imported>Robert Badgett |
imported>Meg Taylor |
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| | {{subpages}} |
| | A '''knee joint''' is a complex, large [[synovial joint]] that includes the two condylar articulations of the [[tibiofemoral joint]] and the articulation of the [[patellofemoral joint]]. Although the knee behaves mainly as a hinge joint, some rotation is essential for locomotion. The articulating surfaces of the tibiofemoral joint (around which most movement takes place) are deepened by the [[menisci]]. The joint cavity is enclosed by a joint capsule only on the lateral and posterior aspects. Several capsular [[ligament]]s help to prevent displacement of the joint surfaces; two collateral ligaments, and the intracapsular anterior and posterior cruciate ligaments. |
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| ==Injuries== | | ==Injuries== |
| ===Fractures===
| | {{main|Knee injury}} |
| The Ottawa knee rule, a [[clinical prediction rule]], can guide need for an [[x-ray]]:<ref name="pmid14734335">{{cite journal |author=Bachmann LM, Haberzeth S, Steurer J, ter Riet G |title=The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review |journal=Ann. Intern. Med. |volume=140 |issue=2 |pages=121–4 |year=2004 |month=January |pmid=14734335 |doi= |url= |issn=}}</ref>
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| # age 55 years or older
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| # "isolated tenderness of patella (no bone tenderness of knee other than patella)"
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| # "tenderness at head of fibula"
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| # "inability to flex 90 degrees"
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| # "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)"
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| ===Torn meniscus or ligament===
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| Many tests have been proposed to improve the [[physical examination]]. Examples are:<br/>
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| '''Meniscal injuries:'''
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| * Apley compression, McMurray's, and medial-lateral grind tests
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| '''Cruciate ligaments injuries:'''
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| * Anterior drawer, posterior drawer, lateral pivot shift, and Lachman tests
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| Injuries to the cruciate ligaments can be accuractly diagnosed with physical examination by orthopedic physicians; meniscal injuries are more difficult to detect.<ref name="pmid11585485">{{cite journal |author=Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL |title=The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination |journal=JAMA |volume=286 |issue=13 |pages=1610–20 |year=2001 |month=October |pmid=11585485 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11585485 |issn=}}</ref> No sign on the physical examination (McMurray's, Apley's, and joint line tenderness) is more than 70% [[sensitivity and specificity|sensitive]] for meniscal injuries.<ref name="pmid17939613">{{cite journal |author=Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC |title=Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis |journal=J Orthop Sports Phys Ther |volume=37 |issue=9 |pages=541–50 |year=2007 |month=September |pmid=17939613 |doi= |url= |issn=}}</ref>
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| The presence of any effusion indicates likely injury to a [[meniscus]] or [[ligament]].<ref name="pmid19154833">{{cite journal |author=Kastelein M, Luijsterburg PA, Wagemakers HP, ''et al'' |title=Diagnostic value of history taking and physical examination to assess effusion of the knee in traumatic knee patients in general practice |journal=Arch Phys Med Rehabil |volume=90 |issue=1 |pages=82–6 |year=2009 |month=January |pmid=19154833 |doi=10.1016/j.apmr.2008.06.027 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-9993(08)01534-7 |issn=}}</ref>
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| The presence of a [[hemarthrosis]] indicates likely injury to a [[meniscus]] or [[ligament]], usually of the [[anterior cruciate ligament]] with high [[sensitivity and specificity|specificity]].<ref name="pmid2356496">{{cite journal |author=Hardaker WT, Garrett WE, Bassett FH |title=Evaluation of acute traumatic hemarthrosis of the knee joint |journal=South. Med. J. |volume=83 |issue=6 |pages=640–4 |year=1990 |month=June |pmid=2356496 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=83&issue=6&spage=640 |issn=}}</ref>
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| ==References==
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| <references/>
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