Download - Knee instability clinical assessment
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Examination of the
Unstable Knee
Examination of the
Unstable Knee
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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
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Hughston (1975)
classified knee
ligament injuries into
straight, rotary,
combined patterns
Hughston (1975)
classified knee
ligament injuries into
straight, rotary,
combined patterns
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Hughston (1975)
PCL was the
Central Pivot
Hughston (1975)
PCL was the
Central Pivot
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Nicholas (1979)
described the
importance of the
quadruple complexes
Nicholas (1979)
described the
importance of the
quadruple complexes
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Anatomy :medial side
Anatomy :medial side
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Lateral structures
Lateral structures
•Fibular collateral ligament
•Biceps femoris•Arcuate popliteal
complex• Iliotibial band
•Fibular collateral ligament
•Biceps femoris•Arcuate popliteal
complex• Iliotibial band
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Quadruple Complexes
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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)
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•Complete, Gentle,
Precise, Systematic
•Comparison with
normal side
•Timing – early / late
•Complete, Gentle,
Precise, Systematic
•Comparison with
normal side
•Timing – early / late
ExaminationExamination
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•Ecchymosis
•Swelling
•Tenderness
•Muscle wasting
•Ecchymosis
•Swelling
•Tenderness
•Muscle wasting
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Stress TestingStress Testing
• Gentle touch
• Comparison• End point• Degree of excursion
• Gentle touch
• Comparison• End point• Degree of excursion
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Valgus stress testValgus stress test
•0o & 30o Degrees
•Tenderness
•Laxity
•End point
•0o & 30o Degrees
•Tenderness
•Laxity
•End point
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Valgus stress test
Valgus stress test
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Valgus stress test
Valgus stress test
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Valgus stress test
Valgus stress test
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Figure of “4” position
Figure of “4” position
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Varus stress at 30o
Varus stress at 30o
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Varus stress at 0o
Varus stress at 0o
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Anterior DrawerAnterior Drawer
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Anterior DrawerAnterior Drawer
videovideo
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Slocum’s Anterior Drawer
Slocum’s Anterior Drawer
•Neutral Rotation
•30o ER
•15o IR
•Neutral Rotation
•30o ER
•15o IR
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Lachman TestLachman Test
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Lachman TestLachman Test
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Lachman TestLachman Test
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Pivot Shift testPivot Shift test
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Posterior SagPosterior Sag
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Posterior SagPosterior Sag
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Posterior SagPosterior Sag
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Posterior DrawerPosterior Drawer
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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
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Quadriceps active test
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Quadriceps active test
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