Knee injuries in general practice

Abstract

Careful technique of examination of the knee joint allows to establish the diagnosis of the most frequent knee joint injuries already through simple clinical and radiological evaluation: Recurrent dislocation of the patella with the Apprehension sign; meniscal injuries with the test of McMurray, pain on the joint line and pain on passive hyperextension; the anterior cruciate ligament tear with Lachman's sign and the Pivot Shift test and posterior cruciate injury with the Sag sign. Further imaging techniques allow to establish a definite diagnosis, which has replaced in many cases the classical, purely diagnostic arthroscopy. Thanks to careful aspiration of the knee joint the patient can be referred with a more precise diagnosis to the traumatologist and orthopaedic surgeon. Meniscal lesions don't have to be treated as emergencies with exception of the locked knee. Equally, in presence of a fresh tear of the anterior cruciate ligament a delay of surgery for eight weeks may be beneficial, be it only to rehab and prepare the knee joint for surgery. Posterior cruciate ligament tears should only be treated by a few centers, since they demand a high degree of experience. The same accounts for the new techniques for the treatment of cartilage lesions like the mosaicplasty or the autologous chondrocyte implantation.