Knee injuries are among the most reported sports injuries.[1] [2] [3] A 2017 study reported that the knee is the third most common site of ligamentous injuries.[4] Many can be treated conservatively with rest, ice, immobilization, and physical therapy. The aim of initial assessment is to identify any neurological or vascular compromise, which could require urgent surgery, then to establish the likely nature of the injury through a focused history and examination.
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Summary
Acute knee injuries
By most definitions, acute knee injuries are defined as being diagnosed within the first 30 to 42 days of the injury or onset of symptoms.
Chronic knee injuries
Chronic knee injuries are due to residual old trauma or surgery, existing degenerative diseases, or previous conditions not resolved within the first 30 to 42 days after the onset.
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First dorsal web space sensation testing (common peroneal nerve)
Lateral foot sensation testing (superficial peroneal nerve)
Extensor hallucis longus strength testing
Small toe extensors strength testing
Foot eversion strength testing
Dorsiflexion strength testing
Medial foot sensation (saphenous nerve)
Plantar flexion strength testing
Foot inversion strength testing
Quadriceps strength testing
Hamstring strength testing
Hip external rotation
Hip internal rotation
Log rolling test
Deep flexion of the knee
External rotation recurvatum test
Palpation of medial plica
Palpation of inferior pole of patella
Palpation of pes anserine bursae
Palpation of prepatellar bursae
Palpation of superior pole of patella
Palpation of semimembranosus bursa
Lateral patellar translation
Medial patellar translation
Rolling superior and inferior poles of patella within trochlear groove
Rolling superior and inferior poles of patella within trochlear groove
Palpation of lateral patellar fat pad
Palpation of medial patellar fat pad
Lachman test
Pivot shift test
Valgus stress test
Palpation of meniscofemoral MCL
Palpation of meniscotibial MCL
Palpation of the biceps femoris bursae
Varus stress test
Posterolateral drawer test
Palpation of tibial tubercle
Dial test at 30° knee flexion in prone position
Dial test at 30° knee flexion in supine position
Dial test at 90° knee flexion in prone position
Dial test at 90° knee flexion in supine position
Reverse pivot shift test
Figure 4 test
Posterior drawer test
Posterior sag sign
Quadriceps active test
Citations
Expert Panel on Musculoskeletal Imaging, Taljanovic MS, Chang EY, et al. ACR appropriateness criteria® acute trauma to the knee. J Am Coll Radiol. 2020 May;17(5s):S12-25.[Abstract][Full Text]
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3. Engebretsen L, Steffen K, Alonso JM, et al. Sports injuries and illnesses during the Winter Olympic Games 2010. Br J Sports Med. 2010 Sep;44(11):772-80.[Abstract]
4. Nabian MH, Zadegan SA, Zanjani LO, et al. Epidemiology of joint dislocations and ligamentous/tendinous injuries among 2,700 patients: five-year trend of a tertiary center in Iran. Arch Bone Jt Surg. 2017 Nov;5(6):426-34.[Abstract]
5. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977 Mar;59(2):236-9.[Abstract]
6. LaPrade RF, Wentorf F. Acute knee injuries: on-the-field and sideline evaluation. Phys Sportsmed. 1999 Oct;27(10):55-61.
7. Quatman CE, Quatman-Yates CC, Hewett TE. A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports Med. 2010 Sep 1;40(9):729-46.[Abstract]
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10. LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997 Jul-Aug;25(4):433-8.[Abstract]
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14. Hughston JC, Andrews JR, Cross MJ, et al. Classification of knee ligament instabilities. Part 1. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. 1976 Mar;58(2):159-72.[Abstract]
15. Veltri DM, Warren RF. Posterolateral instability of the knee. J Bone Joint Surg Am. 1995;44:441-53.[Abstract]
16. Cooper DE. Tests for posterolateral instability of the knee in normal subjects. Results of examination under anesthesia. J Bone Joint Surg Am. 1991 Jan;73(1):30-6.[Abstract]
17. Grood ES, Stowers SF, Noyes FR. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am. 1988 Jan;70(1):88-97.[Abstract]
18. LaPrade RF, Konowalchuk BK. Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair. Am J Sports Med. 2005 Aug;33(8):1231-6.[Abstract]
19. Daniel DM, Stone ML, Barnett P, et al. Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg Am. 1988 Mar;70(3):386-91.[Abstract]
20. Logerstedt DS, Snyder-Mackler L, Ritter RC, et al. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther. 2010 Jun;40(6):A1-A35.[Abstract]
21. Ockert B, Haasters F, Polzer H, et al. Value of the clinical examination in suspected meniscal injuries. A meta-analysis [in German]. Unfallchirurg. 2010 Apr;113(4):293-9.[Abstract]
22. Lathlean T et al; Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S). Diagnostic arthroscopy for conditions of the knee. ASERNIP-S Report no 64. October 2008 [internet publication].
23. Hegedus EJ, Cook C, Hasselblad V, et al. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007 Sep;37(9):541-50.[Abstract]
24. Expert Panel on Musculoskeletal Imaging, Taljanovic MS, Chang EY, et al. ACR appropriateness criteria® acute trauma to the knee. J Am Coll Radiol. 2020 May;17(5s):S12-25.[Abstract][Full Text]
25. Stiell IG, Wells GA, McDowell I, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995 Nov;2(11):966-73.[Abstract]
26. Smith TO, Davies L, Toms AP, et al. The reliability and validity of radiological assessment for patellar instability: a systematic review and meta-analysis. Skeletal Radiol. 2011 Apr;40(4):399-414.[Abstract]
27. LaPrade RF, Bernhardson AS, Griffith CJ, et al. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med. 2010 Feb;38(2):330-8.[Abstract]
28. LaPrade RF, Heikes C, Bakker AJ, et al. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg Am. 2008 Oct;90(10):2069-76.[Abstract]
29. LaPrade RF, Gilbert TJ, Bollom TS, et al. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med. 2000 Mar-Apr;28(2):191-9.[Abstract]
30. Hewett TE, Noyes FR, Lee MD. Diagnosis of complete and partial posterior cruciate ligament ruptures. Stress radiography compared with KT-1000 arthrometer and posterior drawer testing. Am J Sports Med. 1997 Sep-Oct;25(5):648-55.[Abstract]
