|
|
|
|
|
Lateral Knee Pain |
|
|
|
|
|
|
|
|
|
|
Lateral Knee Pain
Diagnosis & Treatment
John P. Albright, MD
June 3, 2004
Pt #1: 15 yo
skier
•
HX
–
Sudden onset
mild lateral knee pain
–
Knee
hyperextended
–
Ski down hill
and quit
–
Swelling in one
hour
•
Exam
–
Lat joint line
tender
–
+ Apley's
–
Painful
McMurray’s
Differential
Diagnosis
•
Intra-articular
•
Extra-articular
Differential
Diagnosis
•
Lateral joint
pathology
•
Ligament
instability
•
Iliotibial band
syndrome
•
Primary
Myofascial Pain
•
Lateral Synovial
Plica
•
Popliteus/biceps
tendonitis
•
Common peroneal
injury
•
Lumbar spine
referral
•
Prox tib-fib
joint sprain
Knee Hemarthrosis
Differential Diagnosis
•
ACL 70%
•
Meniscus 50%
•
Fracture 20%
•
Patellar
dislocation
•
PCL
Intra-articular
Pathology
Meniscus tear
•
Exam findings
–
Joint line tenderness
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+/-”
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+/-”
Pt #1: MRI
MRI
•
LM
MRI of Immature
meniscus
Takeda JBJS 80-B ’98 463-7
Intra-articular
Pathology
Meniscus tear
•
Meniscus tear
•
Meniscal cyst
MRI immature
meniscus
•
108 knees
•
29 adult
controls
•
Takeda JBJS 80-B ’98 463-7
MRI immature
meniscus
•
Prevalence of a
“high signal”
–
Youth = 66%
–
Adults = 29%
MRI immature
meniscus
•
Effects of age
–
10 years = 80%
–
13 years = 65%
–
15 years = 35%
Intra-articular
Pathology
Meniscus tear
•
Exam findings
–
Joint line
tenderness
–
McMurray’s “+”
–
Apley’s “+”
Intra-articular
Pathology
Meniscus tear
•
Meniscus tear
•
Meniscal cyst
•
Discoid meniscus
–
Loud + painful
pops
–
AP weight
bearing X-ray
•
Wide joint space
•
Misshapen Lat
fem condyle
–
MRI “+”
Intra-articular
Pathology
lateral compartment pain
•
Meniscus tear
•
Meniscal cyst
•
Discoid meniscus
•
Chondromalacia
tibia
Chondromalacia
tibia
•
Tender joint
line
•
McMurray’s
(“pain only”)
•
Apley’s “+”
•
MRI “-”
•
Scope (soft)
Pt #1 CT
•
See original CT
films
Intra-articular
Pathology
lateral compartment pain
•
Meniscus tear
•
Meniscal cyst
•
Discoid meniscus
•
Chondromalacia
tibia
•
Plateau fracture
CT scan
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+/-”
•
MRI “+”
•
Scope “+”
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+”
•
MRI “+”
•
Scope “+”
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+”
•
MRI “+”
•
Scope “+”
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+”
•
MRI “+”
•
Scope “+”
Arthroscopic
restoration
Post op bone graft
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+”
•
MRI “+”
•
Scope post op
Plateau fracture
•
Tender joint
line
•
Apley's “+”
•
McMurray’s
(pain only)
•
X-rays “+”
•
MRI “+”
•
Scope second
look
Pt #2 32 RN
•
HX
–
Jumped backwards
off chair
–
“hyperextended”
knee
–
Swelling +
ecchymosis
–
Pain with
walking
•
Clicks
frequently
•
Frequently
“gives away”
–
“X-Rays
“negative”
Pt #2 32 RN
•
Exam
–
Joint line
tender
–
Varus laxity 3
mm (same as rt)
–
Pain with active
Lachman’s test
•
No relief with
post support
–
Dial test “+” at
30 degrees
–
“-” at 90 degrees
Intra-articular
Pathology
lateral compartment
•
Meniscus tear
•
Meniscal cyst
•
Discoid meniscus
•
Chondromalacia
tibia
•
Plateau fracture
•
OCD Lateral
Femur
•
Ligament sprain
Lateral ligament
sprains
•
Lat Collat
Ligament
Lateral ligament
sprains
•
Lateral
Collateral ligament
•
Arcuate complex
Multiple ligament
Sprains
•
ACL
•
PCL
•
LCL
Differential
Diagnosis
•
Extra-articular
–
Lateral
•
Primary
myofascial
•
Iliotibial band
syndrome
•
Peroneal nerve
irritation
–
Posterolateral
•
Prox tib-fib
joint sprain
•
Popliteus/biceps
tendonitis
•
Lumbar spine
referral
Proximal tib-fib
joint sprain
•
Posterior
instability
•
Pain
–
Below joint line
–
Active knee
flexion
–
Ankle motion
–
Distal
compression
|
|
|
|
|
|
|
|
|
|
|
|
|
|
