Arthroscopy may be carried out and damage to any internal structures repaired or trimmed. An arthroscope is a small camera that is placed into the knee joint through the anterolateral or anteromedial aspect of the knee joint. The joint is filled with a saline solution and the telescope is manipulated around the knee joint to assess the cruciate ligaments, menisci, and cartilaginous surfaces.
In the clinic
Anterolateral ligament of the knee
A ligament associated at its origin with the fibular collateral ligament of the knee has been described. This ligament (anterolateral ligament of the knee) courses from the lateral femoral epicondyle to the anterolateral region of the proximal end of the tibia and may control internal rotation of the tibia. (J Anat 2013;223:321–328)
In the clinic
The popliteal artery can become abnormally dilated, forming an aneurysm. The artery is considered aneurysmal when its diameter exceeds 7 mm. Although popliteal artery aneurysms can occur in isolation, they are most commonly associated with aneurysms in other large vessels such as the femoral artery or the thoracic or abdominal aorta. Therefore, once a popliteal aneurysm has been detected, the entire arterial tree needs to be investigated for the presence of coexisting aneurysms elsewhere in the body.
Popliteal artery aneurysms tend to undergo thrombosis and are less likely to rupture than other aneurysms. Therefore the complications are mainly related to distal embolization of the arterial tree and lower limb ischemia, which in the most severe cases can lead to leg amputation.
Ultrasound with duplex Doppler is the most helpful way of diagnosing a popliteal artery aneurysm because it can demonstrate abnormal dilation of the artery, confirm or rule out thrombus within the aneurysm, and help distinguish it from other masses of the popliteal fossa such as a synovial cyst (Baker’s cyst). Popliteal artery aneurysms are usually repaired surgically in view of high risk of thromboembolic complications.
In the clinic
Rupture of the calcaneal tendon is often related to sudden or direct trauma. This type of injury frequently occurs in a normal healthy tendon. In addition, there are certain conditions that may predispose the tendon to rupture. Among these conditions are tendinopathy (due to overuse, or to age-related degenerative changes) and previous calcaneal tendon interventions such as injections of pharmaceuticals and the use of certain antibiotics (quinolone group). The diagnosis of calcaneal tendon rupture is relatively straightforward. The patient typically complains of “being kicked” or “shot” behind the ankle, and clinical examination often reveals a gap in the tendon.
In the clinic
Neurological examination of the legs
Some of the commonest conditions that affect the legs are peripheral neuropathy (particularly associated with diabetes mellitus), lumbar nerve root lesions (associated with pathology of the intervertebral discs), fibular nerve palsy, and spastic paraparesis.
Look for muscle wasting—loss of muscle mass may indicate loss of or reduced innervation.