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Clinical examination After a careful history, it is useful to examine the ‘normal’ knee. This creates trust and reassures the patient.

Inspection ● Observe gait and position of the patient, which is usually the most comfortable ● Muscle wasting of quadriceps and calf muscles ● Asymmetry between knees, such as swelling or discolouration ● Loss of peripatellar groove may sug- gest effusion ● Swelling either medially or laterally may indicate inflammation of collater- al ligaments

of traumatic knee disorders. Am J Sports Med. 1996;24:164-167.

8. Rose NE, Gold SM. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy. 1996;12:398-405. 9. Solomon DH, Simel, et al. Does this patient have a torn meniscus or ligament of the knee? Value of physical examination. JAMA. 2001;Vol286, (131):610-1620.

Palpation ● Temperature differences may suggest inflammation ● Loss of peripatellar groove and palpation of fluid in supine ● Compression of superior and medial aspects of knee and tapping lateral aspect to create a wave of fluid ● Ballottement of the patella - pushing down on patella suggests floating sensa- tion of the patella over the femoral condyle suggests effusion

● Localised swelling over lateral collateral ligaments ● Palpable grating may be present during specific knee movements and these are recorded ● Joint line tenderness in the groove between the femoral condyle and tibia.

Movement ● Comparison of active and passive range of flexion and extension of both knees.

10. Yao L, Phelps CT, et al. Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology. 1988;166:861-864. 11. Fowler PJ, Lubliner JA. The predictive value of five clinical signs in the evaluation of menis- cal pathology. Arthroscopy. 1989;5:181-186. 12. Barry OCD, Smith H, McManus F, MacAuley P. Clinical assessment of suspected meniscal tears. Ir J Med Sci. 1983;152:149-151.

Dr Philip Batty, MRCGP, Dip.Sp.Med was deputy club doctor to Manchester United Football Club between 1996-99 and is cur- rently the club doctor to Blackburn Rovers Football Club. He is medical director of the musculoskeletal injury clinic “Physio 4U” and a part time general practitioner in Lancaster with a diploma in sports medicine.

moving musculoskeletal medicine forwards

‘A Question of Sport’ with keynote speaker

Dr Mike Stroud, OBE

Best known for his record-breaking expeditions with Sir Ranulph Fiennes. He has broken several world records including the first unaided walk across Antarctica from coast to coast.

Saturday 28th June 2003 Loughborough University, Leicestershire

Lectures include:

● Responses and adaptations to exercise by Dr Greg White ● Sports medicine in primary care by Dr Brian Blacklidge ● Heat and cold - physiology and medical problems by Dr Mike Stroud ● Sport is good fun, not good for you by Mr David Finlayson ● Field of play by Dr Bryan English ● Break out sessions with a choice of 4 of the morning speakers ● From ice to dust - travels and medicine in environmental extremes by Dr Mike Stroud

For more details contact Amanda Sherwood on 01454 610255 or via e-mail amandasherwood@compuserve.com

The Football Association in conjunction with the Royal College of Surgeons

15th Joint Conference on Sport Injury Muscle and Tendon Injury 5th-6th July 2003

Staverton Park Hotel, Daventry, Northants

Just a few of the presentations included: ● Presentation of the FA’s Audit of Injury Research Programme

● Muscle Strains: New Thoughts on an Old Nemesis ● Hamstring Tears: Can We Prevent Them? ● Muscle and tendon injury - Diagnostic and Prognostic Imaging

● Current Concepts and Controversies in Acute and ● Chronic Achilles and Patellar Tendon Injuries in Football

● Muscle Injury - Aspects of Treatment and Rehabilitation, Accelerated Rehabilitation Programme

For more details or to be sent a delegate application form contact Julie Brown on 01952 605928 or via e-mail julie.brown@thefa.com

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