
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{{Knee DDX}} | {{Knee DDX}} | ||
== | ==Diagnosis== | ||
*Knee XR to rule-out fracture | |||
*Normally clinically diagnosed initially or referred for re-exam in 4-5 days after decrease of swelling | |||
**Primary medical doctor or orthopedics may later use MRI for definitive diagnosis | |||
==Management== | |||
*Knee immobilizer, ice, elevation, ambulation as soon as comfortable | *Knee immobilizer, ice, elevation, ambulation as soon as comfortable | ||
*Ortho referral | *Ortho referral | ||
== | ==References== | ||
==See Also== | ==See Also== | ||
Revision as of 10:50, 17 November 2015
Background
- Anterior Cruciate Ligament
- Limits anterior translation of tibia
- 75% of all hemarthroses are caused by disruption of ACL
- Posterior Cruciate Ligament
- Limits posterior translation of tibia
- Isolated injuries are rare
- Medial Collateral Ligament
- Provide restraint against valgus (outward) stress
- Lateral Collateral Ligament
- Provide restraint against varus (inward) stress
Clinical Features
ACL
- Healing/feeling a "pop" during injury is pathognomonic
- Anterior Drawer Sign
- Pt supine, knee flexed 90', attempt to displace tibia from femur in a forward direction
- Displacement of >6mm compared w/ opposite knee indicates injury
- Lachman Test
- Pt supine, knee flexed 30', femur held w/ one hand, prox tibia pulled up w/ other hand
- Displacement >5mm or soft end-point indicates injury
- Segond Fracture
- Pathognomonic for ACL tear
PCL
- Posterior Drawer Sign
- Pt supine, knee flexed 90', attempt to displace tibia from femur in backward direction
Meniscus
- Symptoms
- "Locking" of joint or sensation of popping, clicking, or snapping
- Signs
- Effusions that occur after activity
- Joint-line tenderness
- Tests
- McMurray, grind test only 50% Sn
Differential Diagnosis
Knee diagnoses
Acute knee injury
- Knee dislocation
- Knee fractures
- Meniscus and ligament knee injuries
- Patella dislocation
- Patellar tendonitis
- Patellar tendon rupture
- Quadriceps tendon rupture
Nontraumatic/Subacute
- Arthritis
- Gout and Pseudogout
- Osgood-Schlatter disease
- Patellofemoral syndrome (Runner's Knee)
- Patellar tendonitis (Jumper's knee)
- Pes anserine bursitis
- Popliteal cyst (Bakers cyst)
- Prepatellar bursitis (nonseptic)
- Septic bursitis
- Septic joint
- DVT
Diagnosis
- Knee XR to rule-out fracture
- Normally clinically diagnosed initially or referred for re-exam in 4-5 days after decrease of swelling
- Primary medical doctor or orthopedics may later use MRI for definitive diagnosis
Management
- Knee immobilizer, ice, elevation, ambulation as soon as comfortable
- Ortho referral