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Athletic Injuries ATC 222

Athletic Injuries ATC 222. The Knee Chapter 16. Anatomy. bony muscular cartilage ligaments bursa etc. Functional Anatomy. Motions flexion/extension rotation. Evaluation. History Observation Palpation Special Tests. MCL Sprain. Mechanism lateral force external tibial rotation

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Athletic Injuries ATC 222

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  1. Athletic InjuriesATC 222 The Knee Chapter 16

  2. Anatomy • bony • muscular • cartilage • ligaments • bursa • etc

  3. Functional Anatomy • Motions • flexion/extension • rotation

  4. Evaluation • History • Observation • Palpation • Special Tests

  5. MCL Sprain • Mechanism • lateral force • external tibial rotation • hyperextension • More severe and common than LCL • part of capsule • attaches to medial meniscus • Signs and Symptoms • pain over MCL • none to moderate edema/effusion • possible instability • possible ROM and strength loss • pain with passive extension and external tibial rotation

  6. MCL Sprain Treatment • RICER • Crutches? • Immobilization? • Meniscal involvement? • Rehabilitation

  7. LCL Sprain • Mechanism • varus force, internal tibial rotation • Less prevalent that MCL • no meniscal attachment • action of popliteus muscle • common peroneal nerve damage? • Signs and Symptoms • pain over LCL • none to mild edema/effusion • possible instability • possible ROM and strength loss • pain with passive extension and internal tibial rotation • Treatment

  8. ACL Sprain • Mechanism • external tibial rotation with valgus • internal tibial rotation • hyperextension • deceleration • Most common knee ligament to be seriously injured • Signs and Symptoms • heard/felt a “pop” • rapid effusion/hemarthrosis (1-2 hours) • knee “gives out” • instability

  9. ACL Sprain Treatment • RICER • Crutches? • Immobilization? • Conservative vs surgical intervention • commonly associated with meniscal tear

  10. PCL Sprain • Mechanism • force to anterior tibia with knee flexed • hyperflexion • rotation • Signs and Symptoms • “pop” • effusion • instability • Treatment • usually non-operative

  11. Meniscal Lesions • Mechanism • rotation while weight bearing • Acute MCL or ACL sprain • chronic knee instability or degeneration • Signs and Symptoms • clicking, catching, locking • slow developing effusion • pain on joint line • chronic effusion • Treatment • healing rate? • Arthroscopic surgery • removal vs repair

  12. Patellar Subluxation/Dislocation • Mechanism • external tibial rotation • valgus • functional/structural deviations • Signs and Symptoms • deformity • positive apprehension sign • effusion • pain on medial patellar border • Treatment • Reduction • immobilization and crutches? • RICER • rehabilitation

  13. Patellofemoral Syndrome • Structural/functional deviations • Signs and Symptoms • medial peripatellar pain • pain with stairs • crepitus • pain with stairs/prolonged sitting • Treatment • symptomatic • correct functional/structural deviations

  14. Apophyseal Injuries(apophysitis) • Apophysis = Traction Epiphysis • Types • Osgood-Schlatter’s Syndrome • Sinding-Larson-Johanson Syndrome • Signs and Symptoms • pain at tendon attachment • tibial tubercle enlargement • pain with prolonged sitting or pressure • Treatment • symptomatic • flexibility • activity modification • straps and sleeves

  15. Other Injuries • Tendonitis • Osteochondral defects • ITB syndrome

  16. Special Tests of the Knee • tibial/fibular compression/percussion • patellar apprehension • ballotable patella and stroke test • patellar excursion and compression

  17. Other Special Considerations • leg length discrepancy • Mechanics of lower extremity • Q-Angle • 10 males, 15 females • over 20 is abnormal

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