Knee Boney Anatomy Femur Medial condyle & epicondyle Medial condyle of tibia Femur Patellar surface femur Lateral condyle & epicondyle 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

Lateral Collateral Ligament LCL-

Stresses lateral structures 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 Signs and Symptoms Anterior instability Mechanism Swelling Deceleration injury IR of femur with knee flexed and foot planted Hyperextension of knee Swelling Pop at time of injury Pain with AROM PROM Anterior instability Decreased strength Giving way or buckling Signs and Symptoms

Grading Anterior Instability Medial view Right knee Anterior Drawer Test Grading Anterior Instability Medial view Right knee Stabilize Foot Check for hamstrings relaxation Thumbs either side patellar tendon Apply anterior force Grade amount of translation

Lachman’s Test 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 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 Sag Test Posterior Cruciate vs Anterior Cruciate Athlete supine Both knees flexed 90’ Observe laterally

Posterior Drawer Test PCL 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 Medial Meniscus Medial Joint Space Lateral Joint Space

Mc Murray Test 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