Injury of the knee

  

1. Anatomy of the knee

2. Injury of the knee
  

3. Sprains of knee ligaments

MEDIAL COLLATRAL LIGAMENT(MCL)(내측측부인대)

Valgus force (football clip)

Graded 1,2 (partial), 3(complete)

Hx: Medial knee pain

PE: Laxity and/or pain with valgus stress (at to 30 flexion)

XR: AP/Lateral: possibly an avulsion

1. Hinged knee brace

2. Surgical for grade III (usually combination injury)

LATERAL COLLATERAL LIGAMENT(LCL)(외측측부인대)
Varus force(isolated, rare)

Associated with other ligament and peroneal nerve injuries

Hx: Trauma. Pain & swelling

PE: Laxity & pain with varus stress (at 30). Test for foot drop

XR: AP/lateral: possibly an avulsion

1. Nonoperative: see MCL

2. Surgical for grade III (usually combination injury)

Isolated PCL,MCL and LCL injuries are primarily treated non-operatively: operative repair is used when these injuries occur in combination

POSTEROLATERAL CORNER COMPLEX(PLC)(후외측구석 복합체)

Usually with PCL injury

Popliteofibular ligament torn

Hx: Pain, instability

PE: Increased ER at 30 flexion, + posterolateral drawer test

XR: AP/lateral

Early surgical repair

4. Meniscal injury

Young: trauma/twisting injury
Old: Degeneratiion/squat injury
Seen with ACL injurires
Media>/lateral(cysts develop)

Hx.: Pain, catching/locking (esp. bucket-handle tears)
PE: Effusion, jointline tenderness, +McMurray test

XR: AP(extension & 30 flexion)/lateral/sunrise, +/- arthrocentesis

1. Conservative for minor symptoms
2. Debride (inner 2/3 lesion)
3. Repair (outer 1/3 or longitudinal lesion)
Improved results with ACL repair

5. ACL injury

Twisting injury, often no contact
Associated with MCL & meniscus tear (all 3 = Terrible Triad)
Segond fracture: avulsion Fx.

Hx: "Popping" swelling
PE: Effusion. + Lachman, anterior drawer and pivot shift tests;(Lachman most sensitive)

XR: AP/lateral/sunrise: +/- avulsion of ACL
Arthrocentesis(+/-): 70% have hemarthrosis
MR: confirms diagnosis


1. Closed chain exercise
2. Reconstruction needed (usually after several weeks of rehabilitation)

6. PCL injury
  
Anterior force on flexed knee (e.g. dashboard)
Also with other ligament injuries

Hx: Pain, unable to ambulate
PE: + posterior drawer, posterior sag, quad active test

XR: AP/lateral/sunrise: +/- avulsion fracture
MR: confirms diagnosis

1. Non-operative: crutches
2. Quadriceps strengthening (Complication: OA)