I agree that "the knee is a complex and crucial joint," but I disagree with the author that "it is as easily injured during daily rounds as in competitive sports, industrial accidents, or collisions." In the opening paragraph of the preface to this book, Professor Macnicol states that "whether the inextricable mix of synovitis, torn ligament or meniscus, and osteochondral damage can be teased apart may in the end depend upon the experience and investigative skills of the surgeon ..." But in this short book, he emphasizes the importance of a comprehensive history and examination, conventional radiographs, and use of basic principles in managing the "problem knee." In the 9 years since the first edition of this book was published, magnetic resonance imaging and computed tomography have been widely introduced, and arthroscopy has become commonly used. However, these methods are only briefly touched on in this monograph.

The first chapter includes a description of the relevant anatomy with excellent line drawings and pithy discussions of symptoms and signs, including pain, loss of movement, swelling, and locking and instability of the knee; the influence of such factors as the personality and age of the individual patient is also discussed.

The book's content is presented in 10 chapters that cover methods of clinical examinations, pediatric injuries, ligamentous and meniscal lesions, patellofemoral problems, and fractures around the knee. A chapter entitled "Non-traumatic Conditions" covers such conditions as inflammatory arthritis, hemophilia, osteonecrosis, and tumors; but, inextricably (to use one of the author's favorite words), rheumatoid arthritis gets short shrift, and osteoarthritis is ignored. The final chapter discusses the treatment of soft tissue injuries and includes a brief section on knee bracing and physical therapy. Exercise is barely mentioned.

The Problem Knee has a glossary and an appendix that lists knee rating systems and assessment of function. I am usually fond of glossaries, but the author seems to have lost control of this section. To give a few examples of problems in the glossary: The basic definitions of isometric and isotonic are reversed, and arthralgia is defined as an "inflammatory condition." Anserine bursitis (one of my favorite conditions) is not even included.

The author indicates that the book was designed for family physicians, physical therapists, coaches, and "casualty" officers and hopes that it will appeal to those in orthopedic surgical practice. Details of surgical technique have been "expressly avoided," and nowhere could I find even a reference to indications for total knee joint replacement surgery.

I am unable to recommend this book for the general internist or family physician, but portions of it may be of interest to the physiatrist, physical therapist, orthopedic technician, and orthopedic resident.