Knee problems

Our approach in the clinic as we try to say, “Where does it hurt? Why does it hurt there?” sometimes it’s very simple. We take a history and a physical examination and get the answer right away, or so the story is supposed to go. Actually our clinical exercise is merely a set of guesses in which we try to get down to some possible anatomic explanations for the pain and some possible notions about the processes that might be modified. In fact, the number of historical features that seem to have some weight in classic training about diagnosis really may not tell us much. For instance, locking; which is supposed to be quite indicative of a meniscal derangement, was looked at among hundreds and hundreds of possible symptoms in a systematic way. In normal knees and knees that underwent arthroscopy and had these derangements shown and locking was not predictive of a torn meniscus. A buckling, for instance, was not indicative of a cruciate ligament. So we are merely making guesses here. We are beyond what the orthopedists had to do and really judge whether or not an operation needed to be done. We need to make guesses and what we can do about it.

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Practical Management of Common Knee Problems

The knee is a complex joint, a tri-compartmental, diarthrodial, synovial-type hinge joint. Two weight-bearing articulations comprise the concave condyles of the femur, which rest on the flatter tibial plateau. In the knee their congruence and stability is maintained by fibrocartilaginous structures on each side; the menisci. In the intercondylar notch are two broad collagenous structures, the cruciate ligaments which not only prevent A-P translocation but also serve to deliver some proprioceptive information back to the nervous system. (more…)