Detailed Hx is important:

• weight bearing at the time?
• any sounds? - 'pops' are typical of ACL rupture.
• early knee swelling - indicative of haemarthrosis, intra-articular pathology
• clicking/locking and instability
  • suggestive of meniscal tear or chondral pathology
  • instability descending stairs suggests PCL damage
  • AP axis stability but instability on rotation suggests ACL injury

Often difficult in acute setting because of pain

Specific exam techniques:

• ACL rupture - Lever test, Lachman and pivot shift tests (View Lachman test)close

Lever test for ACL rupture

• PCL rupture - post draw and post sag
• Collateral lig injury - varus and valgus stressing
• Patella injury - patella apprehension test
• Meniscal injury – McMurray test, Apley test

Apley test - patient in prone position with the knee flexed to 90 degrees. Fix patient's thigh to table with your knee then laterally and medially rotate the tibia, 1st with distraction then compression, noting any excessive movement, restriction or discomfort. If rotation + distraction is more painful or shows increased rotation relative to the normal side, the lesion is more likely ligamentous. If rotation + compression is more painful or reduced rotation, more likely a meniscus injury.

review of clinical tests vs surgical findings

• usually lateral
• reduction
  • analgesia - N2O with O2 is effective
  • push patella medially while extending knee.
  • rigid splint or POP and crutches. Recurrent dislocations may be managed with pressure bandage until review

• beware bipartite and multi-partite patella on XRay
• non or minimal displaced with intact extensor mechanism - conservative management

• usually occurs when landing with heel strike through a weight bearing limb
• poor blood supply and resultant little healing, almost always requires reconstructive surgery
• Classically there is a sensation of a ‘pop’ and/or ‘shifting’ with immediate, severe pain which eases rapidly but usually followed by episodes of instability
• rapid onset swelling
• XRay - may see fracture of tibial spine or plateau

• predominantly extra-capsular, has better blood supply and therefore better healing
• may have instability descending stairs and walking downhill, but surprisingly little other functional loss
• +ve draw test and posterior sag
• conservative management usually with splinting for pain and physio/rehab for recovery

• extra-capsular ligs injured in either varus or valgus stress
• Grade I - pain without laxity
• Grade II - pain with some laxity
• Grade III - often pain free with greater laxity
• MCL - conservative Mx usually with hinged knee brace
• LCL - rare and often associated with ACL/PCL rupture

• compression with rotational forces through the knee.
• LCL less commonly because less attached and more mobile
• subacute effusion
• tender joint line.
  • McMurray's test when +ve = 95% specific (View test for medial meniscus)close
    • internal rotation of tibia and Varus stress = lateral meniscus test
    • external rotation of tibia and Valgus stress = medial meniscus test
  • Apley's test - prone patient with flexed knee. Compression with rotation = likely meniscal injury, Distraction with rotation = likely ligamentous

• ACL and MCL injuries associated with lateral plateau fracture
• PCL and LCL associated with medial plateau fracture

Schatzker classification - more serious 1→6. II most common.

• Classically results from internal rotation and varus stress of the knee in flexion, the Segond fracture is an avulsion injury of the lateral tibial plateau and mid-lateral capsule that frequently accompanies ACL rupture.
• classical appearance - curvilinear or elliptic bone fragment projected parallel to the lateral aspect of the tibial plateau.
• whilst the fracture may seem insignificant there are commonly extensive other injuries
  • ACL tear or rupture in >75%
  • med or lat meniscal tears ~70%
  • avulsion of biceps femoris attachment

• Synovial Plica Syndrome is a common cause of pain in the antero-medial aspect of the knee
• plicae are folds in the synovium and are found in suprapatellar, mediopatellar, infrapatellar, or lateral locations. The medial plica is the most commonly symptomatic.
• symptoms include: anterior knee pain, clicking, clunking, and a popping sensation on patello-femoral loading activity such as squatting and therefore commonly misdiagnosed as patello-femoral syndrome
• often following strenuous physical work or athletic activity involving repetitive flexion and extension of the knee
• a palpable plica on examination may present as a ribbon like fold of tissue, which can be rolled directly against the underlying medial femoral condyle
• effusion or swelling is usually not present
• more usually a clinical Dx, as a diagnosis of exclusion, Hughston's plica testclose examiner flexes the knee, medially rotates the lower leg, glides the patella medially, and palpates the medial femoral condyle. The test is positive if a pop is appreciated under the examiners fingers and Stutter testsclose The Stutter test is performed by having the patient sit upright with the legs dangling off the edge of the exam table at a 90-degree angle. The examiner places his or her index and middle fingers on the center of the patella of the affected leg. The patient then extends the affected leg while the examiner feels for a stutter of the patella. are provocative tests commonly used to support the diagnosis if both (best) are positive
• Management - usually/mostly conservative with physiotherapy, quadriceps strengthening exercises

• are popliteal synovial cysts, and often associated with other knee pathology including arthritis, meniscal tears, ant cruciate tears, osteoarthritis, inflammatory arthritis etc. Meniscal tears are the most common.
• most commonly found deep to the medial head of gastrocnemius and semimembranosus usually with a valvular opening in post joint capsule
• most common symptoms are swelling behind the knee, or aching, especially worse in extension
• examination may find a lump which is firm with knee extension and soft with flexion
• differential - popliteal artery aneurysm, soft tissue tumours, meniscal cyst, haematoma, thromboemboli, and seroma.
• complications - infection, rupture, and neurovascular compression, thrombophlebitis, compartment syndrome (especially if bleeds following rupture), and compressive neuropathies
• Management
  • conservative - treatment of underlying condition, analgesia, ice packs, physio
  • steroid injection occasionally
  • surgical - generally only if complications

Comp Ortho picture
https://www.orthosports.com.au/pdf-download/SportsKneeInjuries.pdf
https://wikem.org/wiki/
https://radiopaedia.org/articles/segond-fracture?lang=gb
https://litfl.com/patellar-dislocation/
Synovial plica syndrome - review
Plica syndrome review. Embryology
Bakers cyst review