Knee InjuriesKnee Injuries

Patellafemoral ProblemsPatellafemoral Problems One of the most One of the most

challenging knee challenging knee injuries for both athlete injuries for both athlete and health care and health care provider.provider.

Typical complaint is Typical complaint is pain in front of the knee pain in front of the knee (behind the knee cap), (behind the knee cap), with gradual onset. with gradual onset.

The knee may give way The knee may give way and have a grinding and have a grinding noise. noise.

Patellafemoral ProblemsPatellafemoral Problems

Biomechanical assessment Biomechanical assessment is very importantis very important

The patellae may face The patellae may face inward. This may be inward. This may be caused by pronated feet, caused by pronated feet, low arch, weak hip low arch, weak hip external rotators, tight hip external rotators, tight hip internal rotators.internal rotators.

Patella should slide Patella should slide through middle of groovethrough middle of groove

Patellar TendonitisPatellar Tendonitis

High force High force repetitive injury repetitive injury usually a result of usually a result of jumping and/or jumping and/or abrupt change of abrupt change of direction.direction.

AKA jumpers kneeAKA jumpers knee

Patellar TendonitisPatellar Tendonitis

Signs and Sx:Signs and Sx: Anterior knee pain Anterior knee pain

inferior to patellar inferior to patellar tendontendon

Small amount of Small amount of swellingswelling

Special Tests-Special Tests-

Tap TestTap Test

Clark’s SignClark’s Sign

TreatmentTreatment Modified activity to Modified activity to

decrease impactdecrease impact Stretch QuadsStretch Quads Ice after Ice after Massage/US beforeMassage/US before Brace and TapeBrace and Tape

Fat Pad SyndromeFat Pad Syndrome Painful condition in Painful condition in

the infrapatellar the infrapatellar region.region.

Often mistaken for Often mistaken for patellar tendonitispatellar tendonitis

Avoid full knee Avoid full knee extension extension

Treat with ice and Treat with ice and anti-inflammatory anti-inflammatory medsmeds

Special test will Special test will differentiate.differentiate.

Medial Collateral Ligament Medial Collateral Ligament SprainSprain

Causes are blow to the Causes are blow to the

lateral knee or high speed lateral knee or high speed

twisting motion.twisting motion. Classified with three gradeClassified with three grade

scale based on signsscale based on signs

and symptomsand symptoms MOI is importantMOI is important

Medial Collateral Ligament Medial Collateral Ligament SprainSprain

Signs and SxSigns and Sx Limited ROMLimited ROM Tenderness at either Tenderness at either

insertion of MCL or insertion of MCL or along ligament along ligament length.length.

Various levels of pain Various levels of pain and laxity to medial and laxity to medial kneeknee

Special TestSpecial Test

Valgus Stress TestValgus Stress Test

TreatmentTreatment RICE and protectRICE and protect Ice and Ice and

InterferentialInterferential Straight leg Straight leg

strengthening strengthening initially.initially.

Immobilize if Immobilize if necessarynecessary

Lateral Collateral Ligament Lateral Collateral Ligament SprainSprain

Not as common as Not as common as the MCL sprain.the MCL sprain.

Caused by a medial Caused by a medial force to the knee joint force to the knee joint or a twisting.or a twisting.

Classified with 3 Classified with 3 grades like any other grades like any other sprain.sprain.

Lateral Collateral Ligament Lateral Collateral Ligament SprainSprain

Signs and SxSigns and Sx Limited ROMLimited ROM Tenderness at either insertion of LCL or along Tenderness at either insertion of LCL or along

ligament length.ligament length. Various levels of pain and laxity to lateral kneeVarious levels of pain and laxity to lateral knee

Lateral Collateral Ligament Lateral Collateral Ligament SprainSprain

TreatmentTreatment RICE and protectRICE and protect Ice and Ice and

InterferentialInterferential Straight leg Straight leg

strengthening strengthening initially.initially.

Immobilize if Immobilize if necessarynecessary

Special Test Special Test Varus Stress TestVarus Stress Test

Torn Anterior Cruciate Torn Anterior Cruciate LigamentLigament

Can be a contact or non-contact injuy.Can be a contact or non-contact injuy. Can be a blow to the lateral or Can be a blow to the lateral or

posterior knee.posterior knee. Non-contact loaded Non-contact loaded

knee in combined knee in combined

flexion, valgusflexion, valgus

and rotation of theand rotation of the

tibia on the femur.tibia on the femur.

Torn Anterior Cruciate Torn Anterior Cruciate LigamentLigament

Signs and SxSigns and Sx Hear or feel a popHear or feel a pop Rapid effusionRapid effusion Buckling of the Buckling of the

kneeknee Guarding will occur Guarding will occur

quickly so special quickly so special tests need to be tests need to be done within 5 done within 5 minutes of injuryminutes of injury

TreatmentTreatment Splinting, ice, Splinting, ice,

compressive wrap compressive wrap and crutches.and crutches.

Surgery for a ACL Surgery for a ACL tear in necessarytear in necessary

No Grades to this No Grades to this injury it is either injury it is either torn or not.torn or not.

MRI is confirmation MRI is confirmation for diagnosisfor diagnosis

Torn Anterior Cruciate Torn Anterior Cruciate LigamentLigament

Female ACL injuries happen 4-6x Female ACL injuries happen 4-6x more often than male ACL injuries.more often than male ACL injuries.

This is due toThis is due to Biomechanical factors- use more quad Biomechanical factors- use more quad

than hamstring. Land flat footed-don’t than hamstring. Land flat footed-don’t know how to jumpknow how to jump

Hormonal influences-ligament may Hormonal influences-ligament may loosen during cycleloosen during cycle

Anatomic risk factors-Angle of the hips Anatomic risk factors-Angle of the hips relative to knees.relative to knees.

Torn Anterior Cruciate Torn Anterior Cruciate LigamentLigament

Special TestsSpecial Tests Anterior DrawerAnterior Drawer Lachman’s Lachman’s

ManeuverManeuver

Torn Posterior Cruciate Torn Posterior Cruciate LigamentLigament

Occurs when the Occurs when the person falls on a person falls on a flexed knee with flexed knee with the foot the foot plantarflexed.plantarflexed.

The tibia strikes The tibia strikes first and is pushed first and is pushed backward.backward.

Hyperflexion can Hyperflexion can also cause a PCL also cause a PCL tear.tear.

Torn Posterior Cruciate Torn Posterior Cruciate LigamentLigament PCL tear will PCL tear will

rarely require rarely require surgery.surgery.

Strengthening Strengthening will be most will be most important for important for the the quadriceps.quadriceps.

Special TestsSpecial Tests Sag TestSag Test

Picture 161.avi

Meniscus TearMeniscus Tear Meniscus are Meniscus are

cushions in the knee cushions in the knee joint that help make joint that help make it more stable.it more stable.

Medial meniscus is Medial meniscus is attached to attached to posterior and posterior and medial side, it is medial side, it is more often injured.more often injured.

Lateral meniscus is Lateral meniscus is more freely moving, more freely moving, less often injured.less often injured.

Meniscus TearMeniscus Tear

Causes of injuryCauses of injury Twisting of knee when meniscus gets Twisting of knee when meniscus gets

trapped.trapped. When the ligaments are torn, they are When the ligaments are torn, they are

attached.attached. As people age the rubbery meniscus frayAs people age the rubbery meniscus fray

Meniscus TearMeniscus Tear

Signs and SxSigns and Sx Popping, locking, Popping, locking,

giving way of the giving way of the kneeknee

Pain in injury areaPain in injury area General knee General knee

swellingswelling

Meniscus TearMeniscus Tear

TreatmentTreatment Ice and compressionIce and compression CrutchesCrutches StrengtheningStrengthening Surgery may be Surgery may be

necessary if sx do necessary if sx do not subside with not subside with rehabilitationrehabilitation

Participation may Participation may continue if tolerated.continue if tolerated.

Special TestsSpecial Tests McMurray TestMcMurray Test

Epiphyseal Plate InjuriesEpiphyseal Plate Injuries

Injuries that would cause ligamentous Injuries that would cause ligamentous injuries in adults cause growth plate injuries in adults cause growth plate injuries in youthinjuries in youth

Usually due to direct trauma in athletes Usually due to direct trauma in athletes under 14 yearsunder 14 years

Osgood-SchlatterOsgood-Schlatter

The femur is growing The femur is growing faster than the quad faster than the quad muscle and creates a muscle and creates a traction on the tibial traction on the tibial tuberosity where the tuberosity where the patellar tendon attaches.patellar tendon attaches.

Affects males age 12-16Affects males age 12-16 Affects females age 10-14Affects females age 10-14

Osgood-SchlatterOsgood-Schlatter

Signs and SxSigns and Sx Pain and swelling over tibial Pain and swelling over tibial

tuberositytuberosity Increase pain and swelling with Increase pain and swelling with

activityactivity Weakness of quadricepsWeakness of quadriceps Visible lumpVisible lump Pain to touchPain to touch

Osgood-SchlatterOsgood-Schlatter

TreatmentTreatment Manage pain swelling and flexibilityManage pain swelling and flexibility Stretch 4x daily-emphasis on Stretch 4x daily-emphasis on

hamstrings hamstrings Avoid knee extension, squats, power Avoid knee extension, squats, power

clean and plyoclean and plyo Do body weight squats, SLR, hamstring Do body weight squats, SLR, hamstring

curls and calf raises.curls and calf raises. Wear knee brace if needed.Wear knee brace if needed.

Iliotibial Band SyndromeIliotibial Band Syndrome

Inflammation of the Iliotibial Band Inflammation of the Iliotibial Band with a possible problem with the with a possible problem with the bursabursa

Occur due to increaseOccur due to increase

in activity.in activity. Overpronation, leg Overpronation, leg

length discrepancy,length discrepancy,

bowleggednessbowleggedness

Iliotibial Band SyndromeIliotibial Band Syndrome

Special Tests- Special Tests- ober’sober’s

TreatmentTreatment Modification of gait Modification of gait

or footwearor footwear Icing of the areaIcing of the area Massage of the areaMassage of the area Reduce activity Reduce activity