ORTHOPEDICS■ Exam reveals genu valgum (knock-knee) and atrophied quadriceps muscles
(particularly the vastus medialis obliquus).
DIAGNOSIS
■ Patella compression test: Pain and crepitus occur with compression of the
patella into the femoral groove when the knee is extended and quadriceps
muscle tightened.
■ Apprehension test:The quadriceps contracts involuntarily as the patella is
pushed laterally in anticipation of pain.
■ Increased Q angle: The angle between two lines drawn from (1) the anterior
superior iliac spine to the center of the patella and (2) the center of the
patella through the tibial tubercle. Q angle >20° is abnormal.
TREATMENT
NSAIDs and quadriceps-strengthening exercises
PATELLARTENDINITIS(JUMPER’SKNEE)
SYMPTOMS/EXAM
Anterior knee pain; night pain; pain with sitting, standing up, squatting, kneeling,
climbing stairs
DIAGNOSIS
■ Tenderness to palpation over patellar tendon:There is normal range of
motion but can be painful at full extension and with resisted extension.
■ X-rays are usually normal but may show hyperostosis at the upper and
lower pole of the patella.
TREATMENT
Heat, NSAIDs, quadriceps-strengthening exercises
Ligamentous and Meniscal Injuries of the Knee
ANTERIORCRUCIATELIGAMENT(ACL) INJURY
The most common knee ligamentous injury, it results from high-speed, trau-
matic twisting movements (especially if accompanied by a valgus stress)
and can occur from a noncontact injury.
SYMPTOMS/EXAM
■ A“pop”is frequently heard at the time of injury.
■ Hemarthrosis is common (75% of all knee hemarthroses are caused by
ACL tears).
DIAGNOSIS
Positive Lachman’s test(most sensitive) and anterior drawer signare sugges-
tive (see Table 4.3). MRI or arthroscopy is diagnostic.
TREATMENT
Rest, ice, elevate, NSAIDs, immobilization, orthopedics referral, physical
therapy