Knee giving out and locking (Full Version)

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Alex Brenner PT MPT OCS -> Knee giving out and locking (March 7, 2005 3:31:00 AM)

23 year old male with no history of trauma. He complains of occasional knee locking when going from sit to stand. He is able to get the knee to unlock but it is painful. I have left out the lateral view on purpose.

What are the findings?

(all images obtained and used with permission)
[IMG]http://img.photobucket.com/albums/v85/brennerak/kneesunrise.jpg[/IMG]

[IMG]http://img.photobucket.com/albums/v85/brennerak/kneeap1.jpg[/IMG]



jma -> Re: Knee giving out and locking (March 7, 2005 4:00:00 AM)

Hello,
What seems to get my attention is the lateral femur that appears less dense on both views. The joint spaces between the femur and tibia appear to be okay. The patella seems to be okay in the axial view. I cannot appreciate any significant deviation from the groove.

JMA



Jeep -> Re: Knee giving out and locking (March 7, 2005 4:00:00 AM)

looks like Classic joint mouse- Small fragment of cartilage that has detached and undergone calcification. The knee is the most frequent site for these. They are free fragments and move within the joint, sometimes causing it to"lock". Moving the affected joint will reposition the fragment, and "un-lock" the joint. The lateral view would give info if it is in the tendon and not in the joint space.

Thanks Army for these fun exercises.



UTDC -> Re: Knee giving out and locking (March 7, 2005 7:31:00 AM)

I agree with Jeep- there looks to be a opacity in the lateral compartment. There is also a small avulsion? visible on the sunrise view.


Jeff



Shill -> Re: Knee giving out and locking (March 7, 2005 9:14:00 AM)

I also concur with Jeep.



chiroortho -> Re: Knee giving out and locking (March 7, 2005 11:36:00 AM)

Osteochondral fragment, but can't see the donor site. Looks like he 'kneeds' an MRI. :)

The little avulsion doesn't impress me.



jma -> Re: Knee giving out and locking (March 7, 2005 3:06:00 PM)

It would be interesting to see if their is meniscal involvement here.

JMA



FLAOrthoPT -> Re: Knee giving out and locking (March 7, 2005 4:17:00 PM)

looks like his skull has some weird deformities...



FLAOrthoPT -> Re: Knee giving out and locking (March 7, 2005 4:17:00 PM)

oh it's a knee



FLAOrthoPT -> Re: Knee giving out and locking (March 7, 2005 4:18:00 PM)

I'm just kidding everyone settle down



tim -> Re: Knee giving out and locking (March 7, 2005 6:31:00 PM)

I'd say with no history of trauma it is CPPD that has affected his lateral meniscus so far...but this disorder usually occurs past 30 years old with a peak at 60 y.o. Maybe this patient didn't read the book :)
This would also account for the density in the sunrise view as I could not visualize a break in the cortex. I would have liked to see 2 views perpendicular to each other as this is standard of care but.....oh well.
The painful locking makes me think intra-articular if he is sitting with his knees hyperflexed....it would make me think meniscus...definitely.
-Tim Irving
Portland, OR



ehanso -> Re: Knee giving out and locking (March 8, 2005 2:02:00 AM)

I agree. Looks like joint mice. Can't wait to see the laterals.



JLS_PT_OCS -> Re: Knee giving out and locking (March 8, 2005 2:11:00 AM)

Loose body. Question history of patellar dislocation.
Don't see the CPPD mentioned above.
Is is just me, or is that a concave lateral tibial plateau? Maybe it's just the angle..

I guess I can always blame my monitor or a poor film if I'm wrong... :)



Jeep -> Re: Knee giving out and locking (March 8, 2005 2:48:00 AM)

FLA-
Cracking me up!!!!!



fapt -> Re: Knee giving out and locking (March 8, 2005 3:02:00 AM)

hmm
I can't see anything yet!! lol
Did u think the patient had loose body while examining?
Or motor control strategy problem?

I think the patient's knee is ok...

Lin, MS PT Taiwan



Synergy -> Re: Knee giving out and locking (March 8, 2005 8:48:00 AM)

I agree with FLA 100%. Although, I truly feel the foramen magnum is a bit askew. Could be my monitor, but I also see a FRS left sphenoid.

ROFL @ FLA!

On another note, I too see the tiny 'avulsion' just medial to the patella on the sunrise view.



UTDC -> Re: Knee giving out and locking (March 9, 2005 1:14:00 PM)

Tim,
good point regarding CPPD. I don't think that is what this is, but we should have mentioned it as a differential.


Jeff



tim -> Re: Knee giving out and locking (March 9, 2005 4:22:00 PM)

UTDC....yeah probably not but Yochum and Rowe's text mentions painful locking and instability as a possible sequella of CPPD. With the patient's age....my money would be on joint mice....I REALLY want to see the lateral to better determine the position of the "loose" radio-dense body.



Alex Brenner PT MPT OCS -> Re: Knee giving out and locking (March 9, 2005 7:41:00 PM)

Here is the lateral.

[IMG]http://img.photobucket.com/albums/v85/brennerak/jointmouselat.jpg[/IMG]

Due to new Army regulations I no longer will go by ArmyPT but will instead use my real name. I am sorry for any confusion.



SJBird55 -> Re: Knee giving out and locking (March 10, 2005 12:57:00 AM)

Army regulations now state you can't communicate anonymously no matter what form of communication? Hmm, why is that? Kind of limiting "being all you want to be" aren't they? HeHe Barrett will be SO excited over that! He dislikes anonymity.

oh... and I do see an issue in the jointline with this view.



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