KNEE

INJURIES
KNEE
SPECIAL
SPS 523 SPORT INJURY CARE

TEST
AND SAFETY
 GROUP MEMBER
NO NAME STUDENT ID

1. NUR HANNAH BINTI HAMZAH 2021600624

2. NURUL AFIQAH BINTI NORKHAMISZAN 2021834114

3. NURUL SALFARINA BINTI LADJA 2021613102

4. WAN ANIQ ZULKARNAIN BIN WAN 2021600838

YUSMANUDDIN

5. AIMAN HAKIM BIN REDWAN 2021849396

6. HAFIZ BIN HASHIM 2021474162

7. WAN AMIRUL IKMAL BIN WAN LOKMAN 2021858018

8. AMIERUL DANIAL BIN MOHD FADIL 2021474972

9. AZHAD DANIAL BIN ABDUL LATIF 2021613044

 Knee is one of the largest
and most complex joints in
the body

Knee Sprain - torn or

KNEE
overstretched ligament
 ANTERIOR CRUCIATE
LIGAMENT
Definition : THE ANTERIOR
CRUCIATE LIGAMENT (ACL) IS A BAND OF
CONNECTIVE TISSUE WHICH CONNECTS
FROM THE POSTERIOR FEMUR TO THE
ANTERIOR TIBIA.

THE ACL IS A KEY STRUCTURE IN THE KNEE

JOINT, AS IT RESISTS ANTERIOR TIBIAL
TRANSLATION AND ROTATIONAL LOADS.

CRUCIATE: CROSSING

PREVENT ANTERIOR DISPLACEMENT OF

TIBIA
ANATOMY OF ANTERIOR
CRUTIATE LIGAMENT.
UNINJURED VS INJURED
UNINJURED INJURED
 Mechanism of ACL Injury
ACL Injury : USUALLY INJURED
WITH TWISTING TO THE KNEE, SUDDEN
HYPERFLEXION AND SUDDEN
HYPEREXTENSION
•NON CONTACT SPORT: NETBALL, SKIING
•CONTACT SPORT: FOOTBALL, RUGBY,
HOCKEY
•HIT OR GRAB BY AN OPPONENT
SIGN AND SYMPTOM OF INJURY:
ACL INJURY ACUTE: SUDDEN/ SPONTANEOUS
MARKED BY PAIN AND POP SOUND
SIGNIFICANT KNEE SWELLING, EDEMA
DIFFICULTY BEARING WEIGHT ON
AFFECTED KNEE

CHRONIC:
FEELING THE KNEE BUCKLE AND
EXPERIENCING INSTABILITY IN DAILY
BASIS
PROLONGED PAIN AND SWELLING
IF LEFT UNTREATED, IT CAN
ACCELERATE ARTHRITIS (JOINT
IMFLAMMED)
LACHMAN TEST
 MEDIAL COLLATERAL
LIGAMENT SPRAIN
Definition : MCL is band of
tissue that runs along the
inner edge of your knee.

MCL Injury : is a stretch,

partial tear, or complete
tear of the ligament on the
inside of the knee
 Anatomy of uninjured vs
injured
UNINJURED INJURED
Anatomy of uninjured vs
injured
UNINJURED INJURED
Mechanism of Injury
Mechanism of Injury
SIGN AND SYMPTOM OF INJURY:
MCL INJURY GRADE 1
1o SYMPTOM SIGN
-mild medial pain - medial edema
-possibility of swelling and - tenderness
limping
-medial edema
-tenderness

GRADE 2
2 o
SYMPTOM SIGN
-moderate medial pain - medial edema
-swelling and limping - tenderness
-instability

GRADE 3
3 o
SYMPTOM SIGN
-severe medial pain - severe medial pain
- swelling - swelling
- knee gives way into valgus - knee gives way into
valgus

Its a degree of knee flexion . Also known as “degree” of injury

SPECIAL
TEST
-MCL
INJURY
 VALGUS
STRESS TEST
- Known also as medial stress test
- damage to the
medial collateral ligament of the
knee
 A picture is
worth a
thousand words
PROCEDURE OF VALGUS STRESS
TEST
Performing the Test:
1. The patient's leg should be relaxed for this test.
2. This test is typically performed at both 30 and 0 degrees of knee flexion
3. The examiner should passively bend the affected leg to about 30 degrees of
flexion.
4. While palpating the medial joint line, the examiner should apply a valgus force to
the patient's knee.( A positive test occurs when pain or excessive gapping occurs
(some gapping is normal at 30 degrees)). Be sure to not include rotation of the
hip in your application of force.
5. Next the examiner should repeat the test with the knee in neutral (0 degrees of
flexion). A positive test occurs when pain or gapping is produced. There should
be no gapping at 0 degrees.
How to know if the test is positive?

1. When do the test, keep the knee full

extension and put a valgus stress on the
knee.
2. NOTICE, the leg open up a little bit.
3. A normal leg doesnt open up.
4. Negative result - 0 degree gapping
 GRADE OF TEST
SCALE OF ROM QUALITY OF ENDPOINT OTHER EXAMANITION FINDING
LAXITY DEGREES

GRADE 1 1- 4 mm • Mild • Stretch injury or few MCL fibers torn (no significant
• First-degree injury loss of ligament integrity)
• Firm endpoint with no •Tenderness over MCL with no instability
joint laxity

GRADE 2 5-9 mm Moderate • Some MCL fibers remain intact, generating the firm
• Second-degree injury endpoint
• Incomplete / partial MCL • Increased valgus laxity with 5-15 ° of valgus
tear instability at 30 ° flexion
• Firm endpoint +/- mild • No rotatory instability or instability in extension
increase in joint laxity

GRADE 3 > or equal to Severe Increased joint laxity

10 mm • Third-degree injury Significant valgus laxity with more than 15 ° of
• Complete MCL tear instability to valgus stress at 30 ° of flexion with no
• No endpoint with valgus definite endpoint. There may have rotatory instability,
stress instability extension
 Lateral collateral ligament
Definition : LCL injury is a
strain or tear to the lateral
collateral ligament (LCL).

-There has three grade which Grade

I, Grade II and Grade III.
 Mechanism of LCL Injury
LCL Injury :
 Mechanism of LCL Injury
LCL Injury :
SIGN AND SYMPTOM OF INJURY:
LCL INJURY GRADE 1
The ligament overstretches but does not tear. It can
result in mild pain or swelling. A grade 1 sprain does
not usually affect joint stability.

GRADE 2
The ligament overstretches but does not tear. It can
result in mild pain or swelling. A grade 1 sprain does
not usually affect joint stability.

GRADE 3
This involves a complete ligament tear. Symptoms
include swelling, significant bruising, joint instability,
and difficulty putting weight on the leg. A grade 3
sprain increases the risk of injury to other parts of the
knee and leg
SPECIAL TEST
Lateral Cruciate Ligaments Sprain
Varus stress test
- Varus at 0 degrees.
- Apply a varus force to the
patient's knee in 0 degrees of
flexion.

- Varus at 30 degrees.
- Bend the affected leg to
about 30 degrees of flexion.
- Apply a varus force to the
patient's knee.
POSITIVE TEST
•Increased laxity, pain and guarding
st nd
•Pain at (1 or 2 degree sprain)
nd rd
•Laxity at (2 or 3 degree sprain)
GRADE OF TEST
Varus Stress Test 0% - 30%

Grade 0 : No Laxity

Grade 1 : 5% of laxity

Grade 2 : 10% of laxity

Grade 3 : 15% or more of laxity

Dial test
- Flexs the patient knees to 30°.
- A maximal external rotation
force is then applied.
- Foot thigh angle is measured
and compared with the other
side.
Dial test
- The knees are then flexed
to 90°.
- An external rotation force
is applied .
- The foot-thigh angle is
measured again.
POSITIVE TEST
GRADE OF TEST
Dial Test 30% Result

<5% Successful

>5%,<10% Successful

>10%,<15% Failure

>15% Failure
Apley’s distraction test

- The patient in the prone position, flex the patient’s knee to 90˚ while stabilizing
the distal thigh against the table.
- Grasp the ankle with both hands and apply upward traction while rotating the
tibia internally and externally.
POSITIVE TEST
A positive finding is excessive joint separation or excessive internal
or external rotation, with or without pain, implicating involvement
of joint restraints such as the collateral and cruciate ligaments.
 POSTERIOR CRUCIATE
LIGAMENT
● The PCL is a ligament that attached to the posterior intercondylar
area of the tibia and passes anteriorly, medially, and upward to attach
to the lateral side of the medial femoral condyle.
● The ligament that prevents the tibia (shin bone) from sliding too far
backward. Along with the ACL which keeps the tibia from sliding too
far forward.
● This ligament helps to maintain the tibia in a position below the
femur (thigh bone).
 ANATOMY OF
POSTERIOR CRUCIATE
LIGAMENT
(UNINJURED VS INJURED)
MECHANISM OF INJURY
SIGN AND SYMPTOMS OF
INJURY
 GRADE OF INJURY

Grade 1 :
This is a mild injury that causes only microscopic tears in the
ligament.

Grade 2 (Moderate) :
The PCL is partially torn and the knee becomes unstable.

Grade 3 (Severe) :
The PCL is completely torn or is separated at its end from the
bone that it normally anchors.
SPECIAL TEST
POSTERIOR DRAWER TEST
CONT’D
 GRADE OF TEST
Positive : Lack of end feel or excessive posterior translation.

Grade I : < 5 mm
Grade II : 5 – 10 mm
Grade III : >10 mm
REVERSE LACHMAN TEST
CONT’D
 GRADE OF TEST
Positive : The end feel is soft or absent, all with increased posterior
translation of the tibia compared to the other side.

Grade I : 0 – 5 mm
Grade II : 6 – 10 mm
Grade III : >10 mm
GODFREY TEST
CONT’D
 GRADE OF TEST
Positive : Increased sag at the tibial tuberosity.

Grade I : A palpable step of approximately 5 mm

Grade II : Tibial plateau and femoral condyles are level
Grade III : Tibial plateau is displaced below femoral condyles
 MENISCUS TEAR
•The meniscus is a C-shaped piece of cartilage that acts as a
shock absorber between shinbone and thighbone.
•Each meniscus has two ends, both attached to the tibia
•It can be tear if you suddenly twist your knee while bearing
weight on it.Tear of a meniscus is a rupturing of one or
more of the fibrocartilage strips in the knee called meniscus.
The meniscus can be tear from activities like:
•Pivoting
•Twisting
•Rotating
•Squatting
 ANATOMY OF
MENISCUS
(Injured vs Normal)
Types of Meniscus Tears
 Mechanism of Injury

• when the femur is internally rotated, a valgus force applied to a flexed knee may cause
a tear of the meniscus.
Mechanism of Injury
 Signs & Symptoms

• Knee pain
• Swelling of the knee
• Tenderness when pressing on the meniscus
• Popping or clicking within the knee
• Limited motion of the knee joint
Meniscus Tear Special
Test
 MCMURRAY TEST
•The diagnostic accuracy of this test was a low as 63% of all patients were correctly
diagnosed.

● To conduct this test, have your patient in supine laying position, with the
tested knee fully flexed.
1) Up your knee to 90 degrees, then rotate the tibia medially and
bring the knee into extension.

2)You would want to repeat this process a couple of times with

different angle of knee flexion, in order to test the aspect of lateral
meniscus.
 ● In order to test the medial meniscus , bring the knee
into full flexion and laterally rotate the tibia.

Results: This test is considered positive if your patient experiences clicking ,

locking or pain in the knee.
 Thessaly Test
● The most accurate test for meniscus lessions by karachalios in the year
2005.
● When you suspect a meniscus lesion from your patient history taking , you
can still perform those tests, but eventually you might want to send your
patient to get an MRI.
● Sensitivity :- 64%
● Specitivity :- 53%
1) First want to test the uninjured leg , before you move on the injured leg.

2) To perform this test , have your patient on the injured leg which is flexed to 20
degrees.
3) Your patient may hold your arms for support.
4) The rotate over the tibia three times on each side.

Results: This test is positive if your patient is complaining about pain in the
joint line during the rotations.
 Apley’s Test
The statistical accurancy of this test was as low as 58% of the patients were correctly
diagnosed.
1) To perform this test , have your patients in prone position.
2) Then , fixate the tested with your own leg and bring the knee into 90 degrees
of flexion.
 5) Then repeat the same procedure , while you are giving the compression.

Results:If rotations plus distraction is more painful or shows increase rotation relative to the
normal side. The lesion is most probable ligamentous.
If rotations plus distraction is more painful or shows decrease rotation relative to the normal
side. The lesion is most probable meniscus damage.
 Ege’s Test
● Ege's test is performed in a standing position.
● Sensitivity :-
64% (lateral) and 67% (medial)
● Specitivity :-
90% (lateral) and 81% (medial)
To test for a suspected medial meniscus tear, you'll be asked to turn your toes
outward, externally rotating the knee. You'll then squat and slowly stand back
up
To detect a Lateral meniscus tear ,both lower extremities are held in maximum
internal rotation of the knee while the patient squats and stands up.
Results Ege’s test:

● The test is positive when pain or a click is felt by the patient at the
related site of the joint line.
● Further squatting is stopped as soon as the pain or click is felt, thus
a full squat is not needed in all of the patients.
● Sometimes pain and or click may not be felt until maximum squat
or may be felt as the patient comes out of the squat, both of which
are still considered positive for this test.
THANK YOU FOR
WATCHING!!