Knee History

==Groups of Knee Pain==
Acute knee pain with history of trauma or overuse
Atraumatic knee pain with effusion
Atraumatic knee pain without effusion
Referred pain
Location based
==History==
*Mechanism
**Trauma vs atraumatic sudden vs insidious
*Pain
**Location and character
***Any neuropathic qualities?
**Pattern 
***Inflammatory arthropathy – morning stiffness, rest pain, relief on movement
***Mechanical – pain on weightbearing, worse later in day
**Severity – although limited clinical utility
*Swelling – immediate vs delayed?
*Locking, giving way, instability – internal derangement
*Snapping - consider ITB, pes anserine tendons
*Constitutional symptoms – fever, night sweats, weight loss, rash
*Back pain?
*Other joint involvement
*Previous injuries and treatments
*Medical history – any systemic or rheumatological disease? 
*Occupation and hobbies/sports
*Training history
*Possible differential based on history of trauma
**Flexion, rotation, compression: meniscus
**Valgus force: MCL
**Sudden deceleration or change in direction with planted/fixed foot: ACL
**Landing on flexed knee or MVA with posterior force to tibia: PCL
**Force to anteromedial extended knee or external rotation and hyperextension: posterolateral corner injury
**Swelling in knee with occasional locking and clicking: meniscus or loose body
**Pain on prolonged knee flexion, during squats, up and down stairs: PFS
**Anterior knee pain jumping and on full flexion: patellar tendinitis, PFS
==Differential Based on Age==
*Children
**Septic/osteomyelitis
**Apophysitis
***Osgood Schlatters
***Sinding-Larssen- Johanssen
**Neoplasm
***Osteosarcoma
***Ewings sarcoma
**Referred
***Perthes, DDH related AVN
***SUFE
***Transient synovitis
**Non accidental injury
*<50 year old adults
**Trauma
**Overuse syndromes
**Arthritis – Degenerative vs inflammatory
*>50 years
**Trauma
**Arthritis – more likely degenerative, consider gout, late onset RA and other autoimmune arthritides
==History of Conditions==
===ACL===
Immediate effusion, popping sensation, giving way
Sensitivity 0.71; Specificity 0.71; PPV 42%; LR+ 2.5Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Archives of physical medicine and rehabilitation. 2010 Sep 1;91(9):1452-9.
===Meniscal Injury===
*Giving way and locking: PPV 98%, NPV 19%, LR+ 8.3Yan, R., Wang, H., Yang, Z., Ji, Z. H., & Guo, Y. M.. Predicted probability of meniscus tears: Comparing history and physical examination with MRI. Swiss Medical Weekly, 141(DECEMBER 2010). https://doi.org/10.4414/smw.2011.13314
*Clicking: LR+ 2.4, LR– 7.0Cleland J, Koppenhaver S, Su J. Netter’s Orthopaedic Clinical Examination: An evidence based approach. 2016
===Osteosarcoma===
In children, distal femur is 75% of cases. In adults, typically occur more in axial locations. However, lower limb long bones are still the most common site (27%)Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 2009; 115:1531.
==References==
Category:Knee and Leg