INTRODUCTION
• The largest joint in the body • subject to a great variety of traumatic and
degenerative conditions• Outwardly simple but is actually quite
complex• Not just a hinge joint.
INTRODUCTION
• The tibia femoral joint is inherently unstable• Relies heavily on ligaments for stability• Patella is the largest sesamoid bone in the
body – acts as a fulcrum increasing mechanical advantage of quads.
INSPECTIONSurface anatomy
• Anterior: – Patella
• Fracture• Bipartite
– Infra-patellar tendon and Hoffa’s fat pad• Rupture• Tendonitis
– Tibial tubercle• Osgood – Schlatter• avulsions
INSPECTIONSurface anatomy
– Femoral condyles– Pre-patellar bursa• Bursitis
– Extensor mechanism• Rectus femoris• Vastus intermedius• Vastus medialis (VMO)• Vastus lateralis
INSPECTION:Surface anatomy
• Medial:– Pes anserinus• “Say Grace before Tea”
– MCL
• Lateral:– ITB (Gerdy’s Tuburcle)– LCL
INSPECTION:Limb alignment
• INSPECTION:– Genu Valgum• Intra-maleolar distance
– Genu Varum• Intra-condylar distance
– Windswept deformity
INSPECTION:Patella alignment
• Squinting patellae– Increased femoral ante-version– Increased external tibial torsion
• Q angle– Anterior ASIS to center of patella– Center of patella to tibial tubercle– 14° in men, 17° in women
• Patella Alta• Patella baja
INSPECTION:GAIT
• Varus thrust• Valgus thrust• Recur vatum thrust• Antalgic gait• Stiff knee gait• Flexed knee gait
INSPECTION:Range of movement
• Extension: Normal range– Active : 0° – Passive: - 10° (prone hanging test)
• Flexion: Normal range– Active: 0° - 130°– Passive: 0° - 150°
PALPATION:
• Patella• Infra-patella tendon• Tibial tubercle• Pes anserinus• MCL• Medial joint space and meniscus• Medial femoral condyle • VMO
PALPATION:
• Rectus femoris• Vastus intermedius• Vastus lateralis• Lateral femoral condyle• LCL• Lateral joint space and meniscus• ITB and Gerdy’s tubercle
MANIPULATION:
• Muscle testing – Oxford grading (out of 5)• 5 – normal power• 4 – weak power• 3 – against gravity• 2 – with gravity• 1 - Flicker
MANIPULATION:
• Use:– “Flex or extend”– “Hold it there”– “Keep it there”
• Test:– Quads– Hamstrings
• Check for atrophy– Measuring tape (compare)
SPECIAL TESTS:
• VALGUS STRESS TEST:– MCL (30° flexion)– MCL, ACL and capsule (extension)
• VARUS STRESS TEST:– LCL (30° flexion)– LCL, ACL and capsule (extension)
• GRADE LAXITY:– Gr I– Gr II– Gr III
SPECIAL TESTS:
• VARUS RECUVARTUM TEST:– Posterior lateral corner
• SQUAT TEST:– Meniscus
• APLEY’S GRINDING AND DISTRACTION TEST:– Menisci
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