PREFERRED PRACTICE PATTERN
4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Bony or Soft Tissue Surgery1
A 33-year-old female presents with left lateral knee pain following being kicked in the medial left knee during a karate class 1 week ago. The patient reports the pain is worse with trying to use the left leg as a stance leg during kicks and with trying to get out of the car, especially from the driver’s seat. She denies popping, clicking, or giving way in the knee, but does report feeling less stable when performing karate moves that involve standing on the left leg only. There is mild swelling and moderate tenderness in the lateral knee. Range of motion is full with pain at end range extension. There is no pain with resisted knee flexion or extension, but hip abduction in side lying does reproduce pain. Patellar instability testing is negative, but varus stress test is positive for pain with a firm end feel and no apparent laxity.
Injury is generally traumatic, can occur at any age; trauma usually a high-impact force applied to the medial knee.
Clinical diagnosis is generally made through history of injury and knee varus stability testing.
Diagnosis may be confirmed with MRI.2
In this coronal slice MR image, areas of increased signal intensity are noted in the medial and lateral collateral ligaments, suggesting incomplete tears of each. Also note the appearance of the lateral meniscus; the increased signal intensity in the body of the meniscus is consistent with a tear of this structure. (From Malone TR, Hazle C, Grey ML. Imaging in Rehabilitation. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Posterior view of knee joint showing cruciate ligaments. (From Hamilton N, Weimar W, Luttgens K. Kinesiology: Scientific Basis of Human Motion. 11th ed. http://www.accessphysiotherapy.com. Copyright © McGraw-Hill Education. All rights reserved.)