Knee manipulation for internal derangement or loose body

How to perform a loose body manipulation in the knee?

This pathology can easily be missed by the therapist, because you might not "see" the loose body on medical imaging.  It is more common in the arthrotic knee. In that case some typical elements from the history make us think of a loose body.

Typical elements from the history are: 

• twinges, 
• giving way 
• temporary locking of the knee. 
• Some kind of apprehension on going downstairs is also described.
  
  Of course, this kind of manipulation is only useful in case of non bony loose bodies.  Bony loose bodies need to be removed by surgery.

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How to do

Grip: for a left knee, the right index finger is put on the tibia, the palm of the hand facing upwards. The left hand is placed along the achilles tendon and brings the foot in dorsiflexion (to stabilize the ankle joint). 

Execution : the therapist puts his right foot on the couch and brings the patient’s foot onto his thigh. The thigh is fixed by a strap, in order to create a traction component. 

Keeping the patient’s leg up as long as possible, the therapist steps sideways, using his body weight. At the same time, he performs three full rotations