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Common Injuries to the Knee

Common Injuries to the Knee. ANTERIOR CRUCIATE INJURIES. ACL injuries also commonly occur with hyperextension of the knee, deceleration and valgus stress. INDICATIONS FOR SURGERY : Complete tear; associated meniscal pathology

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Common Injuries to the Knee

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  1. Common Injuries to the Knee

  2. ANTERIOR CRUCIATE INJURIES

  3. ACL injuries also commonly occur with hyperextension of the knee, deceleration and valgus stress.

  4. INDICATIONS FOR SURGERY: Complete tear; associated meniscal pathology Well motivated person who will do the rehab program; physiologically young Unwilling to change lifestyle; job and sports require twisting, cutting Minimal evidence of DJD

  5. WHEN TO DO SURGERY : Wait at least 3-4 weeks after injury • Decrease the swelling • Decrease Quad inhibition • Decrease hamstring overfiring • Decrease scarring • Increase ROM; decrease stiffness

  6. SURGERIES PERFORMED • Bone-tendon-bone with middle 1/3 of patellar tendon • Semitendinosis and gracilis: fold them in ½ so have a 4 tendon bundle • Allograph: bone-tendon-bone patellar tendon from cadaver • Key in surgery is correct isometric placement of the graph.

  7. 80-90% of patients have a good result with surgery going back to previous levels of activity. Some complications that may arise and give a less than favorable result are: • Patellar tendonitis • Patellofemoral pain/chondromalacia • Limited ROM at extremes; loss of even a few degrees of terminal extension is a problem • Stretching out of graph

  8. COLLATERAL LIGAMENT INJURIES

  9. MCL tears: most common mechanism is a blow to the outside of the knee followed by planting of the foot and twisting of the knee.

  10. There is a high risk of injury to the medial meniscus with MCL tears.

  11. KNEE REHAB

  12. PATELLOFEMORAL PAIN SYNDROME

  13. The patella must have balanced muscular forces around it to ride properly in the femoral groove. The VMO should fire before the VL. The VMO/VL ratio should be 1:1 Tight ITB, hamstrings and calf can disrupt muscular balance.

  14. OTHER FACTORS CAUSING PFPS: • Overpronation • Anteversion • Weak Hip ER & ABD • Tibial Varum • Increased Q angle

  15. ILIOTIBIAL BAND SYNDROME

  16. Complains of pain on knee flexion May complain of snapping Pain gets worse on ROM from full flexion to full extension. Often result of: genu varum; over pronation; femoral anteversion; spinal problems.

  17. SHIN SPLINTS

  18. Most common area affected is antereomedial shin. Starts out as muscle/tendon injury Can progress to periosteal injury Can end up as a stress fracture

  19. ANKLE SPRAINS

  20. Ottawa ankle rules

  21. JOBST INTERMITTENT COMPRESSION DEVICE

  22. ROM exercises Strengthening Proprioception Agility Running/jumping

  23. Syndesmotic Injury

  24. ACHILLES TENDONITIS

  25. ACHILLES TENDON RUPTURE

  26. LONG REHAB: Average 6-9 months

  27. PLANTAR FASCITIS

  28. Over pronation Pes cavus foot Tight calf muscles Tibial varum Anteversion Weak ER of hip

  29. Pharmacology

  30. DRUGS USED FOR MUSCULOSKELETAL PATHOLOGY • Analgesics • Drugs that directly affect the healing process • Drugs that do both

  31. NON STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) • Treatment of inflammatory arthritic diseases • Treatment of the “itises”

  32. NSAIDS: SIDE EFFECTS • Gastrointestinal Irritation and Ulceration • Decreased Blood Clotting • Kidney Trouble • Other

  33. Common NSAIDs (OTC) • Bayer (aspirin) • Tylenol (acetaminophen) • Aleve or Naprosyn (naproxen) • Advil (ibuprofen)

  34. Celebrex (celecoxib) Voltaren (diclofenac) Lodine (etodolac) Nalfon (fenoprofen) Indocin (indomethacin) Orudis, Oruvail (ketoprofen) Toradol (ketoralac) Daypro (oxaprozin) Relafen (nabumetone) Clinoril (sulindac) Tolectin (tolmetin) Vioxx (rofecoxib Common NSAIDS (Rx)

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