Lower Extremities DDX: Final Review (conditions post-midterm)

Knee Conditions
Medial Ligament Sprain
Definition:

Grade I III sprain of deep (capsular) or superficial (tibial collat lig) medial
ligs dt stretch or valgus force to knee.

Possible Causes

1.
2.

Non-contact: dt Constant stretch

abnormal actions causing internal rotation
repetitive use (eg., breaststrokers knee)
ski fall damaging trailing leg
Contact causing valgus force to knee

Order of medial structures torn dt

valgus trauma?

Order of structures torn: medial capsular lig, tibial collat lig, then ant
cruciate (often tears medial meniscus)

Define Terrible Triad

Two components of medial ligament

- Damaged MCL, ACL and Medial meniscus

1. Tibial collateral ligament (more superficial)
2. Deeper Capsular Ligament (deeper)
Medial meniscus
Medial femoral condyle below pes anserine insertion
Tibial collat lig , adductors and pes anserine mms (can compensate for
laxity)
PT reports
Causes
Stability tests

Deep capsular lig attached to

Tibial collat lig runs
If damaged medial capsular lig, what
provides medial support?
Degree
Pn
Swelling
Sprain
First
Sharp
Minimal

Second

Increased

Minimal
(more than
Grade I)

Third

Severe
(initially)

Swelling

Treatment: 1st Degree Sprain

Treatment: 2nd degree sprain

-PT movement straight

ahead fine,
but cutting
difficult

-Breaststrokers kick
-Skiers
-Pronation (dt rotation
dif between tib and fib
with pronation)
Similar to above but
producing more
damage

Normal

-PT knee buckles

Valgus testing:
when
At 0 degrees: Normal
cutting
At 30 10 laxity but
motions
w/ definite end feel
-ROM: Flexion more
limited than extension
-Heard a pop when

Valgus testing:
injured,
At 0 degrees: some
followed by
laxity
relatively
At 30 10 laxity but
painless
w/ no end feel
period
-Tenderness localized
at one end
of tibial
collateral
lig.
- Tape or support knee with elastic wrap for first couple days
- 3-7 days of recovery and rest
- Use medial heal wedge or low dye taping possible orthotic
- If not acute injury look for underlying strain factors
-First 3 days: Non-weight bearing, no stripping massage, let scar lay down.
-Wear protective cast for 1-2 weeks
- 1 year of rehabilitation (longer than grade 3)
-Gradual return to activity with protective bracing
1

rd

Treatment: 3 degree sprain:

Examining the Knee

Most important questions to ask when
examining injured knee?
Possible palpation results?
Ideal time to conduct ortho test post
acute injury?
Other factors confusing stability tests

-Conservative care may be successful (follow same steps as 2nd dg but

allow more time)
-Surgery may be necessary, give Proteolytic enzymes
-Followed by non-weight bearing, cylinder cast (2-6 wks) + 6 months
rehab)
-Gradual return to activity with protective bracing
(Refer to Attached DDX ortho)
- Where does it hurt? How did you get hurt?
- Have you injured this knee before
- Did you hear a pop?
- Pn at lateral knee at site of blow
- Meniscus involvement at joint line
-W/in 30 minutes. After which, swelling gives false impression of stability
-MM spasm

Patellofemoral Tracking
Disorders

Misalignment of patella in femoral groove

Possible causative conditions

Patella alta, condromalacia patella, patella sublux or dislocation,

retinacular or capsular pn
Congenital:
- Shallow femoral groovesublux or dislocation
- Femoral anteroversion
- Increased Q angle greater lateral pull of quads (pronation, tibial
and femoral torion)
Trauma: Blow accelerates degeneration or cause dislocation
Biomechanical: Forcing lateral tracking of patella
- Weak vastus medialis
- Tight hamstrings (forcing quads to pull harder to flex hip,
pulling patella above protective femoral groove (thus patella
alta)

Congenital causes?

Causative MM imbalances?

Patella anatomy:
-Largest facet?
-Pn receptors in hyaline cartilage lining
posterior aspect of pattella?
-How patella tracks? -------------------Commonly affected populations?

Complications
Hx

P+
Site
Ortho / Neuro tests

-Lateral
-No
-In femoral groove
-Squatters (Baseball catchers, weight lifters who squat, Carpet and tile
layers)
-Adolescent girls (weaker vastus medialis, larger Q angle, shallower
fem groove)
Chondromalacia patella (pathologic degeneration)
Patellofemoral arthralgia: soft tissue simulation
- Prolonged sitting (theatre syndrome)
-Squatting (pn with +/- crepitus)
-Up or down stairs (pn + stiffness)
-Knee extension
Anterior pain (usually)
Positive Patellar inhibition sign
VMO weakness
Tight ITB
Postural indicators of misalignment
2

Tx:
How braces useful?

-Avoid exercises that involve major flexion of the knee

-Addressing Biomechanical and mm imbalances:VMO
-Stretch hamstrings, quads, and ITB
-McConnel taping for symptoms
-Surgery (eg., release lateral retinaculum to optimize patella tracking or
shaving)

Exercises?

Extensor Disorders
Hx

Exam Findings
Sindig-Larson
Patellar Tendinitis
Osgood Schlatters
Management

- Pn after jumping or running

- Pn above or below patella, patellar tendon, or tib tub
- Young person known as Osgood Schlatters
Tenderness at sights above
Pn on resisted extension:
- inferior pole (young patient)
- patellar tendon (aka jumpers knee)
- young pt pn on tib tub
General:
- stretch quads, ice after activity
- train quads and tib ant eccentrically
- Tape or brace
Osgood Schlatters:
- manage as above unless pn is felt at rest and during activity
- usually resolves in 6-9 months

Anterior Cruciate Lig (ACL)

injury
Intra or extra capsular?
Origin and Insertion?
How blood supply leads to
complications
Unique importance of nerve supply
ACL function

Consists of ateromedial band and a large posterolateral band.

Anteromedial provides most protection during flexion, both are relaxed in
flexion
Intracapsular, but extrasynovial.
Lat fem condyle femur to Medial tibial plateaus
Has its own bld supply; if ACL ruptures, lots of swelling

Mech of Injury?

May be integral to knee proprioception

Limits tib movement P-A
Limits tib internal rotation
Accounts for 87% of restraining forces to knee
-Sudden stop, hyperextension, or knee hit from outside

Probability of isolate tear to ACL?

Isolated tears are rare (usually ACL associated with MCL +/or meniscus)

Possible causes of ACL isolated tear?

-Sudden deceleration dt quads contracting (+/- isolated tear) (eg., in

sprinters)
-Force
-Hx of injury with popping, immediate swelling.
-Hx of knee trauma which resolved but left knee unstable
Athletes: sprinters, football players, etc.
Pain in areas not readily apparent
Pn at joint lines (meniscus involvement)
+ Lachmans
+ Drawer Test
+ Pivot shift test tells severity (i.e. is ACL torn? Are other structures
torn?)
-Lachmans (90% accurate)
-MRI (Black: if ACL intact; Gray: more water content dt partial tears)

Hx (Possible indicators of ACL tear)

Commonly affected populations?
Palpation
Stability tests

Most accurate test for ruling out ACL?

Additional Diagnostic Tests

Tx:

Prevention

-Surgery for professional athlete

-Exercise hamstrings: try to get hamstrings close to strength of well leg
quads
-Avoid full knee extension (when working out only do exercises from 0-70
degrees) seat too high on a bike
-Proprioceptive Training
-Brace do everything with brace for a few months
-Land with knees flexed
-When cutting, land on the ball of the foot to round off the cut
-Decelerate with several small steps instead of with one

PCL Injury
Origin / Insertion
PCL function
Possible Causes

Hx
Most commonly affected populations?
Palpation
Ortho / Neuro tests
Tx:
-Which exercises ideal? Which
avoid?

Medial femoral condyle Lateral aspect of Tibial intercondular area

Resist posterior movement of femur (wrt tibia) and internal tibial
rotation
-Anterior blow to tibia or hyperflexion
-Hyperextension both ACL and PCL
-Major Trauma
Moderate pn and swelling (PCL doesnt swell as much b/c blood goes into
lower leg)
Athletes
-No swelling (torn capsule allows fluid escape)
Posterior Sag sign, + posterior drawer
-Exercises (Focus on quads)
-Surgery (not as surgically urgent as ACL)
If combined injury surgery

Meniscus Injury
Anatomy: describe Medial Meniscus?

-C shaped, larger and thicker than Lateral Meniscus, attached to MCL

-Describe lateral meniscus?

-Both menisci composed of

-O shaped, not attached to LCL

-Fibrocartilage, Outer 1/3 vascularized (remainder nourished by
synovium)
-Distribute femur weight over larger area of tibia
-Deepen sockets receiving femoral condyles (increase joint stability)
-Smoothen and synchronize knee rotation (w/ menisci +/- damage)
Lateral (dt not being attached to LCL)

-Function?

Which meniscus less susceptible to

damage?
Possible Causes
Hx

Ortho / Neuro tests

Additional Diagnostic Tests
Tx:

-Injury (compression with rotation)

-Squat too long and come up suddenly (older people)
-Joint line pn
-Joint locking
-Joint swelling
-Pn at bottom of squat
McMurrays; Medial-Lateral Grind (Horizontal tear); Dynamic (lateral
meniscus tear); Bounce Home, Apleys grind
-MRI (definitively diagnosis)
-Conservative okay for: 1) Older less active people, 2) Younger with tear in
outer 1/3
-Surgery if symptoms or pn are frequent and persistent: 1) Meniscal repair,
2) meniscectomies (can lead to early degeneration)
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Fractures

Tibial spine fractures represent avulsions of the ACL

Patellar fractures due to direct blows to the patella
Tibial tuberosity sudden quad contraction or less often osgoods
Segund lateral tibial plateau (lateral capsular sign) indicates ACL damage
Growth plate fractures common with valgus injury in children where as in adults collateral lig
damage occurs

Salter-Harris Fractures
Type I: MOI
Type II: MOI

Type III: MOI

Complications
Treatment
Type IV:
Complication
Treatmen
Type V: MOI
Complication

-Shearing force at junction of epiphysis and metaphysis, usually resolves, involved in

children and infants
-Shearing force separating the epiphysis from metaphysis
-Triangular avulsion of metaphysic
-cause: falling on outstretch hand, ages 6-12 - Usually resolves
-Traverse and longitudinal force, involving lateral or rotational component, part of epiphysis
breaks off
-Prompt restoration, open reduction to prevent bone bridge formation
-Part of epiphysis and metaphysis break off
-Bone bridge
-Reduction with pin fixation
-Crushing Injury, not always seen on x-ray
-Growth retardation

Knee Rehab
General Principals

Open chain okay for

Closed chain okay for

Exercises

-Co-contraction isometrics are safe and effective initial exercises for hams and quads
-Do constantly
-Effective in preventing atrophy
-Try to isolate VMO (med rotation and extension) and VLO in active terminal knee
extension
-patellofemoral problems (some risk if no ACL)
-ACL deficient
-Quad contraction is protective in > 70 degrees of flexion
-Bike okay
-Avoid to high a seat for ACL
-Avoid to low a seat for Patellofemoral arthralgia
-single leg squat: increase quad 100%
-hamstring pull: good and safe
-jump: good for many muscles and proprioception, can use elastic tube tied at waist

Vascular Disorders
Popliteal Aneurysms
Spontaneous Osteonecrosis of the
Knee (SONK)
Bone Infarct

US and angiography to determine

-Usually in women >55yo
-85% medial condyle
-Due to: corticosteroids, Lupus, alcoholism, pancreatitiis, sickle cell, etc.
-Distal femur/proximal tibia
-Due to: corticosteroids, Lupus, alcoholism, pancreatitiis, sickle cell, etc.

Infections
Acute Osteomyelitis

-90% s. aureus
-Tibia MC
-Fever, malaise, etc.
-At least 10 days to be seen on x-ray
-Moth-eaten appearance
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Chronic Osteomyelitis
Brodies Absess
Septic Arthritis

Arthritic Disorders
X-ray
Early OA
Later OA
Exercise program

-aka Garres Sclerosing Osteomyelitis

-may follow a fracture
-Localized infection in bone
-Presents like osteoid osteoma
-May follow trauma, infection or surgery
-Systemic signs with hot swollen joints
Often lose medial meniscus, will look varus
Must do wt. Bearing P-A; shoot between knees with 10 degree caudad tilt
A laxity problem
Spur and scar formation to stabilize
no pn due to maintaining muscle tone which decreases laxity

HIP Disorders
Anatomy of hip
- Ligaments
- iliofemoral: anterior aspect of hip aka Y ligament
- ishiofemoral
- pubofemoral
- fovea capitis: nutrition and blood supply to head of femur
- damage may lead to avascular necrosis
- is a branch from the obturator artery
- motion
- flexion: iliopsoas, rectus femoris, Sartorius, pectinues
- extension: glut max and hamstrings
- abduction: glut med + min, TFL, glut max
- external rotation: piriformis, obturators, quadrates femoris, Sup and inf gemellus
- alteration of hip angle (normal is 120-130)
- coxa vara: reduction of angle leads to genu valgum
- coxa valgum: increased angle leads to genu varum

Hip Disorders
Newborns = Congenital hip dysplasia
Age 2-8 = Avascular necrosis
Age 10-14 = Slipper femoral epiphysis
Age 14-25 = Stress fracture + synovitis
Age 20-40 = Avascular necrosis, synovitiss + RA
Age 45 60 = Osteoarthritis + synovitiss
Age 65 + = Osteoarthritis + fractures

Snapping/Clicking Hip
Definition:
Possible Causes

When must you find a cause?

Tx:

Snapping or clicking of hip

-Joint cavitation
-Movement of ligaments / tendons over bony prominences
-Femoral head sublux
-psoas tendon snap over lesser troch or iliopectineal eminence
-Symphysis Pubis post-partum or post-traumatic
-biceps femoris snaps over isch tub
-When area is painful with motion or clicking (if not, snapping hip not
clinical concern)
-Alter PT movement -Stretch Ligs -Adjust sublux
6

Bursitis (in Hip location)

Which bursae involved?
How DX?
O -- When?
Tx:

SPECIFIC BURSITIS CONDITIONS

Iliopsoas Bursitis
Pt presentation
PHow palpate bursa
Trochanteric Bursitis
Location
Pt presentation
P-

Ischial Bursitis
Pt presentation
PHow palpate bursa

Inflammation of iliopsoas, trochanteric and/or ischial bursa.

Palpate; ROM restrictions; ruling out other pathology
Gradual onset w/ activity often when first getting up (getting up in
morning)
1. Modify activity until S/S subside
2. Ultrasound and IF (Interferential)
3. Stretching (improves flexibility, reduces swelling): hold stretch 10-30
secs several times /day
4. Surgery (last resort) to remove bursa
Deep achy pn in groin
Resisted hip flexion while palpating bursa
Flex involved hip, externally rotate. Deeply palpate by lesser trochanter
Aka ski-runner's hip also found in dancers
Posterior to Greater Trochanter
Dull ache in hip and buttock area
Inflames with overuse (running, cross country skiing, dancing, runners on
crowned roads)
Weight bearing and hip motion
Pn in lower gluteals
Running, walking and sitting
Actively resist hip extension (pn as bursa compressed under hamstrings)
PT prone w/ affected leg hanging off table

Synovitis

Inflammation of synovial membrane of hip joint capsule and associated

structures (not limited to hip joint)

Possible Causes
Complications

Commonly follows trauma (fall or direct blow)

-Tissues swell and thicken +/- avascular necrosis
-Legge-Calve-Perthes (avascular necrosis of child 3-12yo)
Severe pn in hip and groin
1. Rotation
2. Weight bearing (usually not possible)
-Xray (only revealing if underlying avascular necrosis or OA)
-CT and Bone scans may be needed to ddx
1. Rest
2. Limited Weight bearing (use crutches of this doesnt resolve
inflammation)
- Inflammation should resolve in 1- 3 weeks w/ rest, if not test for
avascular necrosis and septic synovitis
3. Ice, Interferential
4. Cortisone injections
Avascular necrosis and Septic Synovitis
1. Gradual or traumatic onset
2. Primarily pre-growth plate closure
3. Stiffness and aversion to internal rotation

Pn
PAdditional Diagnostic Tests
Tx:

DDX with
Similarities between Synovitis;
Legg-Calve-Perthes; Avascular
Necrosis and Slipped Capital

Femoral Epiphysis

4. Hip flexion may cause hip externally rotating

5. Few objective findings

What conditions may progress to

A.N.?

6.

Osteitis Pubis

Chronic inflammatory rxn of unknown etiology effecting pubic symphysis

-Repetitive minor trauma, overuse
-Hockey, indoor track, soccer, kicking
-Rectus/adductor syndrome or gracilis syndrome(most superficial)
Progressive if activity continues and can become chronic or recurrent
Groin
T2P at pubic symphysis
RROM: Active resisted Abdominal contractions show pn
Bone scan (hot in early phases)
Xray: late stages show widening of pubic symphysis, erosions, etc.
Rest and activity restriction (return to sport when s/s resolve), increase
flexibility
Gracilis syndrome/ tendonitis (P- with RROM)
Stress Fx
Inguinal hernia (P- w/ coughing)
Orchitis or prostatitis (digital exam)
Rectus abdnominis strain (P- w/ active mm testing)
Avulsion fx (sharp sever pn, sudden onset)
Arthridities (multiple areas involved; lab tests)
Infection (Lab)
Tumor (xray)

Possible Causes

Complications
Site
Palpation
Range of Motion Findings?
Additional Diagnostic Tests
Tx:
DDX with

One may progress to the other: Syn A.N; Condition of child 3-12
with A.N. is called LCP; Slipped Epiphysis +/- A.N.

Stress Fractures (Hip)

Possible Causes
O -- When?
P-

P+
Site
Additional Diagnostic Tests
-Most sensitive test ?
Tx:

Posterior Hip Dislocations

S/S
Tx
Complications

Anterior Hip Dislocations

S/S
Tx

Jogging, Aerobics
Gradual onset (osteoclast > osteoblast) all exercise no rest
Exercise, weight bearing, discomfort at extremes of hip rotation
Superior transverse type is considered unstable and my need pinning
Inferior aspect = compression
Rest
Hip, groin and inguinal pn (87% of patients)
Xray: occasionally show as a late finding
Bone Scans most sensitive
1. Bed rest (in more severe cases)
2. Less Severe: Non weightbearing with crutches for 3-4 weeks, Heals
in 6
3. Pool walking is good
90% of sports related hip dislocations
Hip help in flexion, adduction, and internal rotation
Splint and transfer, need anesthesia
Sciatic Nerve Damage
Femoral head forced through iliofemoral lig (< 10% Dislocations)
Trauma while leg is extended and externally rotated
Hold leg in flexion, abduction and internall rotation
Same as post dislocation
8

Slipped Epiphysis
Adolescent coxa vera
Most commonly affected populations?
Classic presentation
Site
Additional Diagnostic Tests

Tx:

Legg- Calve Perthes Dx

Prevalence
Hx
Exam

Tx

ASIS Avulsion Injury

MOI
Exam

x-ray

AIIS Avulsion Injury

MOI
Exam
x-ray

Iliac Crest Apophyseal Injury

Muscles involved
Acute contact
Non-contact
Overuse
Exam
Caution

Ischial Apophyseal Injury

MOI

-Progressive or sudden posterior/inferior slippage of femoral epiphysis

-Usually between ages of 8-12
-20-25% bilateral
Very slender rapidly growing children or obese children (frohlich
type)
Onset of hip pn referred to knee in an obese adolescent
Hip and/or Knee (sometimes knee only)
Pain in knee look to hip
X-ray: frog-leg view (lateral) widening of epiphyseal line (compare
bilaterally) (See Yochum )
When bringing leg into flexion it tends to externally rotate
1. Surgery: pinning hip (recovery 6-8 weeks post surgery and can
interfere with growth)
2. Manipulation or immobilization NOT EFFECTIVE, may cause
damage to growth plate
Avascular necrosis of femoral head w/ subchrondral fx
80% b/t ages 4-9, earlier in girls, mc in males
bilateral 10% of time
Chronic limp w/ mild pn aggravated by activity
Pn referred to knee (must always check the hip)
May be flexion/adduction contracture
X-ray needed for diagnosis
Bracing to surgery
Self limiting, closure of ossification center trabeculae become normal
MC from age 13-15, fuses at 21-25
Sudden contraction of sartorius or hyperextension of trunk
D/t sprinting or non-contact football
Antalgia forward and laterally to same side
Tenderness at ASIS worse with passive hip extension, active hip
flexion or abduction
Oblique sometimes necessary
MC from age 13-15, fuses at 16-18
Rectus femoris over contraction dt sprinting
Antalgic gait
Pn with active hip flexion
Should include obliques
MC from age 13-15, fuses at 21-25
Abdominal obliques, TFL, gluteus medius anteriorly, lats and glut
max posteriorly
Contact dt blow or fall
Sudden change in direction
Torsional strains
Pn and tenderness at ant. Iliac crest, worse with resisted abduction of hip
Common occurrence of normal variants simulating pathology
MC from age 14-16, fuses at 18-25
Running, broad jumpers, hurdlers, cheerleaders
9

Exam

Counterforce injury due to pelvic and hip flexion

Antalgic
Tenderness over ischial tub or sacrotuberous ligament
Pn with passive stretching or active contraction of hams or adductors
Confirm with x-ray

Lesser Trochanter
Apophyseal Injury

MC from age 11-12, fuses at 16-17

MOI

Running and football

Forceful contraction of iliopsoas against resistance
Antalgic gait on same side
Anterior hip pn with radiation into groin
Leg held in sleight external rotation
Resisted hip flexion
Passive internal and external rotation
Include slight external rotation to see lesser trochanter

Exam

Provocative
x-ray

Quad Contusion
Possible Causes
PQ
Range of Motion Findings?
Tx:

Avoid
DDX with

Myositis Ossificans
Factors that increase risk:

S/S:
Tx

Quad Strain
MOI

Exam
Severe damage
Tx

Blow to the thigh

Active exercise
Stiffness and nonresponsive leg, pn, spasms
AROM: Flexion is reduced
-Discontinue active exercise
-Avoid NSAIDs (their use prolongs bleeding times)
-RICE in flexed position (ice 20 min/10-20 without)
-Crutches 2-3 days
-Heat, forced stretching, massage
Compartment syndrome: indicated if thigh feels woody and tense with
heat
-Send to ER
Myositis ossificans (Ca++ deposit in mm tissue seen on Xray (3-6
weeks) and Bone scan (2-5 weeks)
Ca++ deposit in mm tissue
1. Athlete returns to activity too soon
2. Massage or heat applied to hematoma
3. Hematoma poorly treated
1. Undue warmth
2. Increasing hardness of hematoma
If lump develops in thigh athlete should be pulled from participation
Tx based on degree of flexion restriction
Range from pull to full rupture
Tight quads
Imbalance b/t legs
Short leg
Missed kick in sports
Inability to actively extend knee
Inability to perform a quad isometric contraction
Severe tenderness or palpable defect
Ice
Neoprene or support taping
10

Crutches depending on severity

Stretching started early, with caution

Hamstring Strain
Caused by

Hx
Tx

1st degree
2nd degree
3rd degree

Adductor Strain
MOI
Sever
Tx

Most commonly strained muscle

Lack of flexibility
Imbalance b/t hams and quads
Imbalance b/t hams
Biceps femoris has separate nerve supply
Felt a pop behind leg
RICE
Crutches until pn free
Gentle stretching
Strengthen when at 75 % ROM
Return to play in 2-4 weeks
4-6 weeks
12 weeks
Occurs most often at myofacial junction of adductor magnus
High jumpers, hurdlers, sprinting, ice hockey, water skiing, football
Affects pubic symphisis
Supportive taping using figure 8
Gentle stretching
Slow return to activity

Hip Orthos to Know (See class text or CCE II lab notes for details)
Test
Hibbs
Laguere
Thomas
Elys

Trendelenburg
Rectus Femoris
stretch
Yeomans

Knee X-rays Views

View

Positive
Lack of motion
Pn in SI joint
Extended hip rises off table
Inability to raise leg
Sharp, localized pain
Femoral radicular pn
Pelvis on nonstance leg falls
Down leg straightens as upper knee
drawn to chest
SI joint pain
Lumbar pain

Pathology Revealed
SI joint
Non-specific hip pathology
Tight hip flexors (iliopsoas, rectus femoris)
Hip lesion
Irritation of iliopsoas and rectus femoris
Irritation of lumbar nerves and/or roots
Weak glut medius on stance leg (L4-L5-S2)
Tight rectus femoris
Anterior SI ligs
L-sp involvement

Use to examine

A-P
Lateral
Tunnel View

Tangential Views

Remarks
Use detail screens, high KVP for
detail

-Femoral condyles for osteochondral fx

-Patella alta and baja
-Osteochondral fx of condyles
-Osteochondritis dissecans (if bone
flattened)
-To visualize patellar contours and
interconylar notch
11

Sunrise

Hughston
Merchant
Stress Views

-Osteochondral fx of condyles
-Patellar and femoral groove contours
-Same as Sunrise but
-Innercondylar notch, congruency angle
and patella position
Ligamentous integrity

Note if shallow groove and flat

patella
Less knee flexion; more tube tilt
PT supine with knees bent
Take with Varus/Valgus stress
Not used much today (MRI better)

See class notes to review: Knee rehab; Appliances

12