knee instability clinical assessment
TRANSCRIPT
Examination of the
Unstable Knee
Examination of the
Unstable Knee
Till the 1970’s, approach to the management of knee ligament injuries was haphazard & individualistic
Till the 1970’s, approach to the management of knee ligament injuries was haphazard & individualistic
Hughston (1975)
classified knee
ligament injuries into
straight, rotary,
combined patterns
Hughston (1975)
classified knee
ligament injuries into
straight, rotary,
combined patterns
Hughston (1975)
PCL was the
Central Pivot
Hughston (1975)
PCL was the
Central Pivot
Nicholas (1979)
described the
importance of the
quadruple complexes
Nicholas (1979)
described the
importance of the
quadruple complexes
Anatomy :medial side
Anatomy :medial side
Lateral structures
Lateral structures
•Fibular collateral ligament
•Biceps femoris•Arcuate popliteal
complex• Iliotibial band
•Fibular collateral ligament
•Biceps femoris•Arcuate popliteal
complex• Iliotibial band
Quadruple Complexes
80% of traumatic
haemarthroses of
knee is due to ACL
rupture
Noyes
(1983)
80% of traumatic
haemarthroses of
knee is due to ACL
rupture
Noyes
(1983)
•Complete, Gentle,
Precise, Systematic
•Comparison with
normal side
•Timing – early / late
•Complete, Gentle,
Precise, Systematic
•Comparison with
normal side
•Timing – early / late
ExaminationExamination
•Ecchymosis
•Swelling
•Tenderness
•Muscle wasting
•Ecchymosis
•Swelling
•Tenderness
•Muscle wasting
Stress TestingStress Testing
• Gentle touch
• Comparison• End point• Degree of excursion
• Gentle touch
• Comparison• End point• Degree of excursion
Valgus stress testValgus stress test
•0o & 30o Degrees
•Tenderness
•Laxity
•End point
•0o & 30o Degrees
•Tenderness
•Laxity
•End point
Valgus stress test
Valgus stress test
Valgus stress test
Valgus stress test
Valgus stress test
Valgus stress test
Figure of “4” position
Figure of “4” position
Varus stress at 30o
Varus stress at 30o
Varus stress at 0o
Varus stress at 0o
Anterior DrawerAnterior Drawer
Anterior DrawerAnterior Drawer
videovideo
Slocum’s Anterior Drawer
Slocum’s Anterior Drawer
•Neutral Rotation
•30o ER
•15o IR
•Neutral Rotation
•30o ER
•15o IR
Lachman TestLachman Test
Lachman TestLachman Test
Lachman TestLachman Test
Pivot Shift testPivot Shift test
Posterior SagPosterior Sag
Posterior SagPosterior Sag
Posterior SagPosterior Sag
Posterior DrawerPosterior Drawer
Additional testsAdditional tests•External rotation
recurvatum test
•Hughston’s recurvatum test
•Flexion rotation drawer test
•Quadriceps active test
•External rotation
recurvatum test
•Hughston’s recurvatum test
•Flexion rotation drawer test
•Quadriceps active test
Quadriceps active test
Quadriceps active test
