^cute Knee Injuries On-the-Field and Sideline Evaluation Robert F LaPrade, MD Fred Wentorf, MS Photo: © 1999. Shelby Thomer/Davld Madison Ira brie f An athlete who has an acute knee injury should be assessed rapidly on the field and then more thoroughly on the sideline or in the training room. On-the-field assessment includes questions about the mechanism of injury and any similar previous injuries, a visual check for knee deformities and skin injuries, a neurovascular exam, and, ideally, tests for flexion and hyperexten- sion. On the sideline or in the training room, standard physical tests are likely to reveal any significant injuries. These include the patellar apprehension, Lach- man, posterior sag, quadriceps active, posterior drawer, posterolateral drawer, valgus and varus stress, pivot-shift, and dial tests. n athlete who has an acutely injured knee on the playing field, court, once requires a thorough evaluation, Ideal- . ly, the knee should be assessed on the field within the first few minutes of injury, since guarding can set in quickly and interfere with a comprehensive examination, However; the ath- lete's pain may preclude certain diagnostic tests, and some tests may be more appropriate for a sideline or training-room exam, . For CME credit, see page 95 Dr LaPrade is an assistant professor and Mr Wentorf is a re- search fellow in the Department of Orthopaedic Surgery at the University of Minnesota in Minneapolis. Dr LaPrade is also a team physician for ice hockey and baseball at the University of Minnesota and a member of the American Or- thopaedic Society for Sports Medicine , in any case, a rapid on-the-field assessment followed by a more comprehensive evaluation on the sideline or in the Gaining room can pro- vide essential information, Using the basic prin- ciples of a history and physical exam that are outlined below will help physicians determine the type and severity of the injury and protect the short- and long-term health of athlete s History The on-the-field assessment of an acute knee injury should be as brief but as thorough as pos- sible and should include a history and initial physical exam The goal is to rule out a fracture, dislocation, or neurovascular injury (table 1) Once these injuries have been assessed and, when necessary, treated, the athlete can be transferred to the sideline or training room for a more comprehensive evaluation Mechanism. One of the first steps is to deter- mine whether the injury involved contact If it is continued T KE PHYSICIAN AND SPORTSMEDICINE • Vol 27 • No 10 • October 1 1999 55