Knee injury

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In medicine and sports medicine, knee injuries are "injuries to the knee or the knee joint".[1]

Fractures

The Ottawa knee rule, a clinical prediction rule, can guide need for an x-ray:[2]

  1. age 55 years or older
  2. "isolated tenderness of patella (no bone tenderness of knee other than patella)"
  3. "tenderness at head of fibula"
  4. "inability to flex 90 degrees"
  5. "inability to bear weight both immediately and in the emergency department for 4 steps (unable to transfer weight twice onto each lower limb regardless of limping)"

Torn meniscus or ligament

Many tests have been proposed to improve the physical examination. Examples are:
The presence of any effusion indicates likely injury to a meniscus or ligament.[3]

The presence of a hemarthrosis indicates likely injury to a meniscus or ligament, usually of the anterior cruciate ligament with high specificity.[4]

Meniscal injuries

  • Diagnosis: Apley compression, McMurray's, and medial-lateral grind tests.
  • Treatment: When to surgically repair anterior cruciate ligaments is not clear.[5]

Cruciate ligaments injuries

  • Anterior drawer, posterior drawer, lateral pivot shift, and Lachman tests. Injuries to the cruciate ligaments can be accurately diagnosed with physical examination by orthopedic physicians; meniscal injuries are more difficult to detect.[6] No sign on the physical examination (McMurray's, Apley's, and joint line tenderness) is more than 70% sensitive for meniscal injuries.[7]

When to surgically repair anterior cruciate ligaments is not clear.[8]

Sports medicine

For more information, see: Sports medicine.

Knee injuries are common in sports, certainly contact sports such as American football, in which two 300-pound men may strike opposite sides of the same leg, but also in individual events requiring explosive effort with the knee. Advanced dancers can have very similar injuries; it is no coincidence that professional football players may study ballet to improve their coordination.

References

  1. Anonymous (2015), Knee injury (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Bachmann LM, Haberzeth S, Steurer J, ter Riet G (January 2004). "The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review". Ann. Intern. Med. 140 (2): 121–4. PMID 14734335[e]
  3. Kastelein M, Luijsterburg PA, Wagemakers HP, et al (January 2009). "Diagnostic value of history taking and physical examination to assess effusion of the knee in traumatic knee patients in general practice". Arch Phys Med Rehabil 90 (1): 82–6. DOI:10.1016/j.apmr.2008.06.027. PMID 19154833. Research Blogging.
  4. Hardaker WT, Garrett WE, Bassett FH (June 1990). "Evaluation of acute traumatic hemarthrosis of the knee joint". South. Med. J. 83 (6): 640–4. PMID 2356496[e]
  5. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H et al. (2013). "Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.". N Engl J Med 369 (26): 2515-24. DOI:10.1056/NEJMoa1305189. PMID 24369076. Research Blogging.
  6. Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL (October 2001). "The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination". JAMA 286 (13): 1610–20. PMID 11585485[e]
  7. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC (September 2007). "Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis". J Orthop Sports Phys Ther 37 (9): 541–50. PMID 17939613[e]
  8. Frobell, Richard B.; Ewa M. Roos, Harald P. Roos, Jonas Ranstam, L. Stefan Lohmander (2010-07-22). "A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears". N Engl J Med 363 (4): 331-342. DOI:10.1056/NEJMoa0907797. Retrieved on 2010-07-22. Research Blogging.