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Grab behind the proximal tibia and pull anteriorly (perpendicular to the tibia).
Stabilize the femur with one hand (so it doesn’t track forward).
Perform the same steps on the opposite (unaffected) knee.
Positive Sign / Significance
Increased anterior translation compared to the other side (or a mushy, soft end-feel) = Anterior cruciate ligament injury
Comments
When the knee is flexed to 90°, the hamstring tendons and iliotibial band also prevent anterior translation of the tibia in relation to the femur. Therefore, this Lachman’s test is preferred over the anterior drawer test.
Drop the leg off the table and flex the knee to 30°.
Put fingers over the lateral joint line.
Grab the ankle/foot and apply a varus stress to the knee (using the medial knee against the outside of the table as a fulcrum and pushing the ankle lateral to medial).
Compare to the opposite, unaffected side.
Seated testing
Grasp the lateral ankle on the involved side of the body
Flex the knee to 20-30°
With the other hand, apply a medial-to-lateral varus force against the medial knee
One video below.Click the black title link above (if you can’t see the video).
1) Left knee injection under fluoroscopy. It is important to note the “mustache sign” in which the contrast spreads to both sides of the joint on the A-P view. Also note the lateral fluoro view that shows contrast spread into the suprapatellar bursa — this is observed in 85% of adults as the septum becomes perforated during the 5th month of development. You will find fluid in the suprapatellar bursa with MRI and ultrasound in patients with knee joint effusion or bursitis. The image of the Baker’s cyst is great in that it shows that they are connected to the knee joint; they are especially common in patients with meniscal tears in which the knee has an effusion that leaks into the cyst and causes a fullness feeling in the back of the knee.
One video below.Click the black title link above (if you can’t see the video).
1) Right C4/5 intraarticular facet injection under fluoroscopic guidance - it is of particular importance to note the contrast spread. It should NOT blob up under the needle tip, but rather should spread out along the joint line and into the capsule recesses at either end (as it does in this video)
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