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By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Ligament injuries
Mechanism
• Injured by mostly twisting or bending force
• MCL
– Valgus force. Abduction of leg on femur
• LCL
– Varus force. Adduction of leg on femur
– Avulsion fracture may occur
– Less common
• ACL
– Associated with MCL or LCL
– Twisting force on a semi flexed knee
– O’Donoghue triad
• PCL
– Tibia forced backward on the femur
Pathoanatomy
• Avulsion fracture
• Grade I, II, III
• May be isolated or more then one ligament
may injure
Diagnosis
• Pain and swelling
• History of fall, injury followed by sound of
something tearing
• Haemarthrosis
• MCL, LCL – Localized pain on medial, lateral
side
• ACL, PCL – Vague pain in knee
• Tests
– MCL tear test
– LCL tear test
– Anterior Drawer test
– Posterior Drawer test
• Radiological examination
• X-ray will be helpful in avulsion fracture. “No
bone fracture” in case of haemarthrosis
• MRI more helpful in diagnosis
• Arthroscopic examination may be done
Treatment
• Conservative method
• For Grade I, II injury
• Haematoma aspiration
• Once swelling subsides Physiotherapy will be
helpful
• Operative methods
• Indicated in grade III and in case of multiple
ligament injury
• Surgery after 2-3 week, once pain subsides
• Repair of ligament
– Done in case of fresh ligament injury
• Reconstruction
– Done in case of case presented late when knee
instability is there
– Ligament is reconstructed using patient’s tendon
and fascia
– Allograft or synthetic ligament has also been used
Complications
• Knee instability
• Osteoarthritis
Thank you
Please share the video and subscribe my
channel.
By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Meniscal injuries
Mechanism
• Semi flexed knee and twisting
• May occur while walking on uneven surface
• Meniscus may be stuck in and nipped as
rotation occurs
• Medial meniscus injury is common as it is less
mobile
Pathoanatomy
• Menisucs is torn most commonly at posterior
horn
• Meniscus is avascular structure
• It left untreated undergoes subtears and can
damage articular surface
• Types of meniscus tear
Clinical features
• Young male actively engaged in sports
• Recurrent episodes of pain and locking of
knee
• Patient may complaint of a sudden jerk while
walking or something flicking over inside the
joint
• Swelling, appears after few hours and lasting
for few days
• History of twisting injury followed by swelling
overnight
• Knee remains in 10 degree knee flexion.
Complete extension is difficult
• Mcmurray’s test
• Apley’s test
• Radiological examination
– No abnormal X-ray
– MRI is useful
– Arthrography
Treatment
• Acute meniscal tear
– If Knee is locked, it is manipulated under general
anesthesia. No special maneuver is needed.
– As knee relaxes, torn meniscus falls into place and
knee is unlocked
– Knee is immobilised for 2-3 weeks, followed by
Physiotherapy.
– Peripheral tear will heal.
• Chronic meniscal tear
– To excise the displaced fragment.
– Arthroscopic surgery is done
– Early return to work is possible
– Aim is to preserve the meniscus as much as
possible.
Thank you
Please share the video and subscribe my
channel.

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15. Knee ligament injury

  • 1. By :- Dr. Bindesh D. Patel, PT Deputy Registrar P P Savani University Ligament injuries
  • 2. Mechanism • Injured by mostly twisting or bending force • MCL – Valgus force. Abduction of leg on femur • LCL – Varus force. Adduction of leg on femur – Avulsion fracture may occur – Less common
  • 3. • ACL – Associated with MCL or LCL – Twisting force on a semi flexed knee – O’Donoghue triad
  • 4. • PCL – Tibia forced backward on the femur
  • 5. Pathoanatomy • Avulsion fracture • Grade I, II, III • May be isolated or more then one ligament may injure
  • 6. Diagnosis • Pain and swelling • History of fall, injury followed by sound of something tearing • Haemarthrosis • MCL, LCL – Localized pain on medial, lateral side • ACL, PCL – Vague pain in knee
  • 7. • Tests – MCL tear test – LCL tear test – Anterior Drawer test – Posterior Drawer test
  • 8. • Radiological examination • X-ray will be helpful in avulsion fracture. “No bone fracture” in case of haemarthrosis • MRI more helpful in diagnosis • Arthroscopic examination may be done
  • 9. Treatment • Conservative method • For Grade I, II injury • Haematoma aspiration • Once swelling subsides Physiotherapy will be helpful
  • 10. • Operative methods • Indicated in grade III and in case of multiple ligament injury • Surgery after 2-3 week, once pain subsides • Repair of ligament – Done in case of fresh ligament injury
  • 11. • Reconstruction – Done in case of case presented late when knee instability is there – Ligament is reconstructed using patient’s tendon and fascia – Allograft or synthetic ligament has also been used
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  • 15. By :- Dr. Bindesh D. Patel, PT Deputy Registrar P P Savani University Meniscal injuries
  • 16. Mechanism • Semi flexed knee and twisting • May occur while walking on uneven surface • Meniscus may be stuck in and nipped as rotation occurs • Medial meniscus injury is common as it is less mobile
  • 17. Pathoanatomy • Menisucs is torn most commonly at posterior horn • Meniscus is avascular structure • It left untreated undergoes subtears and can damage articular surface
  • 18. • Types of meniscus tear
  • 19. Clinical features • Young male actively engaged in sports • Recurrent episodes of pain and locking of knee • Patient may complaint of a sudden jerk while walking or something flicking over inside the joint • Swelling, appears after few hours and lasting for few days
  • 20. • History of twisting injury followed by swelling overnight • Knee remains in 10 degree knee flexion. Complete extension is difficult • Mcmurray’s test • Apley’s test
  • 21. • Radiological examination – No abnormal X-ray – MRI is useful – Arthrography
  • 22. Treatment • Acute meniscal tear – If Knee is locked, it is manipulated under general anesthesia. No special maneuver is needed. – As knee relaxes, torn meniscus falls into place and knee is unlocked – Knee is immobilised for 2-3 weeks, followed by Physiotherapy. – Peripheral tear will heal.
  • 23. • Chronic meniscal tear – To excise the displaced fragment. – Arthroscopic surgery is done – Early return to work is possible – Aim is to preserve the meniscus as much as possible.
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