Knee

HIPMNRS

Basic introduction to regional exam performed by Dr. Vizniak

video resources: palpation, muscle testingROM

regional exam forms – Rehab. & Stretching patient handouts

To learn more see our text books or take our hands on training seminars

Products prohealth

 

Anterior Posterior Drawer Test

Patient supine with knee bent 90°, examiner stabilizes foot with hip & places thumbs over the anterior knee joint line & pulls the tibia anteriorly

(+) Pain → Anterior cruciate ligament sprain

(+) Excessive motion → Anterior cruciate rupture

Degrees of knee joint instability

  1. Grade I – mild, < 5 mm of translation
  2. Grade II – moderate, 5-10 mm of translation
  3. Grade III – severe, > 10 mm translation

This test shows higher sensitivity values when performed on non-acute knee injuries (sn: 18-95 sp: 86-100 +LR: 1.8-8.3 -LR: 0.1-0.5)

Valgus & Varus Stress Test

Valgus Test Procedure (Abduction Stress Test)KN AN MCL Tear_Grade 3

Patient supine with legs straight, examiner stabilizes medial ankle & applies a lateral to medial (valgus) force at the knee, procedure is then repeated with the knee slightly flexed (~25°)

(+) Pain → Medial (tibial) collateral ligament sprain

(+) Increased motion/gapping → Medial (tibial) collateral ligament rupture

Varus Test Procedure (Adduction Stress Test)

Patient supine with legs straight, examiner stabilizes lateral ankle & applies a medial to lateral (varus) force at the knee, procedure is then repeated with the knee slightly flexed (~25°)

(+) Pain → Lateral (fibular) collateral ligament strain

(+) Increased motion/gapping → Lateral (fibular) collateral ligament rupture

Collateral ligament injury classification

  • I 0-5 mm of joint opening, no instability
  • II 5-10 mm of joint opening, mild instability
  • III 10-15 mm, moderate instability
  • IV > 15 mm of joint opening, severe instability

Lachman's Test

Patient supine with knee bent 15°-30°,

Lachman’s Anterior: examiner stabilizes the patient’s femur with one hand & then pulls the tibia anteriorly with the other hand

Lachman’s Posterior: same procedure except repeated with the examiner pushing the tibia posteriorly

(+) Pain with normal anterior translation → ACL sprain

(+) Pain with increased anterior translation → ACL rupture

(+) Pain with normal posterior translation → PCL sprain

(+) Pain with increased posterior translation → PCL rupture

This procedure is considered the gold standard for the evaluation of anterior cruciate & posterior cruciate knee ligament damage (r: 0.38 sn: 63-99 sp: 42-100 +LR: 2.15 -LR: 0.23)

Apley's Compression Test

Patient prone with knee flexed 90°, examiner applies downward force on the foot & rotates internally/externally

(+) Pain or crepitus with compression & rotation, which is relieved by knee distraction → Meniscal damage (r: 0.95 sn: 13-16 sp: 86-100 +LR: 0.8-5.9 -LR: 0.63-1.1)

Signs of a meniscal lesion:

  1. Knee joint line pain
  2. Popping or grating (crepitus) soundésensation with movement
  3. “Locking” of the knee (inability to fully extended)

Apley’s compression test should be followed with a hyperflexion compression test if a meniscal lesion is suspected

Squat Walk Test

If possible, have patient get into a low squat and ‘walk’ forward – this is a better variation for to increase pressure on knee using patient’s own body weight – (+) joint line pain or inability to perform task → meniscal damageKN AN Ligaments_Ant-Post-Superior

Bounce Home Test

Patient supine & relaxed, examiner lifts straight leg & bends knee to approximately 20° by placing a hand behind the popliteal fossa, examiner then proceeds to remove support from the posterior knee allowing it to drop into full extension (bounce home)

Interpretation

(+) Joint line pain → Meniscal tear

(+) Inability to fully extend knee:

  1. Spongy end-feel → Swelling/edema
  2. Rubbery end-feel / pain → Meniscal tear (r: 0.07-0.29 sn: 38-47 sp: 67-85 +LR: 1.2-2.9 -LR: 0.0.7-0.9)

Steinmann's Test

Patient supine with hip flexed 90° & knee flexed 90°, examiner palpates around the knee joint line & proceeds to flex & extend the knee while palpating the joint

(+) Pain with movement & crepitus → Meniscal lesion (r: 0.05 sn: 29 sp: 100)31, 89, osteochondritis dissecans, ligament sprain

This maneuver is essentially passive knee ROM with the examiner palpating the joint (a useful technique to employ with all passive ROM procedures)

Patellar Apprehension Test

Patient supine with legs straight & quadriceps muscles relaxed, examiner gently & slowly pushes the patella laterally & observes the patient for signs of verbal & nonverbal apprehension or reflex quadriceps contraction

(+) Apprehension or reflex quadriceps muscle contraction → Patellar instability, subluxation, tracking disorder, patellofemoral dysfunction

Some clinicians suggest having the knee flexed 30° during this maneuver; with the knee flexed, the patella is much more stable in the patellar groove of the femur (increasing of a false negative), testing with leg straight increases the clinically validity of the test (sn: 7-37 sp: 86-100 +LR: 0.9-2.3 -LR: 0.8-1)

Patellar Facet Pinch Test

Patient supine with KN AN Patella_4 Viewslegs straight & quadriceps muscles relaxed, examiner gently & slowly pushes the patella laterally & palpates the facets, the test is then repeated with the examiner pushing the patella medially

(+) Facet tenderness → Chondromalacia patella

Perkin’s Sign: peripheral patellar tenderness upon medial & lateral displacement

Patellar Grind Test

Synonym: Patellar Grind Test, Clarke’s Sign

Patient supine legs straight, examiner “cups” hand over patella & applies a downward force (compressing the patella against the femur), examiner then proceeds to move the patella laterally, medially, superiorly, inferiorly, & in a twisting motion (“twist & grind”)

(+) Pain and/or crepitus → Chondromalacia patella, DJD, osteochondritis of the patella, patellar fracture (sn: 29-49 sp: 67-75 +LR: 0.9-1.9 -LR: 0.7-1.1)73, 81, 82, 71

Compression of the patella on the femur may cause pain due to aggravation of inflamed or damaged tissues. Many patients may have a feeling of nausea or apprehension (warn patient ahead of time)

Clarke's Test

 

Patient supine with leg straight, examiner compresses the quadriceps muscle 2 cm (1 inch) above the superior pole of the patella, the patient is then instructed to contract the quadriceps muscle

 

(+) Retropatellar pain → Chondromalacia patella, degeneration of the patellofemoral joint

Contraction of the quadriceps compresses the patella against the femoral condyles

Chondromalacia patella causative factors; recurrent patellar dislocation, patella alta & other congenital anomalies, quadriceps muscle imbalance, increased Q-angle at the knee, direct patellar trauma

McMurray's Test

Patient supine or side-lying with hip flexed at 90° & knee flexed 90°, examiner stabilizes patient’s knee over distal quadriceps muscles & grips patient’s heel with the other hand & applies long axis compression; examiner then rotates the tibia internally while applying a varus force, examiner then rotates the tibia laterally while applying a valgus force

(+) Pain or crepitus → Meniscal lesion

  • Valgus force with external rotation → Lateral meniscus
  • Varus force with internal rotation → Medial meniscus

Signs of a meniscal lesion: knee joint line pain, crepitus sensation with movement, “locking” of the knee

Surgical confirmation of McMurray’s test has show that it can be less than 75% accurate. Beware false positives or negatives & cluster with other tests

This test is difficult to perform correctly & takes lots of practice & regular use to be proficient

(r: 0.16-0.35 sn: 16-67 sp: 69-98 +LR: 1.5-9.3 -LR: 0.38-0.86)

Nobel's Test

Patient supine or side-lying, examiner applies lateral to medial pressure over the patient’s lateral epicondyle with thumb & slowly flexes & extends the leg (3-4 times)

(+) Pain over the lateral femoral epicondyle or palpable tendon snapping → Iliotibial band syndrome

Etiologic factors in ITB syndromes:

  • Pelvic tilt, running or cycling on an oblique surface
  • Increased activity, sudden increase in running or cycling distance; Varus knee deformity, overpronation
  • Leg length inequality (may be related to pelvic tilt)

Rinne Test

Patient standing, examiner applies pressure over the patient’s lateral epicondyle with thumb & instructs patient to squat & rise or step up on to a bench

(+) Pain over the lateral femoral epicondyle or palpable tendon snapping → Iliotibial band syndrome

This maneuver provides a more functional weight bearing assessment of the iliotibial band, but it should be noted that the net movement at the knee is the same as Noble’s compression test performed with the patient side-lying or supine

Do NOT confuse this test with the Rinne test for hearing function

Duck Waddle Test

Patient standing with feet approximately ~30 cm apart & legs maximally internally rotated, patient then attempts a full squat; maneuver is repeated with patient’s legs externally rotated

(+) Pain, inability to perform test, audible “clicking” or crepitus →

  • With internal rotation → Lateral meniscus tear
  • With external rotation → Medial meniscus tear

Procedure provides functional weight bearing assessment of potential knee pathologies (sn: 64-67 sp: 81-90 +LR: 3.5-6.4 -LR: 0.4)

Disco/Thessaly Test

Patient standing on a single leg near wall, examiner instructs patient to twist from side to side, test may be repeated with support & weight bearing knee flexed 5° & again at 20° flexion

(+) Pain, inability to perform maneuver, audible “clicking” or crepitus on weight bearing knee → Knee joint pathology, arthritis, meniscal lesion, ligamentous strain, internal derangement

Examiner should provide patient with some support (hold hands) or be ready to catch the patient should they lose their balance

Increased knee flexion may improve diagnostic accuracy (r: 0.95 sn: 66-92 sp: 91-97 +LR: 9-30 -LR: 0.08-0.35)

Follow HIP-MNRS with every patient encounter – History, Inspection, Palpation – Motion, Neurovascular, Referred, Special Tests

Make sure you have a detailed anatomy understanding and can create a list of potential pain generators (muscle, bone, joint, ligament, cartilage, blood vessels, nerves, viscera & lymphatics) – any competent practitioner should be able to give a detailed list of the anatomy below their hand and the tissues they are stretching, compressing or activating

Clinicians performing regional exams must realize that no one sign is of absolute significance in isolation, each individual finding should be evaluated only in the context of other findings & the patient as a whole; this is particularly important with diagnostic procedures that may result in “soft” signs, which are difficult to reproduce & may have a large subjective bias in their interpretation.

When recording test results it is not enough to write “test-X positive.” Record any findings associated with the test (reproduction of symptoms, pain, muscle guarding, numbness & tingling, decreased flexibility, clicking, etc) – more information results in a more accurate assessment & better treatment. Remember assessment is therapeutic! – to learn more see out text books or take our hands on training seminars

References

 

Vizniak, NA. Human Cadaver Dissections. 1999-2016
Pierce CM, O’Brien L, Griffin LW, Laprade RF. Posterior cruciate ligament tears: functional and postoperative rehab. Knee Surg Sports Traumatol Arthrosc. Apr 8 2012;
Abouassaly M, Peterson D, Salci L, Farrokhyar F, D’Souza J, Bhandari M, et al. Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical techniques. Knee Surg Sports Traumatol Arthrosc. May 17 2013;
Ackroyd CE, Polyzoides AJ. Patellectomy for osteoarthritis. A study of eighty-one patients followed from two to twenty-two years. J Bone Joint Surg Br. Aug 1978;60-B(3):353-7.
Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy. Feb 2009;25(2):145-52.
Adachi N, Ochi M, Uchio Y, Kuriwaka M, Shinomiya R. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy. May 2004;20(5):536-42.
Ahn JH, Nha KW, Kim YC, Lim HC, Nam HW, Wang JH. Arthroscopic femoral tensioning and posterior cruciate ligament reconstruction in chronic posterior cruciate ligament injury. Arthroscopy. Mar 2006;22(3):341.e1-4.
Ahn JH, Yoo JC, Wang JH. Posterior cruciate ligament reconstruction: double-loop hamstring tendon autograft versus Achilles tendon allograft–clinical results of a minimum 2-year follow-up. Arthroscopy. Aug 2005;21(8):965-9.
Amis AA, Gupte CM, Bull AM, Edwards A. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc. Mar 2006;14(3):257-63.
Arendt EA, ed. Orthopaedic Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999.
Argenson JN, Guillaume JM, Aubaniac JM. Is there a place for patellofemoral arthroplasty?. Clin Orthop Relat Res. Dec 1995;162-7.
Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. Mar-Apr 1982;10(2):90-5.
Arnoczky SP, Warren RF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med. May-Jun 1983;11(3):131-41.
Baker CL Jr, Norwood LA, Hughston JC. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med. May-Jun 1984;12(3):204-8.
Barber FA, Harding NR. Meniscal repair rehabilitation. Instr Course Lect. 2000;49:207-10.
Barclay L, Nghiem HT. Arthroscopic Surgery May Not Be Helpful for Knee Osteoarthritis. Medscape. Available at http://www.medscape.com/viewarticle/580300. Accessed September 11, 2008.
Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ 3rd, Allen AA. Effect of Graft Selection on the Incidence of Postoperative Infection in Anterior Cruciate Ligament Reconstruction. Am J Sports Med. Nov 13 2009;
Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop. May 28 2008;epub ahead of print.
Belanger MJ, Moore DC, Crisco JJ 3rd, Fadale PD, Hulstyn MJ, Ehrlich MG. Knee laxity does not vary with the menstrual cycle, before or after exercise. Am J Sports Med. Jul-Aug 2004;32(5):1150-7.
Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM, et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. Mar 2003;85(2):223-30.
Bergfeld JA, McAllister DR, Parker RD, et al. The effects of tibial rotation on posterior translation in knees in which the posterior cruciate ligament has been cut. J Bone Joint Surg Am. Sep 2001;83-A(9):1339-43.
Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. Oct 2005;33(10):1579-602.
Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. Apr 2004;20(4):373-8.
Boyd AD Jr, Ewald FC, Thomas WH, Poss R, Sledge CB. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am. May 1993;75(5):674-81.
Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. Oct 6 1994;331(14):889-95.
Brophy RH, Gill CS, Lyman S, Barnes RP, Rodeo SA, Warren RF. Effect of anterior cruciate ligament reconstruction and meniscectomy on length of career in National Football League athletes: a case control study. Am J Sports Med. Nov 2009;37(11):2102-7.
Brophy RH, Wright RW, David TS, McCormack RG, Sekiya JK, Svoboda SJ, et al. Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med. Apr 2012;40(4):808-814.
Browner BD. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, Pa: WB Saunders Co; 1998.
Cain TE, Schwab GH. Performance of an athlete with straight posterior knee instability. Am J Sports Med. Jul-Aug 1981;9(4):203-8.
Camathias C, Festring JD, Gaston MS. Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature. J Pediatr Orthop B. Mar 2011;20(2):74-80.
Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT. Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction?. Am J Sports Med. Sep 2011;39(9):1894-9.
Choi NH, Kim TH, Victoroff BN. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair. Am J Sports Med. Nov 2009;37(11):2144-50.
Chu CR, Convery FR, Akeson WH, Meyers M, Amiel D. Articular cartilage transplantation. Clinical results in the knee. Clin Orthop Relat Res. Mar 1999;159-68.
Clancy WG Jr, Shelbourne KD, Zoellner GB, et al. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg Am. Mar 1983;65(3):310-22.
Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg. Sep-Oct 2001;9(5):297-307.
Cosgarea AJ, Sebastianelli WJ, DeHaven KE. Prevention of arthrofibrosis after anterior cruciate ligament reconstruction using the central third patellar tendon autograft. Am J Sports Med. Jan-Feb 1995;23(1):87-92.
Cox CL, Deangelis JP, Magnussen RA, Fitch RW, Spindler KP. Meniscal tears in athletes. J Surg Orthop Adv. Spring 2009;18(1):2-8.
Cross MJ, Powell JF. Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med. Jul-Aug 1984;12(4):292-7.
Crossley KM, Marino GP, Macilquham MD, Schache AG, Hinman RS. Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis?. Arthritis Rheum. Dec 15 2009;61(12):1719-25.
Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R. Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am. Jun 1985;67(5):720-6.
Daniel DM, Stone ML, Barnett P, Sachs R. Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg Am. Mar 1988;70(3):386-91.
Delee JC. Orthopaedic Sports Medicine, Principles and Practice. Vol 2. Philadelphia, Pa: WB Saunders Co; 1994.
Ding J, Zhao J, He Y, Huangfu X, Zeng B. Risk factors for articular cartilage lesions in symptomatic discoid lateral meniscus. Arthroscopy. Dec 2009;25(12):1423-6.
Donovan. Posterior cruciate ligament injury on artificial turf. Orthop. 1977;1:20.
Duquin TR, Wind WM, Fineberg MS, Smolinski RJ, Buyea CM. Current trends in anterior cruciate ligament reconstruction. J Knee Surg. Jan 2009;22(1):7-12.
Eren OT. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy. Oct 2003;19(8):850-4.
Erickson BJ, Chalmers PN, Yanke AB, Cole BJ. Surgical management of osteochondritis dissecans of the knee. Curr Rev Musculoskelet Med. Jun 2013;6(2):102-14.
Fairbanks TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30:664-70.
Feller JA, Bartlett RJ. Patellectomy and osteoarthritis: arthroscopic findings following previous patellectomy. Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):159-61.
Fitzpatrick PL, Morgan DA. Fresh osteochondral allografts: a 6-10-year review. Aust N Z J Surg. Aug 1998;68(8):573-9.
Fowler PJ, Messieh SS. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med. Nov-Dec 1987;15(6):553-7.
Freedman KB, Nho SJ, Cole BJ. Marrow stimulating technique to augment meniscus repair. Arthroscopy. Sep 2003;19(7):794-8.
Froimson MI, Ratcliffe A, Gardner TR, Mow VC. Differences in patellofemoral joint cartilage material properties and their significance to the etiology of cartilage surface fibrillation. Osteoarthritis Cartilage. Nov 1997;5(6):377-86.
Fu FH, Harner CD, Vince KG, eds. Knee Surgery. Philadelphia, Pa: Lippincott Williams & Wilkins; 1994.
Gardner E, O’Rahilly R. The early development of the knee joint in staged human embryos. J Anat. Jan 1968;102(2):289-99.
Garr EL, Moskowitz RW, Davis W. Degenerative changes following experimental patellectomy in the rabbit. Clin Orthop Relat Res. May 1973;296-304.
Geib TM, Shelton WR, Phelps RA, Clark L. Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy. Dec 2009;25(12):1408-14.
Getelman MH, Friedman MJ. Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg. May-Jun 1999;7(3):189-98.
Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. Nov 1997;79(6):1008-13.
Goodfellow J, Hungerford DS, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br. Aug 1976;58(3):287-90.
Goudie EB, Will EM, Keating JF. Functional outcome following PCL and complex knee ligament reconstruction. Knee. Sep 29 2009;
Grande DA, Singh IJ, Pugh J. Healing of experimentally produced lesions in articular cartilage following chondrocyte transplantation. Anat Rec. Jun 1987;218(2):142-8.
Grelsamer RP, Weinstein CH. Applied biomechanics of the patella. Clin Orthop Relat Res. Aug 2001;9-14.
Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am. 2003;85-A Suppl 2:25-32.
Hart ES, Kalra KP, Grottkau BE, Albright M, Shannon EG. Discoid lateral meniscus in children. Orthop Nurs. May/June 2008;27(3):174-9.
Herberhold C, Faber S, Stammberger T, Steinlechner M, Putz R, Englmeier KH, et al. In situ measurement of articular cartilage deformation in intact femoropatellar joints under static loading. J Biomech. Dec 1999;32(12):1287-95.
Herberhold C, Stammberger T, Faber S, Putz R, Englmeier KH, Reiser M, et al. An MR-based technique for quantifying the deformation of articular cartilage during mechanical loading in an intact cadaver joint. Magn Reson Med. May 1998;39(5):843-50.
Hermans S, Corten K, Bellemans J. Long-term results of isolated anterolateral bundle reconstructions of the posterior cruciate ligament: a 6- to 12-year follow-up study. Am J Sports Med. Aug 2009;37(8):1499-507.
Herzog W, Diet S, Suter E, Mayzus P, Leonard TR, Müller C, et al. Material and functional properties of articular cartilage and patellofemoral contact mechanics in an experimental model of osteoarthritis. J Biomech. Dec 1998;31(12):1137-45.
Hewson GF Jr, Mendini RA, Wang JB. Prophylactic knee bracing in college football. Am J Sports Med. Jul-Aug 1986;14(4):262-6.
Heywood CS, Benke MT, Brindle K, Fine KM. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. Arthroscopy. Feb 2011;27(2):194-9.
Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. Jun 1984;66(5):715-24.
Ikejiani CE, Leighton R, Petrie DP. Comparison of patellar resurfacing versus nonresurfacing in total knee arthroplasty. Can J Surg. Feb 2000;43(1):35-8.
Insall JN, Scott WN, eds. Surgery of the Knee. 3rd ed. Philadelphia, Pa: WB Saunders Co; 2001.
Iwamoto J, Takeda T, Sato Y, Matsumoto H. Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic. Gend Med. Dec 2008;5(4):405-14.
Janousek AT, Jones DG, Clatworthy M, et al. Posterior cruciate ligament injuries of the knee joint. Sports Med. Dec 1999;28(6):429-41.
Järvelä T, Paakkala T, Kannus P, Järvinen M. The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. Am J Sports Med. Jan-Feb 2001;29(1):18-24.
Jerosch J, Riemer S. [How good are clinical investigative procedures for diagnosing meniscus lesions?] [German]. Sportverletz Sportschaden. Jun 2004;18(2):59-67.
Johnson DL, Harner CD, Maday MG. Revision anterior cruciate ligament surgery. Knee Surg. 1994;1:877-95.
Johnson LL, van Dyk GE, Green JR 3rd, Pittsley AW, Bays B, Gully SM, et al. Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy. May-Jun 1998;14(4):347-59.
Joshi AB, Lee CM, Markovic L, Murphy JC, Hardinge K. Total knee arthroplasty after patellectomy. J Bone Joint Surg Br. Nov 1994;76(6):926-9.
Jung TM, Höher J, Weiler A. Screw fixation of a 4 1/2-year-old PCL avulsion injury. Knee Surg Sports Traumatol Arthrosc. May 2006;14(5):469-72.
Jung YB, Jung HJ, Tae SK, Lee YS, Yang DL. Tensioning of remnant posterior cruciate ligament and reconstruction of anterolateral bundle in chronic posterior cruciate ligament injury. Arthroscopy. Mar 2006;22(3):329-38.
Kawakubo M, Matsumoto H, Otani T, Fujikawa K. Radiographic changes in the patella after total knee arthroplasty without resurfacing the patella. Comparison of osteoarthrosis and rheumatoid arthritis. Bull Hosp Jt Dis. 1997;56(4):237-44.
Kelly JD 4th, Ebrahimpour P. Chondral injury and synovitis after arthroscopic meniscal repair using an outside-in mulberry knot suture technique. Arthroscopy. May 2004;20(5):e49-52.
Kelly MA, Insall JN. Historical perspectives of chondromalacia patellae. Orthop Clin North Am. Oct 1992;23(4):517-21.
Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. Aug 2008;248(2):571-8.
Kim BS, Reitman RD, Schai PA, Scott RD. Selective patellar nonresurfacing in total knee arthroplasty. 10 year results. Clin Orthop Relat Res. Oct 1999;81-8.
Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy. Mar 2011;27(3):346-54.