Bipartite patella
Congenital. It can be an incidental finding. You must be able to tell difference between a
fracture and the bipartite patella
If it is congenital development you will have cortical bone on both sides and it will be smooth
If it is a fracture, there are irregularities and you will not have a clear cortical outline.
You do not want to over-manage a problem that is not really a problem and the person has not
had a problem with it their whole life.
Fairbanks sign:
Look for patellar apprehension sign.
This is a patellar dislocation test.
Patella Alta
A patella that rides too high. It rides way above the femur
Patella Infera
A patella that rides too low.
Chondromalacia:
Histological change in the cartilage
Arthroscopic surgery can remove some of the adhesions.
Normal meniscus is semilunar cartilage.
Vertical tears, radial tears, cleavage tears, bucket handle tear (vertical tear, which cleaves)
Osgood Schlatter Lesion:
Tibial tuberosity has an epiphysis of its own.
It is designed to stand tensile stress.
This is an evulsion of the growing tibial tuberosity.
Physis is the growth center of a long bone
Area distal to the Physis is the Epiphysis.
Apophysis is an are that is a secondary growth center. These are especially potential for
evulsions, osteochondrytis. Many of theses conditions will present themselves during
adolescence and will resolve after adolescence.
Kneeling is especially painful.
Quick extension activities involving quad contraction aggravates Osgood Schlatter Lesions.
Bowleg and Knock-knee deformity.
7/6/98
KNEE
Meniscal Injury
Apley's Compression Test
Flex knee to 90 degrees
Push down on sole of foot compressing knee
Then externally rotate to stress medial meniscus
Internally rotate to stress lateral meniscus
Bounce Home
Knee slightly flexed
Traction down on ankle then drop knee
Knee should lock
If meniscal injury, c/c of joint giving way; get oscillation around knee joint
McMurray's
Supine
Hip flexed to 90
Knee flexed to a little past 90
One hand on knee and one on the heel
Palpate into the eyes of the knee (to one side of the other of the patellar tendon at the
level of the knee joint)
Checking for clicking
Payr's Sign
Seated indian style
Push down on knee
Checking medial meniscus and pain in the joint
Steinmann's Tenderness Displacement
Supine; knee extended; raise leg slightly
Palpate into joint line
Then flex knee
Pain goes from distal femur in extension to posterior femur in flexion
Knee Sprain
M/c
Anterior and posterior cruciate
Lateral and medial collateral
Hyperextension injury
Damages posterior capsule and posterior cruciate ligament
Collateral Ligaments
Apley's Distraction
Dr's knee on posterior thigh
Hold tibia and pull tibia away from femur
External rotation checks medial collateral ligament
Internal rotation _ lateral collateral
Abduction Stress Test (Valgus)
Supine
Support ankle
Push medial on thigh just above knee
Opens up medial side of the joint checking the medial collateral
Grade III sprain: will see excess gapping at the joint line
Adduction Stress Test
Same as above but pull out on thigh
Varus
Lateral collateral ligament
Cruciate Ligament
Drawer Test
Anterior and posterior drawer
Look for instability
Supine
Knee and hip flexed
Push posterior of proximal tibia_ posterior
Pull anterior of proximal tibia _ anterior
Lachman Test
Supine
Knee in 30 degrees of flexion
Stabilize femur
Push (post) and pull (ant) tibia
7/8/1998
Synovial Plica
Embryological remnants
Synovium folds
Normally extremely elastic and present no symptom
Problem: injury to them produces healing with fibrous tissue
Medial plica called shelf plica
Can cause snapping and clicking, but is above joint line
Snapping and clicking at 30 degrees
Osteochondritis Dissecans
Common in adolescence
Osseous defect most commonly found in medial femoral condyle
3 stages : 1st 2 are similar radiographically (fracture line without displacement)
Stage 1: crack in bone with cartilage intact
Stage 2: crack in cartilage with no separation
Stage 3: bone separated_ becomes a "joint mouse"
Usually happens in growing bone
Repeitive overloading of growing bone
Osteonecrosis
Obesity a predisposing factor
Symptoms
Vague, intermittent, poorly localized pain that can be worse with exercise and
persists at rest
If stage III, joint can lock or give way
Osgood-Schlatter Lesion
Apophysitis
Inflammation of tibial tuberosity secondary growth center at insertion of the patellar
tendon
Fragments fill in with fibrocartilage
Have enlarged tibial tubercle
Chondromalacia of patella
Histologic disease
Softening of articular cartilage on posterior aspect of patella
Theories (overuse and disuse)
Pain on anterior knee while climbing stairs or sitting for long periods
"kissing lesion" - lesion on patella and matching lesion on femoral condyle
possible grating and gritting on ROM
affects most commonly the vastus medialis muscle (lateral tracking of the patella)
7-13-98
Patellar Dislocation
apprehension test of patella
knee flexed to 30 deg
push patella medial and lateral
look for apprehension and/or contraction of the quads
Dreyer's sign
supine
knee extended, hip flexed
with a patellar fracture, will not be able to flex hip
support thigh right above knee, then it is easier for pt to flex hip
Q angle test
supine
mark ASIS
come straight down ASIS to midpoint of patella
then come down from ASIS to tibial tuberostiy
13-18 degrees normal
13 deg males and 18 deg females
greater than 18 deg. = genu valgum (knock knees)
Patellar Balottment
checking for synovitis of the knee (joint effusion)
supine, knees extended
press down on patella
if there is effusion, get a feeling of submerging patella in fluid (DUH), and get tension or
resistance when you release pressure
Patellar Tap Test
same as above
Fouchet's Sign
supine
direct compression with whole hand on patella
may palpate or hear grating and grinding
Perkin's sign = tenderness on medial margin
Clarke's sign
Supine
Web of hand on thigh and slide down just above patella and push patella inferiorly
slightly
Have pt contract quads