1. Knee injuries
Dr Abir Naguib

2. Knee pain is the most common musculoskeletal complaint (1/3)
Source of significant disability
Most prevalent in physically active individuals

3. Differential diagnosis of knee pain is extensive Accurate diagnosis can be achieved by localizing the anatomic site of pain & patient’s age

6. Trauma Fracture Ligament sprain Tendon rupture Meniscal tear
Patellar dislocation

7. History Pain characteristics:
Onset- location- duration- severity- quality- aggravating and relieving factors
2. Mechanical symptoms:
Pop
Locking
Giving way

8. Exclude referred pain (hip injury)
3. Effusion:
Timing and amount
4. Ability to continue playing
5. History of previous injury
Exclude referred pain (hip injury)

9. 6. Mechanism of injury
Contact
(Direction of blow)
Non-contact
(position of knee)
Twisting
Hyperextension
Deceleration

10. Non-contact injury

11. Hyperextension injury

12. Examination: Inspection: Swelling (location) Ecchymosis Atrophy
Palpation:
Tenderness
ROM
Stability tests
Joint line
Ligament course
Active
passive

13. Investigations Radiological Aspiration Arthroscopy X-ray, CT, MRI
(painful swollen joint)
Clear yellow
Blood
Blood + fat droplets
Arthroscopy

14. MCL injury

15. CO:
Pop at time of injury
Pain , swelling (medial)
OE:
Tenderness, swelling along ligament course
Valgus stress test

16. LCL injury Uncommon Mechanism: blow to medial aspect knee Varus force
Similar: (lateral)
Varus stress test

17. ACL injury
Pop
Immediate swelling
Giving way

19. Anterior drawer test

20. Lachman test

21. ACL

22. PCL injury

23. CO: insecurity of knee
OE: abrasion on proximal tibia (anterior)
mild swelling
posterior drawer test

24. Posterior sag sign

25. PCL

26. Meniscal tear CO: Pain after quick twisting or squatting Locking
OE: Swelling
Joint line tenderness
McMurray test

27. Meniscal tear

29. Extensor mechanism injury
Quadriceps tendon rupture
Patellar tendon rupture
Patellar instability

30. Quadriceps tendon rupture
Aged, poorly conditioned (descending,jumping)
CO: severe anterior knee pain
snap
fall suddenly
OE: swelling, tenderness (local)
Palpable gap proximal to patella
inability to extend knee

32. Quadriceps tendon rupture

33. Patellar tendon rupture
young athletic patients
eccentric loading of quadriceps
OE: Swelling, tenderness
palpable defect at distal pole patella
Impaired knee extension

35. Subluxation – Dislocation
Patellar instability
Subluxation – Dislocation
Young adults
Mechanism: direct blow, forceful Q contraction
CO: Buckling
Anterior knee pain
Difficulty extending knee
OE: Swelling (effusion-hemarthrosis)
Tenderness medial patella
Apprehension sign
DD: history & X-ray

39. In almost 90% of knee injuries an accurate diagnosis can be reached through thorough history taking and careful clinical examination.

40. Thank you