knee pathology

ACL

MOI: non contact cutting/stopping, tibial rotation w/ valgus force

Signs/SX: hear/feel “pop”, sudden give away, pain, swelling, instability

ST: Lachmans, anterior drawer

Treat: POLICE, surgery, rehab

PCL

MOI: knee hyperextension, blow to ant tib while food is PF

Signs/SX: asymptomatic, over time presents w/ pain over post knee, weakness in hamstrings/quads, reduced ROM (flex and ext)

ST: posterior drawer

Treat: conservatively treated, joint loading, congruency, and proprioceptive muscle activity rehab

MCL

MOI: Valgus force to knee, external rotation of tibia w/ foot planted

Signs/SX: pain over medial aspect on/above jt line, increased pain during gait mid stance, decreased ability to change direction, localized swelling, pain and limited ROM (flex and ext)

ST: valgus stress test

Treat: POLICE, conservative care/surgery, use knee brace, restore ROM, strengthen, and proprioceptive training

LCL

MOI: Varys force applied to knee, internal rotation of tibia on femur

Signs/SX: pain of lateral jt line of knee, fibular head, or femoral condyle depending on location of sprain, localized swelling, pain and limited ROM

ST: Varus stress test

Treat: POLICE, conservative care/surgery, extensive rehab

Meniscal tear

MOI: rotation and flexion, degenerative or acute

Signs/SX: locking or clicking, jt line pain, knee giving away, swelling occur 24-48 hours post inj

ST: McMurray test, apley compression/distraction, thessaly

Treat: POLICE, conservative care/surgery, extensive rehab

Patellofemoral pain syndrome

MOI: gradual onset, sx typically related in increase or change activity

Signs/SX: pain over ant/lat aspect of knee, clicking or knee giving out, pain going down stairs, sitting, or other flex activities, mild swelling, increased Q, pronated foot

ST: medial/lateral patellar glide, patellar tilt

Treat: use or orthotics, change footwear, alt or gait, taping, mod of activity

Patellar dislocation or subluxation

MOI: during extension of knee, Change of direction, eccentric contraction, subluxation usually chronic, dislocations acute

Signs/SX: pain over med aspect, knee giving out, pain/instability going down stairs or change of direction

ST: patellar apprehension test

Treat: POLICE, conservation care/surgery, extensive rehab

IT band friction syndrome

MOI: repeated knee flexion and ext

Signs/SX: burning feeling over lateral femoral condyle, point tenderness where IT band and epicondyle meet, pain when decelerating, walking down stairs, walking/running down hills, may avoid full ext when walking

ST: obers test

Treat: correct biomechanics, NSAIDs, stretching TFL, IT band, quads/hamstrings, proprioceptive hip/lower extremity exercises