GC230 Knee Sport Injuries: Part 1
Knee sport injuries encompass a spectrum of traumatic musculoskeletal conditions—including ligament tears (ACL, MCL, PCL, LCL), meniscal injuries, and patellar dislocations—commonly resulting from high-impact or pivoting athletic activities.
Knee Sport Injuries – Part 1: Introduction, Anatomy, Clinical Assessment & Principles of Management
This lecture (GC 230, Part 1 of 6) is the foundation lecture for the entire knee sports injuries series. It does not focus on a single pathology; instead, it lays out the systematic framework you will use for every knee sports injury across Parts 2–6 (ligament, meniscus, cartilage, extensor mechanism, patellofemoral instability). [1]
Big idea: Before you can manage an ACL tear, meniscus tear, or patella dislocation, you need to be able to take a focused knee history, perform a structured knee examination, order the right investigations, and reason through what tissue is injured and whether it can heal.
Learning objectives (directly from slides): [1]
- Anatomy of the knee joint
- Clinical reasoning in knee injuries
- History and symptoms
- Physical examination and signs
- Investigations
- Principles of management
How this fits into exams: The exam loves to test:
- History clues that discriminate between different knee pathologies (e.g., immediate swelling = haemarthrosis = likely ACL; delayed swelling = inflammatory exudate = meniscus/MCL)
- Special tests – what they test, how to perform them, grading
- The principle that definitive management depends on whether the tissue can heal and whether healing restores function
1. Anatomy of the Knee Region
There are three joints in the region of the knee: the knee joint, the patellofemoral joint, and the proximal tibiofibular joint. [1]
| Joint | Type | Surfaces | Primary Motion | Notes |
|---|---|---|---|---|
| Knee joint (tibiofemoral) | Synovial | Distal femur ↔ Proximal tibia | Flexion-extension (sagittal) | Secondary motions: AP translation (sagittal), internal/external rotation (axial) |
| Patellofemoral joint | Synovial | Patella ↔ Trochlea (anterior distal femur) | Patellar tracking over trochlear groove | Maltracking → PF instability |
| Proximal tibiofibular joint | Fibrous | Fibular head ↔ Posterolateral proximal tibia | Minimal | Extra-articular |
Why this matters: Understanding which joint is affected changes your differential. A problem with the tibiofemoral joint suggests ligament/meniscus/cartilage injury. A problem with the PF joint suggests maltracking/dislocation. The proximal tibiofibular joint is extra-articular — injuries here (e.g., fibular head fracture) suggest LCL/posterolateral corner injury. [1][3]
Six key structural categories: bone, cartilage, meniscus, ligament, extensor mechanism, capsule/synovium. [1]
| Category | Structures | Intra/Extra-articular | Clinical Relevance |
|---|---|---|---|
| Bone | Femur, tibia, patella | Intra-articular | Osteochondral fractures, avulsion fractures |
| Fibula | Extra-articular | Fibular head fracture → suspect LCL/PLC injury | |
| Cartilage | Articular hyaline cartilage | Intra-articular | Aneural → no direct pain; damage → subchondral bone exposure → pain |
| Meniscus | Medial and lateral meniscus | Intra-articular | Aneural (inner parts); peripheral capsular attachment is innervated |
| Ligament | ACL, PCL | Intra-articular | Highly vascularised → haemarthrosis on tear |
| MCL, LCL | Extra-articular | Injury → extra-articular swelling, not haemarthrosis | |
| Extensor mechanism | Quadriceps tendon, patellar tendon | — | Rupture → inability to extend knee (extension lag) |
| Capsule & synovium | Joint capsule, synovial membrane | — | Effusion, inflammation |
High Yield – Aneural Structures
Cartilage and the inner parts of meniscus are aneural. This is why a meniscus tear or cartilage defect doesn't always cause pain — pain comes from the capsular attachment being tethered, or from increased pressure on subchondral bone (which IS innervated). This is a commonly tested concept. [1]
2. Clinical Reasoning Framework
When we encounter a patient suffering from knee injury: (1) Establish the DIAGNOSIS through History → Physical Examination → ± Investigation; (2) Recommend the most appropriate MANAGEMENT at the correct time point — Emergency Management and Definitive Management. [1]
The lecture emphasises that not every knee problem presenting in a sports context is traumatic. Always consider: [1]
| Category | Example |
|---|---|
| Traumatic | ACL tear, meniscus tear, patella dislocation |
| Degenerative | Degenerative meniscus tear, OA knee |
| Aging-related | Decreased cartilage proteoglycan |
| Congenital/developmental | Trochlear dysplasia, patella alta |
| Inflammatory | RA, crystal arthropathy |
| Neoplastic | Bone tumour presenting as pathological fracture |
| Metabolic | Gout |
| Others | — |
Healthy tissues (bone, ligament, cartilage, meniscus) will suffer macroscopic damage only if the load exceeds the physiological loading during walking, running, jumping, etc. — i.e., after a significant injury. Damaged healthy tissue has a high potential to heal if treated correctly. [1]
If symptoms increase after a trivial injury or even in the absence of injury, there is likely pre-existing pathology (e.g., a degenerated meniscus tear, a chronic cartilage injury). The chance of healing, even after surgical intervention, is much lower. [1]
Why this is high yield: This is a core clinical reasoning principle. In an OSCE or SAQ, recognising whether the injury was significant (high energy, during sport, clear mechanism) vs. trivial (stepping off a curb, no real trauma) completely changes your differential and your prognosis. A young rugby player with a significant twisting injury → likely traumatic tear → good healing potential. A 55-year-old with knee pain after squatting to tie shoes → likely degenerative tear → lower healing potential even with surgery.
Aging is a progressive decline in physiological function of cells and tissues. Degeneration occurs as a result of repeated micro-injury with failure of complete healing, with or without compensatory changes. [1]
| Feature | Aging | Osteoarthritis (Degeneration) |
|---|---|---|
| Water content | Decrease | Increase |
| Collagen | Relatively unchanged | Becomes disorderly; decreases in severe OA |
| Proteoglycan concentration | Decrease | Decrease |
| Proteoglycan synthesis | Decrease | Increase (attempted repair) |
| Proteoglycan degradation | Decrease | Markedly increase |
| Chondroitin sulphate | Decrease | Increase |
Key concept: In OA, the cartilage is trying to repair itself (increased synthesis) but degradation vastly exceeds synthesis. Water content increases because the collagen network breaks down, losing its ability to resist swelling pressure from proteoglycans. This is fundamentally different from normal aging.
3. History and Symptoms – Detailed Breakdown
Key symptoms to ask about: Pain, Swelling, Locking, Giving way, Stiffness, Weakness, Instability, Deformity, Crepitation/Clunking/Snapping. Also ask about: Age, History of Trauma (mechanism), Systemic/constitutional symptoms, Risk factors. [1]
Organic pain results from the brain's interpretation of a nociceptive stimulus as a painful sensation. [1]
Nociceptor activation requires a noxious stimulus (pressure, temperature, chemicals). The lecture specifically addresses which structures have nociceptors:
| Structure | Innervation | Implication |
|---|---|---|
| Cartilage | Aneural | No direct pain from cartilage damage alone |
| Meniscus | Aneural (inner 2/3) | Pain from capsular tethering, not the meniscus itself |
| Subchondral bone | Innervated | Pain when pressure exceeds physiological load at the subchondral plate |
| Periosteum | Innervated | Much lower threshold for pain |
| Ligament | Innervated | Lower threshold for pain |
| Capsule | Innervated | Lower threshold for pain |
Peripheral sensitisation: Inflammatory cytokines (IL-6, TNF-alpha) activate G-protein coupled receptors, ionotropic receptors, and tyrosine kinase receptors on nerve terminals, lowering the threshold for action potential generation — making it easier to feel pain. [1]
Mechanical Pain vs. Rest Pain
| Feature | Mechanical Pain | Rest Pain |
|---|---|---|
| Worse with | Activity, weight-bearing | Present at rest |
| Causes | Traumatic, degenerative | Inflammatory (RA, infection, crystal), neoplastic |
| Example | ACL injury, degenerative meniscal tear | Inflammatory joint disease, septic arthritis, gout, bone tumour |
Clinical vignette from slides: A 26-year-old man with an acute meniscus tear during rugby: [1]
- Immediate pain at time of injury
- Persistent pain for 1–2 months — initially rest pain (inflammatory phase), then becomes mechanical (especially deep knee flexion)
- No pain after 2–3 months despite persistent meniscus tear on MRI
This directly illustrates the healing phases:
| Phase | Timing | Clinical Correlation |
|---|---|---|
| Haematoma | Seconds | Immediate swelling and pain |
| Inflammation | Days | Rest pain, warmth |
| Healing (Proliferation) | Weeks | Pain becomes mechanical |
| Remodelling | Months | Pain may resolve even with persistent structural abnormality |
The timing of swelling onset after injury is diagnostically important. [1]
| Timing | Nature | Likely Cause | Example |
|---|---|---|---|
| Immediate (within hours) | Haemarthrosis | Bleeding into joint from highly vascularised structure | Acute ACL tear |
| Delayed (1–2 days later) | Inflammatory exudate | Ongoing inflammation from intra-articular or extra-articular injury | Meniscus tear, MCL sprain |
| Pre-existing | Can be fluid or solid | Underlying pathology | Synovitis in RA |
Exam Discriminator – Immediate vs. Delayed Swelling
Immediate swelling = haemarthrosis = think ACL tear (72% of all sports-related haemarthroses), osteochondral fracture (14%), or patellar dislocation (6%). This is one of the most commonly tested facts in knee sports injuries. If the question says "immediate swelling after a pivoting injury," ACL tear is overwhelmingly the most likely answer. [1][3]
Locking is a sudden painful catching sensation in the joint causing inability to move the knee. It occurs when a fragment of torn meniscus or a loose body gets caught between the bones. [1]
| Feature | Acute Locking | Intermittent Locking (meniscus) | Intermittent Locking (loose body) |
|---|---|---|---|
| Pathology | Displaced bucket-handle meniscus tear | Displaceable meniscus tear | Loose body (usually bony) |
| Preceding injury | Usually yes | Yes or no | Usually no |
| Locking position | Cannot fully extend knee passively | Any position of flexion | Any position of flexion |
| Duration | Persistent | Transient | Transient |
| Cause of pain | Tethering of capsule by meniscus fragment attached to capsule | Tethering of capsule by meniscus fragment | Increased pressure on subchondral bone from impingement of LB |
Common Trap
Acute locking from a displaced bucket-handle tear causes inability to fully extend the knee passively — not inability to flex. The displaced meniscus fragment flips into the intercondylar notch and physically blocks extension. In contrast, intermittent locking can occur at any flexion angle.
Giving way is a sudden buckling or giving out of the knee, causing the patient to lose balance or fall. [1]
Three mechanisms:
- Quadriceps weakness — e.g., recurrent patellar instability, poliomyelitis
- Pain-related pseudo-paralysis of quadriceps — e.g., painful meniscus locking causes reflexive quadriceps inhibition
- Collateral ligament deficiency — e.g., complete MCL tear → medial instability → giving way on weight-bearing
4. Physical Examination – Systematic Approach
Three golden rules: [1]
- Examine the NORMAL side before the ABNORMAL side
- Examine ACTIVE before PASSIVE range of motion
- Observe the patient's FACIAL EXPRESSION when anticipating pain or discomfort
| Finding | What to Look For | Clinical Significance |
|---|---|---|
| Deformity | Genu varum (convexity lateral), genu valgum (convexity medial) | Varum → medial compartment OA; Valgum → RA |
| Normal alignment | 5–10° valgus | Important reference; knowing normal prevents over-calling deformity |
| Swelling | Suprapatellar pouch bulging, obliteration of parapatellar gutter | Intra-articular effusion |
| Muscle wasting | Quadriceps atrophy | Chronic injury, disuse |
| Wound/bruise | Open injury, contusion | Severity of trauma |
| Erythema | Redness | Infection, inflammation |
| Scar | Previous surgery | Prior injury/surgery |
| Abnormal gait | See gait table below | Pattern identifies pathology |
Gait Patterns
| Gait | Description | Cause |
|---|---|---|
| Antalgic gait | Shortened stance phase on affected side | Pain in the knee |
| Quadriceps avoidance gait | Avoids full knee extension during stance phase | ACL deficiency (avoiding pivot shift) |
| Lateral thrust gait | Knee thrusts laterally on walking | High-grade LCL laxity |
| Medial thrust gait | Knee thrusts medially on walking | High-grade MCL laxity |
4.2 Palpation
Two clinical tests for effusion: [1]
Fluid Shift Test:
- Patient supine, knee fully extended
- Empty one parapatellar gutter with firm pressure → normal gutter reappears
- Push swelling in opposite gutter → bulging reappears on the first side = fluid travels between gutters = positive
Patellar Tap Test:
- Patient supine, knee fully extended
- If fluid is present, patella floats
- Tap patella downward → "tapping" sensation as patella hits trochlea
- Release → patella floats back up
Both tests distinguish fluid (effusion) from solid swelling (synovitis, tumour). [1]
Common sites of intra-articular swelling: Bulging of suprapatellar pouch and obliteration of parapatellar gutter [1]
Palpate in systematic order (knee flexed to 90°): [1]
- Medial joint line and lateral joint line
- MCL
- LCL
- Quadriceps tendon and patellar tendon
- Medial and lateral hamstring at popliteal fossa
Report ROM in degrees: passive extension – active extension – active flexion – passive flexion. [1]
| Parameter | Normal Value |
|---|---|
| Passive extension | Full (0°) to 3–5° hyperextension (recurvatum) |
| Active flexion | ≥ 135° |
Fixed Flexion Deformity (FFD): Inability to achieve full extension (0°) on passive testing. [1]
Extension Lag: Difference between active and passive extension. [1]
- 5–10° lag → quadriceps weakness
- > 30° lag → suspect extensor mechanism pathology (e.g., quadriceps tendon rupture)
Clinical Pearl
Extension lag > 30° is a red flag for extensor mechanism rupture (quadriceps tendon or patellar tendon). This is an urgent surgical problem. Don't dismiss it as "just weakness." [1]
4.4 Special Tests
Valgus stress test (tests MCL) and Varus stress test (tests LCL) at 0° and 30° knee flexion. [1]
Technique:
- Examiner holds proximal tibia with both hands, patient's ankle in examiner's axilla
- Apply sustained valgus then varus stress
- Test at full extension AND 30° flexion
- Compare to normal side
- Avoid movement at hip
Why test at both 0° and 30°? At full extension (0°), the posterior capsule and cruciate ligaments are taut and provide secondary restraint. If the joint opens at 0°, this implies not just collateral ligament injury but also posterior capsule/cruciate injury (much more severe). At 30° flexion, the posterior capsule is relaxed, isolating the collateral ligament — this is the more sensitive position for detecting isolated collateral ligament injury.
| Grade | Opening (vs. normal) | Endpoint | Clinical |
|---|---|---|---|
| Grade I (Sprain) | 0–5 mm | Present, firm | Pain on stressing |
| Grade II (Partial Tear) | 6–10 mm | Firm endpoint | Moderate laxity |
| Grade III (Complete Tear) | > 10 mm | No endpoint | Gross instability |
1. Lachman Test (most sensitive for ACL) [1][2]
- Position: supine, knee 20–30° flexion
- Stabilise distal femur, apply anterior pulling force on tibia
- Finding: excessive anterior translation vs. normal side
2. Anterior Drawer Test [1]
- Position: supine, knee 90° flexion
- Sit on foot to stabilise, check hamstring relaxation
- Apply anterior drawing force on proximal tibia
- Finding: excessive anterior translation
3. Pivot Shift Test (tests rotatory instability) [1]
- Position: supine, knee full extension + internal rotation
- Apply valgus stress, then flex knee from extension to 30–40°
- Finding: clunk/jump at Gerdy's tubercle
| Grade | Finding |
|---|---|
| Grade I | "Gliding" movement |
| Grade II | Obvious "clunk" |
| Grade III | "Locked subluxation" of knee |
1. Posterior Sagging [1]
- Both knees flexed to 90°, observed from side
- Normal: anterior border of proximal tibia is ~1 cm anterior to distal femoral condyle
- Abnormal: tibia sags posteriorly
| Grade | Finding |
|---|---|
| Grade I | Sag present but tibia still anterior to femoral condyle |
| Grade II | Tibia and femoral condyle in same plane |
| Grade III | Tibia posterior to femoral condyle |
2. Posterior Drawer Test [1]
- Position: supine, knee 90° flexion
- Check for posterior sagging first — if present, reduce it before testing
- Apply posterior pushing force on proximal tibia
- Same grading as posterior sagging
Critical Trap – False Positive Anterior Drawer
If the tibia is posteriorly sagged (PCL deficiency), reducing the sag may be mistaken for a positive anterior drawer test. Always check for posterior sagging before performing the anterior drawer test. The Lachman test is less susceptible to this pitfall because it is performed at 20–30° flexion where the sag is less pronounced. [1]
McMurray Test [1]
- Position: supine, knee full flexion
- Apply compression + rotation, gradually extend
- Repeat for medial and lateral meniscus
- Positive: patient reports pain, click, or clunk
Limitations: Nearly always positive in acute knee injury (regardless of meniscus tear). Sensitivity is LOW for chronic meniscus tear. [1]
1. J-Sign [1]
- Patient sitting, knee at 90°
- Actively extend knee → observe patellar tracking
- Positive: lateral displacement of patella at terminal extension = trochlear dysplasia
2. Q-Angle [1]
- Angle between: ASIS → centre of patella, and centre of patella → tibial tuberosity
- Normal: males 14 ± 3°, females 17 ± 3°
- Increased Q-angle → increased risk of patellar instability
- Conditions that increase Q-angle: genu valgum, increased femoral anteversion, increased external tibial torsion, laterally positioned tibial tuberosity
3. Apprehension Test [1]
- Position: supine, knee 20–30° flexion
- Push patella laterally
- Positive: patient feels pain and impending dislocation, tries to stop examiner
5. Investigations
Investigations serve to: (1) confirm the clinical diagnosis; (2) assist surgical planning. [1]
Standard views: AP, Lateral, Skyline (tangential view of PFJ) [1] Rule of 2s for trauma X-rays: Two sides (especially immature skeleton), ± Special view (tunnel view), ± Two joints, ± Two occasions [1]
Key points from slides:
Obvious long bone fractures and knee dislocations are UNCOMMON findings in knee sports injuries. [1]
Most significant X-ray findings in knee sports injuries are SUBTLE — e.g., avulsion fracture of tibial attachment of ACL, osteochondral fracture of patella. [1]
A majority of post-knee dislocation X-rays appear "NORMAL" because of spontaneous reduction. High degree of suspicion is required. [1]
| X-Ray Finding | Associated Condition |
|---|---|
| Avulsion fracture tibial ACL attachment | ACL injury |
| Segond fracture (lateral tibial plateau avulsion) | Pathognomonic of ACL injury [2] |
| Osteochondral fracture of patella | Patella dislocation |
| Fibular head fracture | LCL/PLC injury [3] |
| PCL tibial avulsion fracture | PCL injury [3] |
| Lipohaemarthrosis (fat-fluid level on lateral) | Intra-articular fracture [2] |
CT and MRI: Appropriate use of 3D imaging in indicated cases helps arrive at the correct diagnosis early. [1]
- CT: Best for bony detail (fracture pattern, surgical planning)
- MRI: Gold standard for soft tissue — distinguishes partial vs. complete tears, assesses meniscus, cartilage, and associated injuries [2]
6. Principles of Management
Emergency management aims to reduce further tissue damage and relieve symptoms by controlling the post-injury inflammatory response. [1]
Two components:
- Reduce further tissue damage:
All acute knee dislocations should be reduced as soon as possible to minimise potential secondary damage (neurovascular injury, articular cartilage damage). [1]
- Control post-injury inflammatory response — "RICE": [1]
- Rest
- Ice
- Compression
- Elevation
- + NSAIDs if not contraindicated
Definitive management depends on whether the injured tissue can heal AND whether it can restore normal function if allowed to heal. [1]
| Scenario | Management | Example |
|---|---|---|
| Tissue likely can heal + function can be restored | Non-operative | Partial MCL tear, first-time patella dislocation |
| Low chance of healing OR normal function cannot be restored even after healing | Surgical intervention | ACL reconstruction, bucket-handle meniscus repair |
Surgical timing options: Urgent / Early / Elective [1]
Types of surgery (the 5 R's): [1]
- Repair — suture the damaged structure
- Resection — remove damaged tissue (e.g., partial meniscectomy)
- Reconstruction — replace with graft (e.g., ACL reconstruction)
- Replacement — e.g., knee replacement for end-stage OA
- Regeneration — e.g., cartilage regeneration techniques
Exam Intelligence
| If the stem says... | Think... | Why |
|---|---|---|
| Immediate swelling after pivoting injury | ACL tear | Haemarthrosis from highly vascularised ACL |
| Delayed swelling 1–2 days later | Meniscus tear or MCL sprain | Inflammatory exudate, not blood |
| Cannot fully extend knee (locked) | Bucket-handle meniscus tear | Displaced fragment blocks extension |
| Giving way during pivoting sport | ACL deficiency | Loss of rotational stability |
| Lateral thrust gait | LCL laxity | High-grade lateral collateral deficiency |
| Extension lag > 30° | Extensor mechanism rupture | Quadriceps tendon or patellar tendon |
| Segond fracture on X-ray | ACL injury | Pathognomonic avulsion of lateral tibial plateau |
| Normal X-ray after high-energy knee injury | Post-dislocation (spontaneous reduction) | Most knee dislocations self-reduce |
-
Confusing locking with stiffness: Locking is a mechanical block — cannot passively extend. Stiffness is resistance to motion (e.g., from effusion, fibrosis). Examiners test this difference.
-
Anterior drawer false positive in PCL injury: If the tibia is posteriorly sagged and you "draw it forward" to neutral, you're just reducing the sag, not demonstrating ACL laxity. Always check for posterior sagging first.
-
McMurray test limitations: Nearly always positive acutely (non-specific). Low sensitivity for chronic tears. Don't rely on it alone.
-
Q-angle gender difference: Males ~14°, females ~17°. Don't mix these up.
-
Testing at 0° vs 30°: If the knee opens at 0° (full extension) → multiple structures injured (collateral + posterior capsule ± cruciate). If it only opens at 30° → isolated collateral injury.
Past Paper Questions
Based on indexed past paper context, the following questions are directly relevant:
A 68-year-old lady suffered from left knee mechanical pain for 3 years. X-ray of the left knee showed reduced joint space in the medial compartment with marginal osteophyte formation. Which of the following is an effective and evidence-supported treatment of knee osteoarthritis? A. Arthroscopic debridement B. Glucosamine C. Knee replacement D. Paracetamol
Answer: C. Knee replacement
Rationale: This directly tests the principle from this lecture that definitive management includes replacement when the joint is irreversibly damaged. Arthroscopic debridement and glucosamine lack strong evidence. Paracetamol has weak evidence in OA (recent trials show minimal benefit over placebo). Knee replacement is the most effective and evidence-supported treatment for end-stage knee OA. [1][4]
A 45-year-old lady complained of multiple joint pain involving both hands, elbows, and wrists for 1 year. There was stiffness in the morning. She started to have pain and swelling in her knees recently. (a) State the MOST LIKELY diagnosis. (b) Give two laboratory investigations and their findings. (c) Name three expected radiological findings. (d) Name four possible deformities.
Answer: Rheumatoid Arthritis. This is relevant because the lecture highlights RA as an inflammatory cause of knee symptoms (rest pain, genu valgum deformity), and this past paper tests differentiation from traumatic/degenerative causes. [1][5]
No other directly relevant past paper questions on "knee sports injuries Part 1" (general introduction/examination framework) were identified in the indexed past paper context. Parts 2–6 are likely tested more heavily for specific pathology questions.
High Yield Summary
1. Three joints in the knee region: Knee joint (tibiofemoral), patellofemoral joint, proximal tibiofibular joint (extra-articular).
2. Significant injury → healthy tissue → high healing potential. Trivial/no injury → pre-existing pathology → low healing potential.
3. Swelling timing is diagnostic: Immediate = haemarthrosis (ACL 72%, osteochondral fracture 14%, patella dislocation 6%); Delayed 1–2 days = inflammatory exudate (meniscus, MCL).
4. Locking: Acute locking (bucket-handle tear) = cannot passively extend; Intermittent locking = transient, any position.
5. Special tests and what they test: Valgus/varus stress → MCL/LCL; Lachman (most sensitive), anterior drawer, pivot shift → ACL; Posterior sag, posterior drawer → PCL; McMurray → meniscus; Q-angle, J-sign, apprehension → PFJ instability.
6. Grading of collateral/cruciate laxity: Grade I (0–5 mm), Grade II (6–10 mm, firm endpoint), Grade III ( > 10 mm, no endpoint).
7. X-rays in knee sports injuries are often subtle. Post-dislocation X-rays usually look normal (spontaneous reduction). Segond fracture = pathognomonic ACL tear.
8. Emergency management: Reduce dislocations ASAP, RICE, NSAIDs, knee aspiration (diagnostic + therapeutic).
9. Definitive management principle: Can heal + restores function → non-operative. Cannot heal or function not restored → surgery (Repair, Resection, Reconstruction, Replacement, Regeneration).
10. Extension lag > 30° = suspect extensor mechanism rupture. Normal Q-angle: males 14 ± 3°, females 17 ± 3°.
Active Recall - Knee Sport Injuries Part 1
[1] Lecture slides: GC 230. Knee Sport Injuries_Part 1.pdf [2] Senior notes: Maksim Surgery Notes.pdf (Section 7.2 Soft tissue injuries) [3] Lecture slides: GC 230. Knee Sport Injuries_Part 2.pdf [4] Past papers: 2025 Fourth Summative MCQ.pdf (Q48) [5] Past papers: 2020 Fourth Summative SAQ.pdf (Q2)
GC229 Hip Arthritis
Degenerative or inflammatory disease of the hip joint characterized by cartilage loss, pain, stiffness, and progressive limitation of mobility.
GC230 Knee Sport Injuries: Part 2
Continuation of knee sport injuries covering conditions such as meniscal tears, collateral and cruciate ligament injuries, and associated soft tissue damage resulting from athletic activities.