Knee

Key Points

• In clinical examination of ligament injuries about the knee, the Lachman test is the most sensitive for anterior cruciate ligament (ACL) instability.

• The clinician should maintain a high level of suspicion of associated ligament injuries, especially the lateral collateral ligament (LCL) and posterolateral corner. Acute surgical intervention (within 3 weeks) of LCL and posterolateral corner injuries significantly improves prognosis.

• Viscosupplementation, therapeutic exercise, and oral supplementation with glucosamine and chondroitin sulfate may all provide some symptomatic relief and functional improvement for generalized knee arthritis. Arthroscopic debridement alone (in the absence of loose bodies, cartilage flaps, and meniscus tears) may not provide relief.

• Vertical, peripheral meniscus tears in the vascular zone of the meniscus of young patients should be treated with meniscus repair whenever possible to avoid focal increased pressures in the articular surface and future risk of degenerative joint disease.

• In older patients with degenerative meniscus pathology and no locking, prevention of arthritic progression may be surgical or nonsurgical. When performed, partial is preferred to complete meniscectomy.

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