the patient's leg between your crossed thighs. Apply your staggered hands to the medial aspect of the femur and the lateral aspect of the tibia with firm compression. Circumduct the knee using both hands and as the point of tension builds, sharply increase the pressure with both hands while straightening your knees to produce a traction effect.
Tips: As this position is inherently unstable for the operator it may help to lean against the side of the table. Keep the patient's knee slightly flexed throughout.
31.19 • Thrust for medial shift of tibia supine
Fix the patient's leg between your crossed thighs. Apply your staggered hands to the medial aspect of the tibia and the lateral aspect of the femur. Use firm compression and circumduct your hands until tension accumulates and then apply the thrust with both hands at the same time as straightening your knees to produce the traction.
Tips: Maintain a small amount of flexion to prevent the patient's knee from locking.
31.20 • Thrust for medial shift of tibia and lateral meniscus Fix the abducted leg between your body and forearm and grip the knee firmly just below the joint. Maintain a small amount of flexion and firm compression and apply a rapid circumduction and lateral gapping force by rotating your body away from the table. A direct lateral force will tend to correct the tibial shift whereas an abduction force will reach the lateral meniscus.
Tips: Visualize a piece of string with a weight attached tied around the knee, with the weight hanging down medially. The movement of this technique is to flick the weight from the medial side over to the lateral side.
31.21 • Thrust for lateral shift of tibia and medial meniscus Place the leg between your body and forearm and clasp the knee firmly between your hands. Use several small oscillating movements to prime the joint and then apply a small rotation of your body toward the table to open the medial side of the joint. This can be a circumduction movement or a medial gapping movement.
Tips: This technique can be suitable for correcting an internal rotation restriction of the tibia if the tibia is held firmly with both hands and externally rotated at the same time as the gapping force is applied.
31.23 • Thrust for internal rotation fixation of tibia Firmly clasp the upper end of the tibia between your hands and hold the lower end between your forearm and body. Adduct the thigh to produce a torsional force into external rotation of the knee. Apply a small extension force to break fixation into an external rotation direction.
31.22 • Thrust for external rotation fixation of tibia Grasp the tibia firmly between your hands and against your body with your forearm. Abduct the thigh and flex the knee slightly and then apply an internal rotation force by using your grip and by sidebending your body toward the table. A small final extension force may be necessary.
Tips: Use the weight of a more abducted thigh as a resistance to the internal rotation force.
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