Examen clinique du genou ligamentaire
William Wanbiervliet
Kinésithér Scient 2013,0547:13-17 - 10/10/2013
L'examen ligamentaire du genou traumatique a comme objectif de déceler toutes distensions ou ruptures des structures assurant sa stabilité. Il doit être précédé d'un interrogatoire précis qui cerne le mécanisme du traumatisme et recherche les signes de gravité, comme le craquement initial ou l'instabilité induite. L'examen recherche ensuite une laxité anormale du genou. Cette phase doit être méticuleuse et comparative. De nombreux tests cliniques ont été décrits dans un plan frontal, horizontal ou sagittal. En particulier, pour l'évaluation du pivot central, la recherche d'un tiroir antérieur, le test de Trillat-Lachman et le ressaut rotatoire interne présentent une excellente spécificité. Il est en revanche important de bien connaître les conditions qui font varier leur sensibilité. Enfin, de nombreuses équipes travaillent aujourd'hui sur la mise au point de méthodes d'enregistrement et de quantification du ressaut rotatoire interne. Il n'existe pas à ce jour de gold standard. Nous attendons toujours celle qui pourra être utilisée en routine clinique. En pratique, l'IRM est incontournable mais un examen précis permet de proposer très tôt une prise en charge adaptée et efficace.
The ligamentary examination of the traumatic knee has for objective to reveal any distensions or breaks of the structures assuring its stability. He must be preceded by a precise interrogation which encircles the mechanism of the trauma and looks for the signs of gravity as the initial crackle or the led instability. The examination looks for then an abnormal laxité of the knee. This phase must be accurate and comparative. Numerous clinical tests were described in a frontal, horizontal or sagittal plan. In particular, for the evaluation of the central pivot, the search (research) for the previous drawer, the test of Trillat-Lachman and the lateral pivot shift present an excellent specificity. It is on the other hand important to know well the conditions which make vary their sensibility. Finally numerous teams work on the development of methods of recording and quantification of the lateral pivot shift today. It does not exist this day of gold standard. We always wait for the one who can be used in clinical routine. In practice, the MRI is inescapable but a precise examination allows to propose very early an adapted and effective care.
The ligamentary examination of the traumatic knee has for objective to reveal any distensions or breaks of the structures assuring its stability. He must be preceded by a precise interrogation which encircles the mechanism of the trauma and looks for the signs of gravity as the initial crackle or the led instability. The examination looks for then an abnormal laxité of the knee. This phase must be accurate and comparative. Numerous clinical tests were described in a frontal, horizontal or sagittal plan. In particular, for the evaluation of the central pivot, the search (research) for the previous drawer, the test of Trillat-Lachman and the lateral pivot shift present an excellent specificity. It is on the other hand important to know well the conditions which make vary their sensibility. Finally numerous teams work on the development of methods of recording and quantification of the lateral pivot shift today. It does not exist this day of gold standard. We always wait for the one who can be used in clinical routine. In practice, the MRI is inescapable but a precise examination allows to propose very early an adapted and effective care.
