The knee made easy

Preface
Contents
Chapter 1: Introduction
Chapter 2: Knee Clinical Anatomy
	2.1 Knee—Anatomical Structures
		2.1.1 Femur
		2.1.2 Tibia
		2.1.3 Patella
		2.1.4 Fibula
		2.1.5 Fabella
	2.2 Knee Joint
		2.2.1 Capsule of the Knee Joint
		2.2.2 Synovium of the Knee Joint
		2.2.3 Ligaments
		2.2.4 Menisci
		2.2.5 Fat pads of the Knee
	2.3 Proximal Tibiofibular Articulation
	2.4 Muscles
		2.4.1 Muscles that Connect the Pelvis to the Tibia/Fibula
		2.4.2 Muscles that Connect the Pelvis to the Femur
		2.4.3 Muscles that Connect the Femur to the Tibia
		2.4.4 Muscles that Connect the Femur to the Foot
	2.5 Synovial Folds (Plicae)
	2.6 Bursae
	2.7 Anatomy Overview
		2.7.1 Orientation of the Knee Bones in Space
		2.7.2 Overview of the Soft Tissue Structures of the Knee
		2.7.3 Popliteal Fossa
	2.8 Arterial Supply of the Knee and Lower Limb
		2.8.1 Patellar Blood Supply
		2.8.2 Quadriceps Tendon Blood Supply
	2.9 Veins of the Knee and Lower Limb
	2.10 Nerve Supply of the Knee and Lower Limb
		2.10.1 Sensory Supply of the Knee and Lower Limb
		2.10.2 Motor Supply of the Knee and Lower Limb
		2.10.3 Nerves of the Knee and Lower Limb
		2.10.4 Cutaneous Sensory Supply of the Knee
		2.10.5 Deep Sensory Supply of the Knee
	References
Chapter 3: Knee Biomechanics: Tibiofemoral Articulation
	3.1 Knee Flexion/Extension at the Tibiofemoral Joint [1–16]
	3.2 Initiation of Knee Extension (Screw Home Mechanism)
	3.3 Range of Motion at the Knee
	3.4 Muscles Bringing about Motion
		3.4.1 Muscles Controlling Tibiofemoral Joint Motion
	3.5 GAIT
	3.6 Forces Transmitted by the Tibiofemoral Joint
		3.6.1 Forces Acting on the Tibiofemoral Joint
	3.7 Tibiofemoral Joint Loading [28–36]
	3.8 Weightbearing—Mechanical Axis
	3.9 Knee Adduction Moment
		3.9.1 Relation of the GRF to the Knee in the Coronal Plane
	3.10 Menisci and Loading of the Knee
	3.11 Forces with Aquatic Exercises [25–27]
	3.12 Tibiofemoral Joint Stability
		3.12.1 Joint Stability
		3.12.2 Tibiofemoral Joint Stability – Static Stabilizers
		3.12.3 Dynamic Tibiofemoral Joint Stabilisers
			3.12.3.1 Sagittal Quadriceps/Hamstring Force Couple
		3.12.4 Core Control and Tibiofemoral Joint Stability [75, 77–87]
		3.12.5 Hip Muscles
	3.13 Biomechanics of Tibiofemoral Degeneration [88–97]
		3.13.1 Primary Medial Compartment OA with Intact ACL
		3.13.2 OA Secondary to ACL Deficiency (Due to Previous Tear)
		3.13.3 OA Associated with PCL Deficiency
		3.13.4 Primary Lateral Compartment OA
	References
Chapter 4: Knee Biomechanics—Patellofemoral Articulation
	4.1 Patellofemoral Motion
	4.2 Patellar Motion in Relation to the Femur and Tibia
	4.3 Patellofemoral Joint Forces
	4.4 Variation of Patellar Contact Pressures with Knee Flexion
	4.5 Asymmetrical Loading of the Patella
	4.6 Patella Alta
	4.7 Downhill Walking Induced Muscle Damage and Delayed Onset Muscle Soreness [24–26]
	4.8 Patellofemoral Joint Stability
	4.9 PF Joint Stabilisers
		4.9.1 Static Factors
			4.9.1.1 Bone and Articular Cartilage Morphology
			4.9.1.2 Ligaments
			4.9.1.3 Tendons
			4.9.1.4 The following describe the various static ligamentous/tendinous restraints to PF instability in various directions:
			4.9.1.5 Interaction of Static Restraints
		4.9.2 Dynamic Factors in PF Stability
			4.9.2.1 Knee Muscles
			4.9.2.2 Muscles of the Core, Hip, Foot and Ankle
	4.10 Lateral PF Instability
	4.11 Biomechanics of Patellofemoral Degeneration
		4.11.1 Osteoarthritis Associated with Posterior Cruciate Ligament/Posterolateral Corner Deficiency [54–56]
	References
Chapter 5: Clinical History for Knee Conditions
	5.1 Presenting Complaint
		5.1.1 Nature of Complaint
		5.1.2 Onset of Complaint
		5.1.3 Progress of Complaint
		5.1.4 Exacerbating and Relieving Factors
		5.1.5 Impact of Presenting Complaint
		5.1.6 Up to Date Management of Presenting Complaint
	5.2 Previous Musculoskeletal History
	5.3 Activities History
	5.4 Previous Medical History
	5.5 Previous Surgical History
	5.6 Medication History
	5.7 Family Musculoskeletal History
	References
Chapter 6: Clinical Examination of the Knee
	6.1 Look
	6.2 Feel
	6.3 Move
		6.3.1 Overall Gait
		6.3.2 Knee Movements Assessed
		6.3.3 Lumbosacral Spine Movements Assessed
		6.3.4 Hip Movements Assessed
		6.3.5 Ankle Movements Assessed
	6.4 Special Tests in Knee Examination
	6.5 Assessing Muscle Strength in Knee Examination
		6.5.1 Testing Muscle Strength—Individual Muscles
			6.5.1.1 Quadriceps
				Active Extension Lag
				Quadriceps Resistance Strength Test
			6.5.1.2 Hamstrings
				Flexion Strength
	6.6 Pain Provoking Tests
		6.6.1 Patellofemoral Compression Test [2, 23]
		6.6.2 Meniscal Tear Pain Provoking Tests
		6.6.3 Hoffa’s Test [26]
		6.6.4 Medial Patellar Plica (MPP) Test [27]
	6.7 Laxity Assessment
		6.7.1 Assessment of Tibiofemoral Knee Laxity
			6.7.1.1 Anterior Knee Laxity
				Lachman Test [28]
				Anterior Drawer Test [29]
				Pivot Shift Test [32]
			6.7.1.2 Posterior Knee Laxity
				Posterior Tibial Sag Sign [36, 37]
				Posterior Drawer Test [38, 39]
				Reverse Pivot Shift Test [41, 42]
			6.7.1.3 Valgus/Varus Laxity
				Valgus Laxity
					Valgus Test [43, 44]
					Valgus Thrust
				Varus Laxity [45]
					Varus Test
					Varus Thrust
			6.7.1.4 Rotatory Laxity [49–51]
		6.7.2 Assessment of Patellofemoral Laxity [55]
		6.7.3 Assessment of Proximal Tibiofibular Joint Laxity [60]
		6.7.4 Assessment of Generalised Joint Hyperlaxity
	6.8 Knee Instability Tests
		6.8.1 Tests for ACL Instability
		6.8.2 Tests for PCL Instability
		6.8.3 Tests for Valgus Instability
		6.8.4 Tests for Varus Instability
		6.8.5 Tests for Posterolateral Corner Instability
		6.8.6 Tests for Patellofemoral Instability
		6.8.7 Tests for Proximal Tibiofibular Joint Instability
	6.9 Lumbosacral Spine Tests
	6.10 Core Balance Tests [69–71]
	6.11 Knee Muscle/Tendon Flexibility Tests
	6.12 Hip Abductors’ Strength
	6.13 Rotational Profile [79]
	References
Chapter 7: Investigations for Knee Disorders
	7.1 Radiological Investigations
		7.1.1 Plain Radiographs
		7.1.2 Plain Radiographs Stress Views [7–14]
		7.1.3 Ultrasound [15–17]
		7.1.4 Plain Magnetic Resonance Imaging [18–20]
		7.1.5 Contrast Enhanced MRI [21–23]
		7.1.6 MRI Arthrography [24–26]
		7.1.7 Computed Tomography
		7.1.8 CT Arthrography [24, 25]
		7.1.9 Bone Scan [27, 28]
		7.1.10 Radio-Labelled White Cell Bone Scan
		7.1.11 Single-Photon Emission Computed Tomography SPECT (+/− arthrography) [29–32]
	7.2 Assessment of Lower Limb/Knee Alignment [33–37]
		7.2.1 Lower Limb Alignment
			7.2.1.1 Coronal Alignment
			7.2.1.2 Sagittal Alignment
			7.2.1.3 Rotational Alignment
			7.2.1.4 Bone Morphology
	7.3 MRI Subchondral Oedema [38, 39]
	7.4 Neurophysiological Investigations for Knee Conditions [40, 41]
		7.4.1 Nerve Conduction Studies
		7.4.2 EMG
	7.5 Diagnostic Knee Injections
	7.6 Gait Analysis
	References
Chapter 8: Challenges in Managing Knee Disorders
	8.1 Natural History of Knee Disorders
	8.2 Incidental Clinical Findings in the Evaluation of the Knee
	8.3 Incidental Investigation Findings in the Evaluation of the Knee
	8.4 Not all Pathological Knee Findings Need Addressing
	8.5 Clinical Symptoms Originating from Multiple Knee Sources
	8.6 Systemic/Distant Disorders Causing Knee Clinical Symptoms
	8.7 Consider Clinical Symptoms Rather than Pathology in Knee Evaluation
	8.8 Uncertainty as to How Some Clinical Knee Symptoms Are Mediated
	8.9 Uncertainty as to How Knee Interventions Work
	8.10 Lack of Evidence Supporting Knee Interventions
	8.11 Inability to Accurately Predict those Who Will Benefit from an Intervention
	8.12 Intervention Management Ladder for Knee Disorders
	References
Chapter 9: Surgical Interventions for Knee Disorders
	9.1 Principles of Surgical Interventions
	9.2 Arthroscopic and Open Knee Surgery
		9.2.1 Arthroscopic Knee Surgery
			9.2.1.1 Surgical Portals in Arthroscopic Knee Surgery
				Anterolateral Portal
				Anteromedial Portal
				Superomedial Portal
				Posteromedial Portal
				Posterolateral Portal
		9.2.2 Open Knee Surgery
	9.3 Patient Positioning for Knee Surgery
	9.4 Minimising Bleeding in Knee Surgery
	9.5 Types of Knee Surgical Procedures
		9.5.1 Soft Tissue Procedures
		9.5.2 Cartilage/Bone Procedures
			9.5.2.1 Partial Meniscectomy
			9.5.2.2 Meniscal Repair
			9.5.2.3 Articular Cartilage Restoration Procedures
				Bone Marrow Stimulation Techniques
				Cartilage Implantation Techniques
				Osteochondral Allografts
				Autologous Cartilage Implantation (ACI)
				Fixation of Detached Osteochondral Fragments
		9.5.3 Bone Procedures
			9.5.3.1 Osteotomy
				Level of Osteotomy
			9.5.3.2 Knee Joint Arthroplasty
	References
Chapter 10: External Devices for Disorders of the Knee
	10.1 Knee External Devices
		10.1.1 Medial Compartment Unloading Braces
		10.1.2 Functional ACL Braces
		10.1.3 PCL Braces
		10.1.4 Stretching Knee Braces
	10.2 External Devices for the Ankle and Foot (Ankle/Foot Orthoses)
		10.2.1 Combining Foot with Ankle Orthosis [44–47]
		10.2.2 Compliance in Foot Orthoses
	References
Chapter 11: Knee Injection and Needling Therapy
	11.1 Injection Therapy
	11.2 Types of Knee Injections
		11.2.1 Steroid Injections [1–3]
		11.2.2 Visco-supplementation-Hyaluronic Acid Injections
		11.2.3 Platelet Rich Plasma Injections
		11.2.4 Mesenchymal Stem Cells [26–30]
		11.2.5 Ozone Injections [31–33]
		11.2.6 Local Anaesthetic Injections [34–39]
		11.2.7 Normal Saline Injections
	11.3 Contraindications to Injection Therapy
	11.4 Potential Complications of Knee Injections
	11.5 Knee Injection Techniques
		11.5.1 Knee Joint Intra-articular Injection
		11.5.2 Pes Anserinus Injection
	11.6 Dry Needling
	11.7 Barbotage
	References
Chapter 12: Knee Physiotherapy: A Surgeon’s Perspective
	12.1 Physiotherapy Nomenclature
	12.2 Physiotherapy Techniques
		12.2.1 Local Treatment to Improve Pain
		12.2.2 Muscle Strengthening
			12.2.2.1 Quadriceps Strengthening
			12.2.2.2 Hamstring Strengthening
		12.2.3 Joint Mobilisation
		12.2.4 Core Strengthening and Balancing
		12.2.5 Soft Tissue Stretching
		12.2.6 Proprioception Training [29–45]
		12.2.7 Biofeedback
		12.2.8 Symptom Modification Techniques
	12.3 Physiotherapy to Improve Knee Stability
	12.4 Physiotherapy to Reduce Joint Stiffness
		12.4.1 Stretching Exercises to Improve Extension
		12.4.2 Stretching Exercises to Improve Flexion
	12.5 Rehabilitation of a Knee Following a Soft Tissue or Bony Injury
	12.6 Rehabilitation Post-Surgical Soft Tissue or Bony Repair
	12.7 Early vs. Delayed Mobilisation and Loading in Soft Tissue Injuries or Surgery
	12.8 Rehabilitation of Articular Cartilage Injuries/Repair
	12.9 Milestones of Rehabilitation [68, 69]
		12.9.1 Weightbearing
		12.9.2 Progressing in Activity
	12.10 Arthrogenic Muscle Inhibition
		12.10.1 Investigations
		12.10.2 Management
	References
Chapter 13: Knee Pain
	13.1 Sources of Knee Pain
		13.1.1 Tibiofemoral Joint Pain
		13.1.2 Patellofemoral Joint Pain
		13.1.3 Proximal Tibiofibular Joint Pain
		13.1.4 Periarticular Tendon Pain
		13.1.5 Ligamentous Pain
		13.1.6 Periarticular Bursal Pain
		13.1.7 Pain Referred from a Distal Site
			13.1.7.1 Lumbosacral Spine Origin Pain
			13.1.7.2 Hip Origin Pain
		13.1.8 Peripheral Nerve—Neurogenic Pain
		13.1.9 Myofascial Pain
	13.2 Identifying the Origin of Knee Pain
		13.2.1 Pain Location
		13.2.2 Pain Onset
		13.2.3 Patient’s Age
		13.2.4 Symptoms Associated with Knee Pain
		13.2.5 Palpable Knee Tenderness
		13.2.6 Knee Pain Provoking Clinical Tests
	13.3 Investigations for Knee Pain
	13.4 Management of Knee Pain
	References
Chapter 14: Knee Stiffness
	14.1 True Versus Apparent Knee Stiffness
	14.2 Passive Versus Active Knee Motion
	14.3 Differential Diagnosis of Knee Stiffness
	14.4 Investigations for Knee Stiffness
	14.5 Management of Knee Stiffness
	References
Chapter 15: Knee Locking
	15.1 True Knee Locking Versus Apparent Knee Locking (Pseudolocking)
	15.2 Clinical Symptoms of True Knee Locking
	15.3 Clinical Signs of True Knee Locking
	15.4 Sources of True Knee Locking
	15.5 Investigations for Knee Locking
	15.6 Management of Knee Locking
	References
Chapter 16: Knee Instability
	16.1 Describing Knee Instability
	16.2 Causes of Knee Instability
	16.3 Clinical Symptoms of Knee Instability
	16.4 Clinical Signs of Knee Instability
	16.5 Investigations for Knee Instability
	16.6 Management of Knee Instability
		16.6.1 Non-surgical
		16.6.2 Surgical
	16.7 Special Situations of Knee Instability
		16.7.1 Initial Presentation after an ACL Tear
		16.7.2 First time Patellar Dislocator
		16.7.3 Non-Compliant Patients
		16.7.4 Posterolateral Corner Injury
		16.7.5 Instability vs. Hyperlaxity
		16.7.6 Knee Instability in Osteoarthritis [38–40]
	References
Chapter 17: Knee Weakness
	17.1 True Versus Apparent Knee Weakness
	17.2 Causes of Knee Weakness [1]
	17.3 Identifying the Cause of Knee Weakness
		17.3.1 Investigations for Knee Weakness
	17.4 Management of Knee Weakness
	References
Chapter 18: Knee Paraesthesia
	18.1 Sensory Pathways [1]
	18.2 Sites of Neurological Dysfunction
	18.3 Causes of Neurological Dysfunction
	18.4 Conditions Leading to Knee Paraesthesia
	18.5 Clinical Symptoms in Knee Paraesthesia
	18.6 Clinical Examination in Knee Paraesthesia [14, 15]
	18.7 Identifying the Cause of Paraesthesia
	18.8 Investigations for Knee Paraesthesia
	18.9 Management of Knee Paraesthesia
	18.10 Management of Extrinsic Causes of Nerve Dysfunction
	References
Chapter 19: Knee Noise
	19.1 Sources of Abnormal Knee Noise
		19.1.1 Physiological Noise
		19.1.2 Knee Noise following Knee Replacement Arthroplasty
		19.1.3 Knee Noise following Anterior Cruciate Ligament Reconstruction Surgery
	19.2 Clinical Symptoms of Knee Noise
	19.3 Clinical Signs of Knee Noise
	19.4 Investigations for Knee Noise
	19.5 Management of Knee Noise
	References
Chapter 20: Knee Swellings
	20.1 Types of Knee Swellings
	20.2 Clinical Symptoms of Knee Swellings
	20.3 Clinical Examination for Knee Swellings
	20.4 Investigations for Knee Swellings
	20.5 Management of Knee Swellings
	References
Chapter 21: Knee Tendon Disease
	21.1 Knee Tendinopathy
	21.2 Causes of Knee Tendinopathy
	21.3 Clinical Symptoms of Knee Tendinopathy
	21.4 Clinical Signs of Knee Tendinopathy
	21.5 Investigations for Knee Tendinopathy
	References
Chapter 22: Quadriceps Tendinopathy
	22.1 Clinical Symptoms of Quadriceps Tendinopathy
	22.2 Clinical Signs of Quadriceps Tendinopathy
	22.3 Investigations for Quadriceps Tendinopathy
	22.4 Management of Quadriceps Tendinopathy
		22.4.1 Non-surgical Interventions [19–21]
		22.4.2 Surgical Interventions [22, 23]
	References
Chapter 23: Patellar Tendon Tendinopathy
	23.1 Pathogenesis
	23.2 Risk Factors for Patellar Tendinopathy
	23.3 Clinical Symptoms of Patellar Tendon Tendinopathy
	23.4 Clinical Signs of Patellar Tendon Tendinopathy
	23.5 Investigations for Patellar Tendon Tendinopathy
	23.6 Management of Patellar Tendon Tendinopathy
		23.6.1 Non-surgical Interventions [16–25]
		23.6.2 Surgical Interventions [26–32]
	References
Chapter 24: Hamstring Tendon Tendinopathy
	24.1 Clinical Symptoms of Hamstring Tendon Tendinopathy
	24.2 Clinical Signs of Hamstring Tendon Tendinopathy
	24.3 Investigations for Hamstring Tendon Tendinopathy
	24.4 Management of Hamstring Tendon Tendinopathy
		24.4.1 Non-surgical Interventions
		24.4.2 Surgical Interventions [2, 10]
	References
Chapter 25: Calcific Tendinopathy/Ligamentopathy
	25.1 Pathophysiology of Calcific Tendinopathy
	25.2 Clinical Symptoms of Calcific Tendinopathy
	25.3 Clinical Signs of Calcific Tendinopathy
	25.4 Investigations for Calcific Tendinopathy
	25.5 Management of Calcific Tendinopathy
		25.5.1 Non-surgical [21–23]
		25.5.2 Surgical [24, 25]
	25.6 Pellegrini-Stieda Disease
	References
Chapter 26: Iliotibial Band Syndrome
	26.1 Clinical Symptoms of ITB Syndrome
	26.2 Clinical Signs of ITB Syndrome
	26.3 Investigations for ITB Syndrome
	26.4 Management of ITB Syndrome [1, 14–18]
		26.4.1 Non-surgical
		26.4.2 Surgical
	References
Chapter 27: Quadriceps Tears
	27.1 Causes of Quadriceps Tears [1–17]
		27.1.1 Factors Predisposing to Quadriceps Tears
	27.2 Description of Quadriceps Tears
	27.3 Demographics of Quadriceps Tears
	27.4 Clinical Symptoms of Quadriceps Tears
	27.5 Clinical Signs of Quadriceps Tears
	27.6 Investigations for Quadriceps Tears
	27.7 Management of Quadriceps Tears [27–41]
		27.7.1 Non-surgical
		27.7.2 Surgical
			27.7.2.1 Quadriceps Tendon Repair
			27.7.2.2 Tendon Repair Augmentation
			27.7.2.3 Tendon Lengthening
			27.7.2.4 Tendon Bridging
	References
Chapter 28: Patellar Tendon Tears
	28.1 Causes of Patellar Tendon Tears [1–13]
		28.1.1 Factors Predisposing to Patellar Tendon Tears
	28.2 Description of Patellar Tendon Tears
	28.3 Demographics of Patellar Tendon Tears [14]
		28.3.1 Clinical Symptoms of Patellar Tendon Tears
		28.3.2 Clinical Signs of Patellar Tendon Tears
	28.4 Investigations for Patellar Tendon Tears
	28.5 Management of Patellar Tendon Tears [15–27]
		28.5.1 Non-surgical
		28.5.2 Surgical
	References
Chapter 29: Tibial Tubercle Apophysitis
	29.1 Demographics of Tibial Tubercle Apophysitis
	29.2 Clinical Symptoms of Tibial Tubercle Apophysitis
	29.3 Clinical Signs of Tibial Tubercle Apophysitis
	29.4 Investigations for Tibial Tubercle Apophysitis
	29.5 Management of Tibial Tubercle Apophysitis [8–16]
		29.5.1 Non-surgical
		29.5.2 Surgical
	References
Chapter 30: Fabella Pain Syndrome
	30.1 Clinical Symptoms of Fabella Pain Syndrome
	30.2 Clinical Signs of Fabella Pain Syndrome
	30.3 Investigations for Fabella Pain Syndrome [16–19]
	30.4 Management of Fabella Pain Syndrome [20–25]
		30.4.1 Non-surgical
		30.4.2 Surgical
	References
Chapter 31: Knee Tendon Snapping Syndrome
	31.1 Snapping of Knee Tendons
	31.2 Causes of Snapping Tendons
	31.3 Clinical Symptoms of Knee Tendon Snapping Syndrome
	31.4 Clinical Signs of Knee Tendon Snapping Syndrome
	31.5 Investigations for Knee Tendon Snapping Syndrome [21, 22]
	31.6 Management of Knee Tendon Snapping Syndrome
		31.6.1 Non-surgical: Successful in Most Cases
		31.6.2 Surgical (Open or Arthroscopic)
	References
Chapter 32: Knee Intra-articular Snapping Syndrome
	32.1 Clinical Symptoms of Knee Intra-articular Snapping Syndrome
	32.2 Clinical Signs of Knee Intra-articular Snapping Syndrome
	32.3 Investigations for Knee Intra-articular Snapping Syndrome
	32.4 Management of Knee Intra-articular Snapping Syndrome
		32.4.1 Non-surgical
		32.4.2 Surgical (Open or Arthroscopic) [9–12]
	References
Chapter 33: Meniscal Tears
	33.1 Causes of Meniscal Tears
	33.2 Description of Meniscal Tears
	33.3 Demographics of Meniscal Tears [16–20]
	33.4 Clinical Symptoms of Meniscal Tears
	33.5 Clinical Signs of Meniscal Tears
	33.6 Investigations for Meniscal Tears [21–26]
	33.7 Management of Meniscal Tears [27–35]
		33.7.1 Treatment for Pain
			33.7.1.1 Non-surgical
			33.7.1.2 Surgical
		33.7.2 Treatment for Locking
			33.7.2.1 Non-surgical
			33.7.2.2 Surgical
	33.8 Meniscal Root Tear
	33.9 Meniscal Extrusion
	References
Chapter 34: Discoid Meniscus Syndrome
	34.1 Demographics of Discoid Meniscus
	34.2 Classification of Discoid Meniscus
	34.3 Clinical Symptoms of Discoid Meniscus
	34.4 Clinical Signs of Discoid Meniscus
	34.5 Investigations for Discoid Meniscus
	34.6 Management of Discoid Meniscus
		34.6.1 Treatment for Pain
			34.6.1.1 Non-surgical [15, 16]
			34.6.1.2 Surgical [17–20]
		34.6.2 Treatment for Locking
			34.6.2.1 Non-surgical
			34.6.2.2 Surgical
	34.7 Prognosis
	References
Chapter 35: Parameniscal Cysts
	35.1 Clinical Symptoms of Parameniscal Cysts
	35.2 Clinical Signs of Parameniscal Cysts
	35.3 Investigations for Parameniscal Cysts
	35.4 Management of Parameniscal Cysts
		35.4.1 Non-surgical
		35.4.2 Surgical [9–11]
	References
Chapter 36: Meniscal Deficiency Knee Syndrome
	36.1 Clinical Symptoms of Meniscal Deficiency Knee Syndrome
	36.2 Clinical Signs of Meniscal Deficiency Knee Syndrome
	36.3 Investigations for Meniscal Deficiency Knee Syndrome
	36.4 Management of Meniscal Deficiency Knee Syndrome
		36.4.1 Non-surgical
		36.4.2 Surgical [3–12]
	References
Chapter 37: Medial Plica Syndrome
	37.1 Clinical Symptoms of Medial Plica Syndrome
	37.2 Clinical Signs of Medial Plica Syndrome
	37.3 Investigations for Medial Plica Syndrome [8, 9]
	37.4 Management of Medial Plica Syndrome
		37.4.1 Non-surgical [10, 11]
		37.4.2 Surgical Management [12, 13]
	References
Chapter 38: Suprapatellar Plica Syndrome
	38.1 Clinical Symptoms of Suprapatellar Plica Syndrome
	38.2 Clinical Signs of Suprapatellar Plica Syndrome
	38.3 Investigations for Suprapatellar Plica Syndrome
	38.4 Management of Suprapatellar Plica Syndrome
		38.4.1 Non-surgical Management
		38.4.2 Surgical Management
	References
Chapter 39: Infrapatellar Plica Syndrome
	39.1 Clinical Symptoms of Infrapatellar Plica Syndrome
	39.2 Clinical Signs of Infrapatellar Plica Syndrome
	39.3 Investigations for Infrapatellar Plica Syndrome
	39.4 Management of Infrapatellar Plica Syndrome
		39.4.1 Non-surgical
		39.4.2 Surgical
	References
Chapter 40: Patellofemoral Pain Syndrome
	40.1 Clinical Symptoms of Patellofemoral Pain Syndrome
	40.2 Clinical Signs of Patellofemoral Pain Syndrome
	40.3 Investigations for Patellofemoral Pain Syndrome
	40.4 Management of Patellofemoral Pain Syndrome [16–49]
		40.4.1 Non-surgical
		40.4.2 Surgical
	40.5 Natural History of PF Pain
	References
Chapter 41: Infrapatellar Fat Pad Dysfunction
	41.1 Clinical Symptoms of Infrapatellar Fat Pad Dysfunction
	41.2 Clinical Signs of Infrapatellar Fat Pad Dysfunction
	41.3 Investigations for Infrapatellar Fat Pad Dysfunction [11–13]
	41.4 Management of Infrapatellar Fat Pad Dysfunction [13–15]
		41.4.1 Non-surgical
		41.4.2 Surgical
	References
Chapter 42: Suprapatellar Fat Pad Dysfunction
	42.1 Clinical Symptoms of Suprapatellar Fat Pad Dysfunction
	42.2 Clinical Signs of Suprapatellar Fat Pad Dysfunction
	42.3 Investigations for Suprapatellar Fat Pad Dysfunction [5–8]
	42.4 Management of Suprapatellar Fat Pad Dysfunction
		42.4.1 Non-surgical [9]
		42.4.2 Surgical
	References
Chapter 43: Prefemoral Fat Pad Dysfunction
	43.1 Clinical Symptoms of Prefemoral Fat Pad Dysfunction
	43.2 Clinical Signs of Prefemoral Fat Pad Dysfunction
	43.3 Investigations for Prefemoral Fat Pad Dysfunction
	43.4 Management of Prefemoral Fat Pad Dysfunction
		43.4.1 Non-surgical
		43.4.2 Surgical
	References
Chapter 44: Patellar Tendon Lateral Femoral Condyle Friction Syndrome
	44.1 Clinical Symptoms of Patellar Tendon Lateral Femoral Condyle Friction Syndrome
	44.2 Clinical Signs of Patellar Tendon Lateral Femoral Condyle Friction Syndrome
	44.3 Investigations for Patellar Tendon Lateral Femoral Condyle Friction Syndrome
	44.4 Management of Patellar Tendon Lateral Femoral Condyle Friction Syndrome
		44.4.1 Non-surgical
		44.4.2 Surgical
	References
Chapter 45: Bipartite/Tripartite Patella Pain Syndrome
	45.1 Demographics of Bipartite Patella
	45.2 Classification
	45.3 Clinical Symptoms of Bipartite Patella
	45.4 Clinical Signs of Bipartite Patella
	45.5 Investigations for Bipartite Patella
	45.6 Management of Bipartite Patella
		45.6.1 Non-surgical [8, 9]
		45.6.2 Surgical [10–15]
	45.7 Prognosis of Treatment of Bipartite Patella
	References
Chapter 46: Knee Bursal Dysfunction
	46.1 Clinical Symptoms of Bursal Dysfunction
	46.2 Clinical Signs of Bursal Dysfunction
	46.3 Investigations for Bursal Dysfunction [41–45]
	46.4 Management of Bursal Dysfunction [46–57]
		46.4.1 Non-surgical
		46.4.2 Surgical
	References
Chapter 47: Osteonecrosis of the Knee
	47.1 Causes of Osteonecrosis of the Knee [7–42]
	47.2 Demographics [8, 9]
	47.3 Distribution of Osteonecrosis
	47.4 Pathogenesis
	47.5 Clinical Symptoms of Osteonecrosis of the Knee
	47.6 Clinical Signs of Osteonecrosis of the Knee
	47.7 Investigations for Osteonecrosis of the Knee
	47.8 Classification of SPONK
	47.9 Management of Osteonecrosis of the Knee
		47.9.1 Non-surgical [43–49]
		47.9.2 Surgical [46, 50–61]
	47.10 Natural History of Osteonecrosis of the Knee [62–68]
		47.10.1 SPONK
		47.10.2 Secondary Osteonecrosis
	References
Chapter 48: Chondral Disruption of the Knee
	48.1 Causes of Cartilage Loss
	48.2 Classification of Chondral Disruption
		48.2.1 Outerbridge Classification of Chondral Dysfunction
	48.3 Demographics of Articular Cartilage Disruption [2–6]
	48.4 Clinical Symptoms of Articular Cartilage Disruption
	48.5 Clinical Signs of Articular Cartilage disruption [6, 7]
	48.6 Investigations for Articular Cartilage Disruption
	48.7 Management of Localised Chondral Disruption
		48.7.1 Non-surgical [8–10]
		48.7.2 Surgical [11–22]
	References
Chapter 49: Osteochondritis Dissecans of the Knee
	49.1 Demographics of Osteochondritis Dissecans [8, 9]
	49.2 Pathogenesis of Osteochondritis Dissecans
	49.3 Clinical Symptoms of Osteochondritis Dissecans
	49.4 Clinical Signs of Osteochondritis Dissecans
	49.5 Investigations for Osteochondritis Dissecans
	49.6 Classification of Osteochondritis Dissecans
		49.6.1 Dipaola MRI Classification of Osteochondritis Dissecans [14]
		49.6.2 Macroscopic (Arthroscopic) ICRS Classification [18]
	49.7 Management of Osteochondritis Dissecans
		49.7.1 Non-surgical
		49.7.2 Surgical
	49.8 Natural History of Osteochondritis Dissecans [35–37]
	References
Chapter 50: Knee Arthritis
	50.1 Osteoarthritis Compartment Involvement
	50.2 Causes of OA
	50.3 Pathogenesis of OA
	50.4 Clinical Symptoms of Knee OA
	50.5 Clinical Signs of Knee OA
	50.6 Investigations for Osteoarthritis
	50.7 Clinical Phenotypes of Knee OA
	50.8 Management of Knee OA
		50.8.1 Non-surgical [26–32]
		50.8.2 Surgical [33–83]
	50.9 Knee Replacement Arthroplasty for Knee OA
		50.9.1 Tibiofemoral UKR
		50.9.2 Patellofemoral Replacement Arthroplasty
		50.9.3 Bicompartmental Knee arthroplasty [53–56]
	50.10 Osteotomy for Medial Compartment OA—Varus Knee
		50.10.1 HTO Techniques
	50.11 Osteotomy for Lateral Compartment OA—Valgus Knee
		50.11.1 DFO Techniques
	50.12 HTO vs. UKR
	50.13 UKR vs. Osteotomy vs. TKR
	50.14 Complications of Knee Replacement Arthroplasty
	50.15 Outcomes of TKR
	50.16 Managing Stairs Following TKR
	50.17 Kneeling Following TKR
	50.18 Complex Primary TKR
		50.18.1 Lower Limb Vascular Disease
		50.18.2 Previous Knee Scars
		50.18.3 Knee Instability
		50.18.4 Lower Limb Malalignment
		50.18.5 Knee Stiffness
		50.18.6 Bone loss [82]
		50.18.7 Patellofemoral Disruption
	50.19 Instability in Knee OA [90, 91]
	50.20 Acute Flare Ups in Knee OA [92–96]
	References
Chapter 51: Painful Knee Replacement Arthroplasty
	51.1 Differential Diagnosis of Painful Knee Arthroplasty
	51.2 Clinical Symptoms of Painful Knee Replacement Arthroplasty
	51.3 Clinical Signs
	51.4 Investigations for the Painful Knee Replacement Arthroplasty
	51.5 Management of Painful Knee Replacement Arthroplasty
		51.5.1 Non-surgical
		51.5.2 Surgical [14–30]
			51.5.2.1 Stiffness
			51.5.2.2 Instability
			51.5.2.3 Infection
			51.5.2.4 Arthritis Progression
			51.5.2.5 Loosening/Wear
	References
Chapter 52: Instability in Knee Replacement Arthroplasty
	52.1 Describing Knee Instability
	52.2 Causes of Knee Instability
		52.2.1 Static
		52.2.2 Dynamic
	52.3 Clinical Symptoms of Knee Replacement Arthroplasty Instability
	52.4 Clinical Signs of Knee Replacement Arthroplasty Instability
	52.5 Investigations for Knee Replacement Arthroplasty Instability
	52.6 Management of Knee Replacement Arthroplasty Instability
		52.6.1 Non-surgical
		52.6.2 Surgical
			52.6.3 Tibiofemoral Instability Following Knee Replacement Arthroplasty
			52.6.4 Patellofemoral Instability Following Knee Replacement Arthroplasty
	References
Chapter 53: Synovial Chondromatosis of the Knee
	53.1 Clinical Symptoms of Synovial Chondromatosis
	53.2 Clinical Signs of Synovial Chondromatosis
	53.3 Investigations for Synovial Chondromatosis [12–14]
	53.4 Differential Diagnosis of Synovial Chondromatosis
	53.5 Management of Synovial Chondromatosis
		53.5.1 Non-surgical
		53.5.2 Surgical
	References
Chapter 54: Pigmented Villonodular Synovitis of the Knee
	54.1 Clinical Symptoms of Pigmented Villonodular Synovitis
	54.2 Clinical Signs of Pigmented Villonodular Synovitis
	54.3 Investigations for Pigmented Villonodular Synovitis
	54.4 Differential Diagnosis of Pigmented Villonodular Synovitis
	54.5 Management of Pigmented Villonodular synovitis [15–26]
		54.5.1 Non-surgical
		54.5.2 Surgical
	References
Chapter 55: Proximal Tibiofibular Joint Arthropathy
	55.1 Clinical Symptoms of Tibiofibular Joint Arthropathy
	55.2 Clinical Signs of Tibiofibular Joint Arthropathy
	55.3 Investigations for Tibiofibular Joint Arthropathy
	55.4 Management of Tibiofibular Joint Arthropathy
		55.4.1 Non-surgical
		55.4.2 Surgical
	References
Chapter 56: Anterior Cruciate Ligament Knee Instability
	56.1 Causes of ACL Instability [1–16]
	56.2 Risk Factors for ACL Disruption
	56.3 Intra-articular Disruptions Associated with ACL Tears
	56.4 Effects of ACL Disruption
	56.5 Clinical History of a Traumatic Event
	56.6 Clinical Symptoms of ACL Instability
	56.7 Clinical Signs of ACL Instability
	56.8 Investigations for ACL Instability
	56.9 Management of ACL instability [17–38]
		56.9.1 Non-surgical
		56.9.2 Surgical
	56.10 ACL Extra-Articular Procedures [40–43]
	56.11 Considerations in the Management of Post-Traumatic ACL Deficiency
		56.11.1 Natural History
		56.11.2 Timing of Encountering the ACL Instability Patient
		56.11.3 Timing of ACL Reconstruction
		56.11.4 ACL Disruption in Older Age
		56.11.5 ACL Disruption Associated with a Meniscal Tear
		56.11.6 ACL Disruption Associated with Malalignment
		56.11.7 ACL Disruption Associated with Osteoarthritis
	56.12 Return to Sports Following ACL Reconstruction [37, 67]
	References
Chapter 57: Posterior Cruciate Ligament Knee Instability
	57.1 Causes of PCL Instability [1–9]
	57.2 Effects of PCL Disruption
		57.2.1 Intra-articular Disruptions Associated with a PCL Tear
	57.3 Clinical History of a Traumatic Event
	57.4 Clinical Symptoms of PCL Instability
	57.5 Clinical Signs of PCL Instability
	57.6 Investigations for PCL Instability [12–18]
	57.7 Management of PCL Instability [19–27]
		57.7.1 Non-surgical
		57.7.2 Surgical
	57.8 Considerations in the Management of Post-Traumatic PCL Deficiency
		57.8.1 Natural History of PCL Disruption
		57.8.2 Timing of Encountering the Patient
		57.8.3 Timing of PCL Reconstruction
		57.8.4 Associated Injuries
		57.8.5 PCL Disruption Associated with Arthritis
		57.8.6 PCL Disruption Associated with Malalignment [34–37]
	57.9 Return to Sports Following PCL Non-surgical and Surgical Management
	References
Chapter 58: Medial Collateral Ligament Knee Instability
	58.1 Causes of Medial Collateral Ligament Instability [1–7]
	58.2 Effects of Medial Collateral Ligament Disruption
	58.3 Clinical History of a Traumatic Event
	58.4 Clinical Symptoms of Medial Collateral Ligament Instability
	58.5 Clinical Signs of Medial Collateral Ligament Instability
	58.6 Investigations for MCL Instability
	58.7 Management of MCL Instability [8–29]
		58.7.1 Non-surgical
		58.7.2 Surgical
	58.8 Considerations in the Management of Post-Traumatic MCL Deficiency
		58.8.1 Natural History
		58.8.2 Timing of Encountering the Patient
		58.8.3 MCL Disruption Associated with Malalignemnt [30, 31]
	References
Chapter 59: Posterolateral Corner Ligament Knee Instability
	59.1 Causes of Posterolateral Corner Ligament Instability [1–4]
	59.2 Classification of Posterolateral Corner Ligament Instability
	59.3 Effects of Posterolateral Ligament Disruption
	59.4 Clinical History of Trauma in Posterolateral Corner Ligament Instability
	59.5 Clinical Symptoms of Posterolateral Corner Ligament Instability
	59.6 Clinical Signs of Posterolateral Corner Ligament Instability [6]
	59.7 Investigations for Posterolateral Corner Ligament Instability
	59.8 Management of PLC Instability
		59.8.1 Non-surgical [9–11]
		59.8.2 Surgical [12–22]
	59.9 Considerations in the Management of Post-Traumatic Posterolateral Corner Deficiency
		59.9.1 Natural History [17–20]
		59.9.2 Timing of Encountering the Patient
		59.9.3 PLC Disruption Associated with Malalignment [21, 22]
	References
Chapter 60: Multiligament Knee Instability
	60.1 Causes of Multiligament Knee Instability [1–6]
	60.2 Effects of Multiligament Disruption
	60.3 Timing of Encountering the Patient
	60.4 Clinical History of a Traumatic Event in Multiligament Knee Instability
	60.5 Clinical Symptoms of Multiligament Knee Instability
	60.6 Clinical Signs of Multiligament Knee Instability
	60.7 Investigations for Multiligament Knee Instability
	60.8 Management of Multiligament Knee Instability
		60.8.1 Acute Presentation
		60.8.2 Chronic Presentation
		60.8.3 Non-surgical
		60.8.4 Surgical
	60.9 Considerations in the Management of Multiligament Knee Instability
		60.9.1 Surgical Management for All vs. Some of the Ligaments
		60.9.2 Multiligament Knee Instability Associated with Malalignment
	60.10 Prognosis of Multiligament Knee Instability
	References
Chapter 61: Patellofemoral Instability
	61.1 Spectrum of Patellofemoral Instability
	61.2 Causes of Patellofemoral Instability
	61.3 Clinical Symptoms of Patellofemoral Instability
	61.4 Clinical Signs of Patellofemoral Instability
	61.5 Investigations for Patellofemoral Instability [14–22]
		61.5.1 Sagittal Evaluation
		61.5.2 Coronal Evaluation
		61.5.3 Axial Evaluation
	61.6 Management of Patellofemoral Instability [22–56]
		61.6.1 Non-surgical
		61.6.2 Surgical
	61.7 Special Situations of Patellofemoral Instability
		61.7.1 First Time Patellar Dislocator [57–62]
		61.7.2 Instability vs. Hyperlaxity
	61.8 Medial Patellofemoral Instability
		61.8.1 Causes
		61.8.2 Clinical Symptoms
		61.8.3 Clinical Signs
		61.8.4 Management
			61.8.4.1 Non-surgical
			61.8.4.2 Surgical
	References
Chapter 62: Proximal Tibiofibular Joint Instability
	62.1 Causes of Proximal Tibiofibular Joint Instability [1–8]
	62.2 Clinical History of a Traumatic Event
	62.3 Clinical Symptoms of Proximal Tibiofibular Joint Instability
	62.4 Clinical Signs of Proximal Tibiofibular Joint Instability
	62.5 Investigations for Proximal Tibiofibular Joint Instability [9–12]
	62.6 Management of Proximal Tibiofibular Joint Instability [13–20]
		62.6.1 Non-surgical
		62.6.2 Surgical
	References
Chapter 63: Knee Hyperextension: Recurvatum
	63.1 Clinical Symptoms of Knee Hyperextension—Recurvatum
	63.2 Clinical Signs of Knee Hyperextension—Recurvatum
	63.3 Management of Knee Hyperextension—Recurvatum [22–47]
		63.3.1 Non-surgical
		63.3.2 Surgical
	63.4 Clinical Significance of Knee Hyperextension—Recurvatum
	References
Chapter 64: Post-Traumatic Knee Stiffness
	64.1 Clinical Symptoms of Post-Traumatic Stiffness
	64.2 Clinical Signs of Post-Traumatic Stiffness
	64.3 Investigations for Post-Traumatic Stiffness
	64.4 Differential Diagnosis of Post-Traumatic Stiffness
	64.5 Management of Post-Traumatic stiffness [10–17]
		64.5.1 Non-surgical
		64.5.2 Surgical
	References
Chapter 65: Common Peroneal Nerve Dysfunction
	65.1 Causes of Common Peroneal Nerve Dysfunction
	65.2 Clinical Symptoms of CPN Dysfunction
	65.3 Clinical Signs of CPN Nerve Dysfunction
	65.4 Investigations for CPN Dysfunction [52–54]
	65.5 Management of CPN Dysfunction [55–66]
	References
Chapter 66: Superficial Peroneal Nerve Dysfunction
	66.1 Causes of Superficial Peroneal Nerve Dysfunction
	66.2 Clinical Symptoms of SPN Dysfunction
	66.3 Clinical Signs of SPN Dysfunction
	66.4 Investigations for Superficial Peroneal Nerve Dysfunction [25, 26]
	66.5 Management of Superficial Peroneal Nerve Dysfunction [27–29]
	References
Chapter 67: Deep Peroneal Nerve Dysfunction
	67.1 Causes of Deep Peroneal Nerve Dysfunction
	67.2 Clinical Symptoms of Deep Peroneal Nerve Dysfunction
	67.3 Clinical Signs of Deep Peroneal Nerve Dysfunction
	67.4 Investigations for Deep Peroneal Nerve Dysfunction
	67.5 Management of Deep Peroneal Nerve Dysfunction [17–21]
	References
Chapter 68: Tibial Nerve Dysfunction
	68.1 Causes of Tibial Nerve Dysfunction
	68.2 Clinical Symptoms of Tibial Nerve Dysfunction
	68.3 Clinical Signs of Tibial Nerve Dysfunction
	68.4 Investigations for Tibial Nerve Dysfunction
	68.5 Management of Tibial Nerve Dysfunction [28–32]
	References
Chapter 69: Saphenous Nerve Dysfunction
	69.1 Causes of Saphenous Nerve Dysfunction
	69.2 Clinical Symptoms of Saphenous Nerve Dysfunction
	69.3 Clinical Signs of Saphenous Nerve Dysfunction
	69.4 Investigations for Saphenous Nerve Dysfunction [22, 23]
	69.5 Management of Saphenous Nerve Dysfunction [17–21, 24–26]
	References
Chapter 70: Infrapatellar Nerve Dysfunction
	70.1 Causes of Infrapatellar Nerve Dysfunction
	70.2 Clinical Symptoms of Infrapatellar Nerve Dysfunction
	70.3 Clinical Signs of Infrapatellar Nerve Dysfunction
	70.4 Investigations for Infrapatellar Nerve Dysfunction [15, 16]
	70.5 Management of Infrapatellar Nerve Dysfunction [17–20]
	References
Chapter 71: Sciatic Nerve Dysfunction
	71.1 Causes of Sciatic Nerve Dysfunction
	71.2 Clinical Symptoms of Sciatic Nerve Dysfunction
	71.3 Clinical Signs of Sciatic Nerve Dysfunction
	71.4 Investigations for Sciatic Nerve Dysfunction
	71.5 Management of Sciatic Nerve Dysfunction
	References
Chapter 72: Myofascial Trigger Points of the Knee
	72.1 Clinical Symptoms of Myofasial Trigger Points
	72.2 Clinical Signs of Myofascial Trigger Points
	72.3 Investigations for Myofasial Trigger Points
	72.4 Management of Myofascial Trigger Points [11–20]
	References