Knee Injuries Review From Core EM And Other Sources

Here is a list of resources I have reviewed for Knee Injuries:

  1. Episode 122.0 – True Knee Dislocations, Nov 20, 2017. From Core EM.
    1. “This week we discuss the tibio-femoral knee dislocation focusing on identification of the dangerous complications.”
    2. Link To Podcast And Show Notes.
    3. [All patients should be considered for CT angiogram.]
  2. True Knee + Patellar Dislocations, June 1, 2016. From Core EM.
    1. Link To Post
  3. Anterior Cruciate Ligament (ACL) Injuries, Jan 3, 2018.  From Core EM
    1. Link To Post
    2. The Lever Test, YouTube video, July 19, 2016.
    3. Classification
      1. Always important to note if the injury is isolated or associated with damage to another structure, such as the cartilage, meniscus, or other ligaments (common in 50% of ACL injuries)
    4. MCL/LCL injuries
        • Assessed with gradual varus/valgus stress to the knee
        • Always compare to the contralateral knee as many patients, particularly children, may have some baseline laxity
        • Valgus Stress Video
        • Varus Stress Video
    5. ED Management
      • There is no need for emergency intervention in an isolated ACL injury
      • Supportive Care
        • Rest, Ice, Compression, and Elevation
        • Analgesia
        • Crutches for comfort if needed
        • Knee immobilizer brace if unstable for comfort in the acute phase
          • Long term use of knee immobilizer associated with muscle atrophy and stiffening of joint leading to prolonged recovery
          • Patients will likely be switched to hinged brace by orthopedics on follow up
      • Referral to orthopedic surgery
        • May obtain delayed MRI
          • no indication for urgent MRI
          • Image quality may improve as swelling decreases
        • Surgical options: Patellar tendon graft, hamstring tendon graft, and allograft
  4. Medial Collateral Ligament (MCL) Injuries, Feb 21, 2018. From Core EM.
    1. Link Is To Post
    2. Definition: Stretch or tear of the medial collateral ligament (MCL).
    3. Epidemiology: See Majewski 2006, Abstract:
      1. “The knee is an anatomically and biomechanically complex joint. Few studies have been published reporting the type and frequency of knee injuries. However, this information that may help to prevent, diagnose, and treat knee joint injuries. We have documented 17,397 patients with 19,530 sport injuries over a 10-year period of time. 6434 patients (37%) had 7769 injuries (39.8%) related to the knee joint. 68.1% of those patients were men and 31.6% were women. Almost 50% of the patients were between the ages of 20-29 (43.1%) at the time of injury. The injuries documented were ACL lesion (20.3%), medial meniscus lesion (10.8%), lateral meniscus lesion (3.7%), MCL lesion (7.9%), LCL lesion (1.1%), and PCL lesion (0.65%). The activities leading to most injuries were soccer (35%) and skiing (26%). LCL injury was associated with tennis and gymnastics, MCL with judo and skiing, ACL with handball and volleyball, PCL with handball, lateral meniscus with gymnastics and dancing, and medial meniscus with tennis and jogging.”
    4. ED Management

    5. Regardless of injury grade, ED management of isolated MCL injuries is supportive

      • Ice, compression, elevation, and NSAIDs
      • Weight bearing as tolerated
      • hinged knee brace should be applied
        • Protect against additional valgus injury
        • Avoid knee immobilizers as they can lead to knee stiffness and muscle weakness
      • Always encourage early mobilization (within the first week)
      • Indications for emergent ortho consultation
        • Associated open fracture
        • Neurovascular deficit
        • Suspected tibiofemoral dislocation
        • Unstable knee joint
          • Due to muscle spasm and soft tissue swelling, an unstable knee might appear stable
          • Immobilize, make non-weight bearing, and obtain close follow-up if unstable joint without evidence of dislocation (within 1 week) for re-examination
  5. Meniscus Injuries*, October 12, 2018 from                *See also Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline
    BMJ 2017; 357 doi: (Published 10 May 2017)
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