knee instability clinical assessment

Examination of the

Unstable Knee

Examination of the

Unstable Knee

Till the 1970’s, approach to the management of knee ligament injuries was haphazard & individualistic

Till the 1970’s, approach to the management of knee ligament injuries was haphazard & individualistic

Hughston (1975)

classified knee

ligament injuries into

straight, rotary,

combined patterns

Hughston (1975)

classified knee

ligament injuries into

straight, rotary,

combined patterns

Hughston (1975)

PCL was the

Central Pivot

Hughston (1975)

PCL was the

Central Pivot

Nicholas (1979)

described the

importance of the

quadruple complexes

Nicholas (1979)

described the

importance of the

quadruple complexes

Anatomy :medial side

Anatomy :medial side

Lateral structures

Lateral structures

•Fibular collateral ligament

•Biceps femoris•Arcuate popliteal

complex• Iliotibial band

•Fibular collateral ligament

•Biceps femoris•Arcuate popliteal

complex• Iliotibial band

Quadruple Complexes

80% of traumatic

haemarthroses of

knee is due to ACL

rupture

Noyes

(1983)

80% of traumatic

haemarthroses of

knee is due to ACL

rupture

Noyes

(1983)

Mechanism of injury

Mechanism of injury

•Complete, Gentle,

Precise, Systematic

•Comparison with

normal side

•Timing – early / late

•Complete, Gentle,

Precise, Systematic

•Comparison with

normal side

•Timing – early / late

ExaminationExamination

•Ecchymosis

•Swelling

•Tenderness

•Muscle wasting

•Ecchymosis

•Swelling

•Tenderness

•Muscle wasting

Stress TestingStress Testing

• Gentle touch

• Comparison• End point• Degree of excursion

• Gentle touch

• Comparison• End point• Degree of excursion

Valgus stress testValgus stress test

•0o & 30o Degrees

•Tenderness

•Laxity

•End point

•0o & 30o Degrees

•Tenderness

•Laxity

•End point

Valgus stress test

Valgus stress test

Valgus stress test

Valgus stress test

Valgus stress test

Valgus stress test

Figure of “4” position

Figure of “4” position

Varus stress at 30o

Varus stress at 30o

Varus stress at 0o

Varus stress at 0o

Anterior DrawerAnterior Drawer

Anterior DrawerAnterior Drawer

videovideo

Slocum’s Anterior Drawer

Slocum’s Anterior Drawer

•Neutral Rotation

•30o ER

•15o IR

•Neutral Rotation

•30o ER

•15o IR

Lachman TestLachman Test

Lachman TestLachman Test

Lachman TestLachman Test

Pivot Shift testPivot Shift test

Posterior SagPosterior Sag

Posterior SagPosterior Sag

Posterior SagPosterior Sag

Posterior DrawerPosterior Drawer

Additional testsAdditional tests•External rotation

recurvatum test

•Hughston’s recurvatum test

•Flexion rotation drawer test

•Quadriceps active test

•External rotation

recurvatum test

•Hughston’s recurvatum test

•Flexion rotation drawer test

•Quadriceps active test

Quadriceps active test

Quadriceps active test