Knee Boney Anatomy
Femur
Patellar surface femur
Lateral condyle & epicondyle
Medial condyle & epicondyle
Medial condyle of tibia
Head fibula
Tibial tuberosity
Fibula
Medial Collateral Ligament
MCL Mechanism of Injury Valgus Stress
MCL Sprain
1st Degree
2nd Degree
3rd Degree
Valgus Stress Test
Stresses MCL
Valgus Stress at 0 - 5º
Valgus Stress at 25 - 30 º
Lateral Collateral Ligament
LCL-
MOI of LCL Injury
Varus Stress Test
Stresses lateral structures
Varus
Stress
Varus Stress at 0 º and 25 º to 30º of flexion
Anterior Cruciate Ligament
ACL Tear
• Anterior instability
• Mechanism
– Deceleration injury
– IR of femur with knee flexed and
foot planted
– Hyperextension of knee
• Swelling
• Pop at time of injury
• Pain with
Signs
and
Symptoms
– AROM
– PROM
• Anterior instability
• Decreased strength
• Giving way or buckling
Anterior Drawer Test
Grading
Anterior Instability
Medial view
Right knee
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Stabilize Foot
Check for hamstrings relaxation
Thumbs either side patellar tendon
Apply anterior force
Grade amount of translation
Lachman’s Test
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Better test than Anterior Drawer
Takes opposition of hamstrings out of play
Knee flexed 15 º - 30º
Stabilize femur
Apply anterior force to tibia
Pivot Shift Test
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Gold standard test for ACL
Leg is externally rotated
Valgus force is applied as leg is flexed
Positive test indicated by clunk sensation
Posterior
Cruciate
Ligament
Posterior cruciate
Posterior Sag Test
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Posterior Cruciate vs Anterior Cruciate
Athlete supine
Both knees flexed 90’
Observe laterally
Posterior Drawer Test
PCL
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ACL
Athlete supine
Knee flexed 90’
Foot neutral
Sit on foot to stabilize it
Posterior force applied at tibial plateau
Positive test indicates PCL injury
Medial and Lateral Meniscus
Medial meniscus “C” shaped
Lateral meniscus more circular shaped
• Mechanism of Injury
– Squat with rotation
– Internal rotation of femur
– on fixed tibia
Joint Space Orientation
Lateral Meniscus
Lateral Joint Space
Medial Meniscus
Medial Joint Space
Mc Murray Test
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Flex knee fully
Palpate medial & lateral joint spaces with one hand
Rotate tibia opposite to femur as knee is extended
Palpable pop and/or pain indicate a positive test
Apley’s Compression Test
External rotation of tibia tests medial meniscus
Internal rotation of tibia tests lateral meniscus
Apley’s Distraction Test
Unloads the meniscus
Stressess MCL and LCL