Thrust meniscus supine Fix the femur3113 Thrust medial meniscus supine Firmly

between your hand, the table and the lateral aspect clasp the ankle between your body and forearm.

of your thigh. You can then circumduct the tibia to Grip around the leg just below the knee and alternately apply medial and lateral gapping to the introduce a circumduction movement. Within this knee. This forms a very efficient articulation tech- circumduction there will be a point of tension. This nique and if the fixing hand presses directly over point usually occurs with a combination of abduc-

the joint line, a firm abduction and extension force tion and external rotation of the tibia. At this point can often allow a medial meniscus fixation to be apply a force combining further abduction, external released. If the lateral meniscus is the target, rotation and extension. It is more of a flick than a adduction combined with extension is necessary. thrust.

Tips: As the hand pressure increases over the Tips: Visualize a piece of string with a weight joint the available ranges of abduction and adduc- attached tied around the knee and hanging down tion will reduce to a specific small arc. Within this on the lateral side. Try to flick the weighted string arc will be found the appropriate barrier to apply over to the medial side sharply. This gives an image the final very short amplitude force. of the direction and type of force necessary.

31.14, 31.15 and 31.16 Thrust to medial meniscus supine This series of photographs shows the sequence of moves normally used in this technique. Flex and externally rotate the knee to break fixation in the medial meniscus. Gently repeat this a few times until nearly full flexion is attained. Maintaining the external rotation and some abduction of the knee, extend it until the position shown in photograph 15. At this point the final part of the technique takes over which is an extension, traction and internal rotation movement. At the end of the technique it is important to hold the knee firmly into extension, to avoid reflex muscle contraction into flexion that may dislodge the meniscus again.

Tips: Least useful where there is a suspected tear in the meniscus and the extension movement would be very painful. Extra considerations: It may take several attempts to produce sufficient flexion to unlock the joint. It may be very uncomfortable at the position shown in photograph 31.15 where the patient loses active control of the joint. It is important to pass through this point fairly quickly.

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