Knee instability clinical assessment

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Knee instability clinical assessment

  1. 1. Examination ofthe UnstableKnee
  2. 2. Till the 1970’s, approachto the management ofknee ligament injurieswas haphazard &individualistic
  3. 3. Hughston (1975) classifiedknee ligament injuries intostraight, rotary, combinedpatterns
  4. 4. Hughston (1975)PCL was theCentral Pivot
  5. 5. Nicholas (1979) describedthe importance of thequadruple complexes
  6. 6. Anatomy :medial side
  7. 7. Lateral structures•Fibular collateralligament•Biceps femoris•Arcuate poplitealcomplex•Iliotibial band
  8. 8. QuadrupleComplexes
  9. 9. 80% of traumatichaemarthroses ofknee is due to ACLruptureNoyes (1983)
  10. 10. Mechanism of injury
  11. 11. •Complete, Gentle,Precise, Systematic•Comparison withnormal side•Timing – early / lateExamination
  12. 12. •Ecchymosis•Swelling•Tenderness•Muscle wasting
  13. 13. Stress Testing• Gentle touch• Comparison• End point• Degree of excursion
  14. 14. Valgus stress test•0o& 30oDegrees•Tenderness•Laxity•End point
  15. 15. Valgus stress test
  16. 16. Valgus stress test
  17. 17. Valgus stress test
  18. 18. Figure of “4” position
  19. 19. Varus stress at 30o
  20. 20. Varus stress at 0o
  21. 21. Anterior Drawer
  22. 22. Anterior Drawervideo
  23. 23. Slocum’s AnteriorDrawer•Neutral Rotation•30oER•15oIR
  24. 24. Lachman Test
  25. 25. Lachman Test
  26. 26. Lachman Test
  27. 27. Pivot Shift test
  28. 28. Posterior Sag
  29. 29. Posterior Sag
  30. 30. Posterior Sag
  31. 31. Posterior Drawer
  32. 32. Additional tests•External rotation recurvatum test•Hughston’s recurvatum test•Flexion rotation drawer test•Quadriceps active test
  33. 33. Quadriceps active test
  34. 34. Quadriceps active test

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