Knee Injury Acute History

Aka: Knee Injury Acute History, Knee Injury

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II. History: Mechanism of injury

  1. Type of activity
  2. Type of Trauma (Contact?)
  3. Playing surface (Concrete?)

III. History: Red Flags

  1. Possible Fracture, dislocation, or tendon or ligament rupture
    1. Severe acute pain
    2. Immediate swelling with injury
    3. Instability
    4. Inability to bear weight
  2. Septic Joint
    1. Fever
    2. Erythema
    3. Limited range of motion

IV. History: Direction of injury force

  1. Hyperextension Injury
    1. Anterior Cruciate Ligament Tear
    2. Patella Dislocation
  2. Direct blow to lateral side of knee (Valgus Stress)
    1. Medial Collateral Ligament Injury
    2. Knee Dislocation (Tibial Femoral Dislocation) or Knee Subluxation
    3. Tibial Plateau Fracture
  3. Direct blow to medial side of knee (Varus Stress)
    1. Lateral Collateral Ligament Injury
    2. Knee Dislocation (Tibial Femoral Dislocation) or Knee Subluxation
    3. Tibial Plateau Fracture
  4. Direct blow to anterior knee (e.g. knee hits dashboard)
    1. Posterior Cruciate Ligament injury
    2. Knee Dislocation (Tibial Femoral Dislocation) or Knee Subluxation
    3. Patella Fracture
  5. Twisting Injury
    1. Anterior Cruciate Ligament Tear
    2. Meniscus Injury
    3. Patella subluxation or Patella dislocation
  6. Quick stop or sharp cut
    1. Anterior Cruciate Ligament Tear

V. History: Concurrent Sensations

  1. "Snap" or "pop" at time of injury
    1. Anterior Cruciate Ligament Tear
  2. Locking, clicking or catching Sensation
    1. Meniscus Injury
    2. Knee Joint loose bodies
  3. Knee locks in flexed position
    1. Bucket-handle tear (anterior to MCL)
  4. Giving-way or buckling Sensation
    1. Anterior Cruciate Ligament Tear
    2. Meniscus Injury
    3. Patella subluxation
    4. Knee Joint loose bodies

VI. History: Immediate knee swelling and difficult walking (or unable to ambulate)?

  1. Anterior Cruciate Ligament Tear
  2. Acute Patella dislocation
  3. Osteochondral Fracture (Tibial Plateau Fracture)
  4. Knee Dislocation (Tibial Femoral Dislocation) or Knee Subluxation
  5. Tibial Plateau Fracture
  6. Patella Fracture
  7. Proximal Fibula Fracture

VII. History: Athlete continued participating in activity after Injury

  1. Meniscus Injury
  2. Patella subluxation
  3. Mild collateral ligament injury

VIII. History: Morning stiffness lasts >30 minutes (esp. Polyarticular)

  1. Age <50 years
    1. Rheumatoid Arthritis
    2. Reactive Arthropathy
    3. Systemic Lupus Erythematosus
  2. Age >50 years
    1. Knee Osteoarthritis

IX. History: Other relevant history

  1. See Acute Knee Pain
  2. Knee Pain history
    1. Knee Pain location ("point with one finger")
    2. Knee Pain duration
  3. Knee Injury history
    1. History of prior Knee Injury
    2. History of change in recent activities
  4. Past medical history
    1. Prior knee injuries or surgeries
    2. Sexually Transmitted Infections (e.g. Gonorrhea, Chlamydia, Syphilis)
    3. Lyme Disease
    4. Concurrent rheumatic or Autoimmune Conditions
      1. Acute Gouty Arthritis
      2. Pseudogout
      3. Rheumatoid Arthritis
      4. Knee Osteoarthritis

X. References

  1. Bunt (2018) Am Fam Physician 98(9): 576-85 [PubMed]

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