Knee Injuries

1. Knee Injuries

2. Patellafemoral Problems • One of the most challenging knee injuries for both athlete and health care provider. • Typical complaint is pain in front of the knee (behind the knee cap), with gradual onset. • The knee may give way and have a grinding noise.

3. Patellafemoral Problems • Biomechanical assessment is very important • The patellae may face inward. This may be caused by pronated feet, low arch, weak hip external rotators, tight hip internal rotators. • Patella should slide through middle of groove

4. Patellar Tendonitis • High force repetitive injury usually a result of jumping and/or abrupt change of direction. • AKA jumpers knee

5. Signs and Sx: Anterior knee pain inferior to patellar tendon Small amount of swelling Special Tests- Tap Test Clark’s Sign Treatment Modified activity to decrease impact Stretch Quads Ice after Massage/US before Brace and Tape Patellar Tendonitis

6. Fat Pad Syndrome • Painful condition in the infrapatellar region. • Often mistaken for patellar tendonitis • Avoid full knee extension • Treat with ice and anti-inflammatory meds • Special test will differentiate.

7. Medial Collateral Ligament Sprain • Causes are blow to the lateral knee or high speed twisting motion. • Classified with three grade scale based on signs and symptoms • MOI is important

8. Signs and Sx Limited ROM Tenderness at either insertion of MCL or along ligament length. Various levels of pain and laxity to medial knee Special Test Valgus Stress Test Treatment RICE and protect Ice and Interferential Straight leg strengthening initially. Immobilize if necessary Medial Collateral Ligament Sprain

9. Lateral Collateral Ligament Sprain • Not as common as the MCL sprain. • Caused by a medial force to the knee joint or a twisting. • Classified with 3 grades like any other sprain.

10. Lateral Collateral Ligament Sprain • Signs and Sx • Limited ROM • Tenderness at either insertion of LCL or along ligament length. • Various levels of pain and laxity to lateral knee

11. Treatment RICE and protect Ice and Interferential Straight leg strengthening initially. Immobilize if necessary Special Test Varus Stress Test Lateral Collateral Ligament Sprain

12. Torn Anterior Cruciate Ligament • Can be a contact or non-contact injuy. • Can be a blow to the lateral or posterior knee. • Non-contact loaded knee in combined flexion, valgus and rotation of the tibia on the femur.

13. Signs and Sx Hear or feel a pop Rapid effusion Buckling of the knee Guarding will occur quickly so special tests need to be done within 5 minutes of injury Treatment Splinting, ice, compressive wrap and crutches. Surgery for a ACL tear in necessary No Grades to this injury it is either torn or not. MRI is confirmation for diagnosis Torn Anterior Cruciate Ligament

14. Torn Anterior Cruciate Ligament • Female ACL injuries happen 4-6x more often than male ACL injuries. • This is due to • Biomechanical factors- use more quad than hamstring. Land flat footed-don’t know how to jump • Hormonal influences-ligament may loosen during cycle • Anatomic risk factors-Angle of the hips relative to knees.

15. Torn Anterior Cruciate Ligament • Special Tests • Anterior Drawer • Lachman’s Maneuver

16. Torn Posterior Cruciate Ligament • Occurs when the person falls on a flexed knee with the foot plantarflexed. • The tibia strikes first and is pushed backward. • Hyperflexion can also cause a PCL tear.

17. Torn Posterior Cruciate Ligament • PCL tear will rarely require surgery. • Strengthening will be most important for the quadriceps. • Special Tests • Sag Test

18. Meniscus Tear • Meniscus are cushions in the knee joint that help make it more stable. • Medial meniscus is attached to posterior and medial side, it is more often injured. • Lateral meniscus is more freely moving, less often injured.

19. Meniscus Tear • Causes of injury • Twisting of knee when meniscus gets trapped. • When the ligaments are torn, they are attached. • As people age the rubbery meniscus fray

20. Meniscus Tear • Signs and Sx • Popping, locking, giving way of the knee • Pain in injury area • General knee swelling

21. Treatment Ice and compression Crutches Strengthening Surgery may be necessary if sx do not subside with rehabilitation Participation may continue if tolerated. Special Tests McMurray Test Meniscus Tear

22. Epiphyseal Plate Injuries • Injuries that would cause ligamentous injuries in adults cause growth plate injuries in youth • Usually due to direct trauma in athletes under 14 years

23. Osgood-Schlatter • The femur is growing faster than the quad muscle and creates a traction on the tibial tuberosity where the patellar tendon attaches. • Affects males age 12-16 • Affects females age 10-14

24. Osgood-Schlatter • Signs and Sx • Pain and swelling over tibial tuberosity • Increase pain and swelling with activity • Weakness of quadriceps • Visible lump • Pain to touch

25. Osgood-Schlatter • Treatment • Manage pain swelling and flexibility • Stretch 4x daily-emphasis on hamstrings • Avoid knee extension, squats, power clean and plyo • Do body weight squats, SLR, hamstring curls and calf raises. • Wear knee brace if needed.

26. Iliotibial Band Syndrome • Inflammation of the Iliotibial Band with a possible problem with the bursa • Occur due to increase in activity. • Overpronation, leg length discrepancy, bowleggedness

27. Iliotibial Band Syndrome • Special Tests- ober’s • Treatment • Modification of gait or footwear • Icing of the area • Massage of the area • Reduce activity