Injuries to the knee continue to be a common and highly publicized occurrence in athletes. Despite improvements in playing conditions, athletic equipment, rules changes, and physical conditioning of the athlete, medical research articles and the lay news services are reporting an ever-increasing number of problems related to the diagnosis, treatment, and long-term knee function in this special patient population. Recently, the identification of a higher rate of knee ligament injuries in female athletes at a time when women's sports is enjoying an explosion of popularity causes further concern.<sup>3 Arendt E., Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature Am J Sports Med 1995 ;  23 : 694-701  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Sports medicine physicians who treat knee injuries will be challenged by patients, coaches, trainers, business agents, the press, and family members with an ever-increasing sophistication of medical knowledge. It is most appropriate that these physicians remain well read on this topic and continue to improve their physical examination skills. Although the natural tendency of both the patient and physician is to corroborate the initial diagnosis with noninvasive studies, the history and physical examination remain the most accurate and cost-effective tools in evaluating the injured athlete.

A current literature search on this topic reveals several hundred articles, often with conflicting data or substandard design study, with questionable conclusions. Outcome studies with better analytic designs are needed.<sup>33 Keller R.B. Outcomes research in orthopaedics J Am Acad Orthop Surg 1993 ;  1 : 122-129

Cliccare qui per andare alla sezione Riferimenti</sup> This article is designed as a “primer” to present accepted information on commonly occurring athletic knee injuries that can be used by any physician covering a team, athlete, or athletic event. Owing to obvious constraints, a detailed discussion of all possible knee injuries is precluded. The reader is encouraged to further pursue needed information in the many fine textbooks devoted solely to these problems.

An anatomic approach to injury evaluation and treatment has been selected. It must be remembered, however, that these injuries rarely occur in isolation, but commonly occur in combination. Therefore, any force significant enough to produce damage to one tissue most probably will injure another, and these often-subtle concomitant injuries must be sought. Regardless of the suspected diagnosis, an underlying generalized ligamentous laxity evaluation of the knees, elbows, wrists, and hands should be performed on every patient. This provides a greater understanding of what “normal” is for the patient being examined, because this can vary from athlete to athlete. Every knee examination should be done in a bilateral fashion, that is, examining the uninjured side first and then comparing it with the injured side. It is this comparison of normal to abnormal on which so much of our soft-tissue evaluation is based. A good rapport with the athlete and the capacity to make them comfortable and relaxed is essential. Any protective muscle spasm could invalidate the physical examination findings. In the evaluation of the supine athlete, it is important that they remain with their head supported by a pillow and not be allowed to “curl up” to watch the examiner, because this tightens the pelvis and lower extremity musculature and could lead to a false-negative ligament examination. Regardless of which ligament is being tested, it must be remembered that the unconstrained knee has six degrees of freedom. This allows for the rotation around, and translation along, the X, Y, and Z axes (Figure 1). Normal knee motion couples some elements of translation and rotation. The examiner must define the abnormal pathologic motion due to ligament injury along all three axes.<sup>42 Noyes F.R., Cummings J.F., Grood E.S. , e al. The diagnosis of knee motion limits, subluxations, and ligament injury Am J Sports Med 1991 ;  19 : 163-171  [cross-ref]

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