The document provides an overview of knee joint injuries, detailing anatomy, mechanisms of injuries, types of fractures, and treatment protocols. It discusses common injuries such as condylar, patellar, and tibial plateau fractures, as well as meniscal tears, along with their clinical features, diagnosis, and treatment options. Additionally, it touches upon rare injuries around the knee, including dislocations and disruptions of the extensor apparatus.

1. INJURIES AROUND KNEE JOINT
BY DR. BHRAMPREET

2. ANATOMY
• Largest and most superficial joint.
• Hinge joint
• Flexionn and extension
• Tibia and femur (tibio femoral joint)
• Patella and femoral condyles (patello femoral
joint)
• Fibula is not a part of the joint
• Stability ligaments
• Collateral ligaments: medial and lateral ligaments
• Cruciate ligaments: anterior and posterior

3. • Menisci
• Fibrocartilage
• Act as shock absorbers
• Medial meniscus- c shaped, broader
posteriorly than anteriorly
• Lateral meniscus: almost circular, freely
movable, smaller

4. MECHANISM OF KNEE INJURIES
• The knee joint is subjected to a variety of forces
during day-to-day activities and sports.
• . The nature of the forces may be direct or
indirect.
• An indirect force on the knee may be:
(i) valgus
(ii) varus
(iii) Hyperextension or
(iv) twisting

6. CONDYLAR FRACTURES OF FEMUR
• Condylar fractures of the femur are of three
types:
(i) supracondylar fractures
(ii) intercondylar fractures – T or Y types and
(iii) unicondylar fractures – medial or
lateral.
• These fractures commonly result from a
direct trauma to the lower end of the femur.

7. • Diagnosis of these fractures is suggested by
pain, swelling and bruising around the knee.
• Diagnosis is made on X-rays.
• A careful assessment of the intra-articular
extension of the fracture and joint incongruity
must be made.

8. TREATMENT
• Unicondylar fractures:
1. If undisplaced, a long leg cast is given for 3-6
weeks,
2. followed by protected weight bearing.
3. If displaced, open reduction and internal
fixation with multiple cancellous screws is
performed.
4. A buttress plate may be required in some
cases

9. • Intercondylar fractures: The aim of treatment is
to restore congruity of the articular surface as
far as possible.
1. In displaced T or Y fracture with minimal
comminution, the joint is reconstructed by open
reduction and internal fixation with Condylar
blade-plate, DCS and LCP are popular implants.
2. Comminuted fractures are difficult to accurately
reconstruct, but well done open reduction and
internal fixation permits early knee mobilisation
and thus better functions.

10. • In selected comminuted fractures,
conservative treatment in skeletal traction
may be the best option, and give acceptable
results.

11. • Supracondylar fractures:
It is best to treat displaced supracondylar
fractures with internal fixation. This could be
done by closed or open techniques. Nail or
plate may be used.

12. COMPLICATIONS
• Knee stiffness: Residual knee stiffness
sometimes remains because of dense intraand
peri-articular adhesions. A long course of
physiotherapy is usually rewarding. Arthrolysis
may be required in resistant cases.
• Osteoarthritis: Fractures with intra-articular
extension give rise to osteoarthritis a few
years later.

13. • Malunion: A malunion may result in varus or
valgus deformities, sometimes requiring a
corrective osteotomy.

14. FRACTURES OF PATELLA
• This is a common fracture.
• It may result from a direct or an indirect force.
• In a direct injury, as may occur by a blow on
the anterior aspect of the flexed knee, usually
a comminuted fracture results.
• Sometimes, a sudden violent contraction of
the quadriceps, gives rise to a fracture.

16. CLINICAL FEATURES
• The patient complains of pain and swelling
over the knee.
• In an undisplaced fracture the swelling and
tenderness may be localised over the patella.
• A crepitus is felt in a comminuted fracture.
• In displaced fractures, one may feel a gap
between the fracture fragments. The patient
will not be able to lift his leg with the knee in
full extension (extensor lag)

17. • Radiological examination: Antero-posterior
and lateral X-rays of the knee are sufficient in
most cases.
• In some undisplaced fractures, a ‘skyline view’
of the patella may be required.

19. TREATMENT
• It depends upon the type of fracture, and in
some cases on the age of the patient.
• a) Undisplaced fracture: A plaster cast
extending from the groin to just above the
malleoli, with the knee in full extension
(cylinder cast) should be given for 3 weeks,
followed by physiotherapy.

20. • b) Clean break with separation of fragments
(two-part fracture): The pull of the quadriceps
muscle on the proximal fragment keeps the
fragments apart, hence an operation is always
necessary.
• The operation consists of reduction of the
fragments, fixing them with tension-band
wiring (TBW) and repair of extensor
retinaculae.

21. • c) Comminuted fracture: In comminuted
fractures with displacement, it is difficult to
restore a perfectly smooth articular surface, so
excision of the patella (patellectomy) is the
preferred option.

23. COMPLICATIONS
• Knee stiffness
• Extensor weakness
• Osteoarthritis

24. TIBIAL PLATEAU FRACTURES
• These are common fractures sustained in two
wheeler accidents when one lands on the
knee.
• Either or both condyles of tibia are fractured.
• The mechanism of injury is: (a) an indirect
force causing varus or valgus force on the
knee or (b) a direct hit on the knee.

25. • Types of fracture:
• These fractures commonly occur in six
patterns (Schatzker types). Type I-IV involve
only one condyle, lateral or medial.
• Type V and VI are more complex inter
condylar fractures.

26. • Symptoms and signs:
• The patient complains of pain and swelling,
and inability to bear weight.
• Often crepitus is heard or felt.
• Diagnosis can be made on X-rays.
• CT scan may be required for accurate
evaluation.

27. • Treatment: Both conservative and operative
methods can be used.
• Conservative methods are used for minimally
displaced fractures, and those in elderly
people.
• Surgical treatment with orif and plating.

28. MENISCAL INJURIES OF THE KNEE
• These constitute a common group of injuries
peculiar to the knee, frequently being
reported with increasing sporting activity.
• The injury is sustained when a person,
standing on a semi-flexed knee, twists his
body to one side. The twisting movement, an
important component of the mechanism of
injury, is possible only with a flexed knee.

29. • The meniscus may be torn with a minor
twisting, as may occur while walking on
uneven surface.
• . The medial meniscus gets torn more often
because it is less mobile (being fixed to the
medial collateral ligament).
• A degenerated meniscus in the elderly may
get torn by minimal or no injury.

30. • Types of meniscal tear:
• The bucket-handle tears are the commonest
type; others are radial, anterior horn,
posterior horn and complex tears.

31. CLINICAL FEATURES
• The patient is generally a young male actively
engaged in sports like football, volleyball etc.
• The presenting complaint is recurrent
episodes of pain, and locking of the knee.
• At times, the patient complains of a ‘jhatka’, a
sudden jerk while walking,
• or‘something flicking over’ inside the joint.

32. CLINICAL FEATURES
• This may be followed by a swelling, appearing
after a few hours and lasting for a few days. After
some time, the pain becomes persistent but with
little or no swelling
• followed by a swelling appearing overnight as
effusion collects.
• After the effusion subsides, the knee may remain
in about 10 degrees of flexion, beyond which the
patient is unable to extend his knee (locking).

33. • . The displaced fragment sometimes returns
to its original position spontaneously and thus
the original episode of locking may never be
noticed.
• The history of sudden locking and unlocking,
with a click located in one or other joint
compartment, is diagnostic of a meniscus tear.

34. ON EXAMINTAION
• In a typical episode presenting after injury, the
knee may be swollen.
• There may be tenderness in the region of the
joint line, either anteriorly or posteriorly.
• The knee may be locked.
• The manoeuvres carried out to detect a
hidden meniscus tear are McMurray's and
Apley's test

35. RADIOLOGICAL EXAMINATION
• With meniscal tears there are no abnormal X-
ray findings.
• X-rays are taken to rule out any associated
bony pathology.
• MRI is a non-invasive method of detecting
meniscus tears. It is a very sensitive
investigation, and sometimes picks up tears
which are of no clinical significance.

36. • ARTHROSCOPY :
• This is a technique where a thin endoscope,
about 4-5 mm in diameter – the arthroscope,
is introduced into the joint through a small
stab wound, and inside of the joint examined

37. TREATMENT
• Treatment of acute meniscal tear: If the knee
is locked, it is manipulated under general
anaesthesia. No special manoeuvre is needed.
Followed by immobalisation for 2-3 weeks.
• Treatment of a chronic meniscal tear: Once
the diagnosis is established clinically, the
treatment is to excise the displaced fragment
of the meniscus. Now-a-days, it is possible to
excise a torn meniscus arthroscopically.

38. RARE INJURIES AROUND KNEE
1. Dislocation of the knee: This rare injury
results from severe violence to the knee so
that all of its supporting ligaments are torn.
• It is a major damage to the joint, and is often
associated with injury to the popliteal artery.
• Treatment is by reduction followed by
immobilisation in a cylinder cast.

39. 2. Disruption of extensor apparatus: Injury from
sudden quadriceps contraction most often
results in fracture of the patella.
• Sometimes, it may result in tearing of the
quadriceps tendon from its attachment on the
patella,
• or tearing of the attachment of the patellar
tendon from the tibial tubercle.
• In either case, operative repair of the tendon is
required.

40. 3. Dislocation of the patella: The patella usually
dislocates laterally.
• It can be one of three types:
(i) acute dislocation;
(ii) recurrent dislocation and
(iii) habitual dislocation