Knee Injuries

Sports Medicine 2

Knee Structures

Hinge Joint Stability comes from ligamentous support Femur, tibia, fibula, patella Menisci

~ 2 oval fibrocartilages

Ligaments

ACL~ Prevents the tibia from moving anteriorly or the femur from moving posteriorly

PCL~ Prevents posterior movement of the tibia on the femur, hyperextension

MCL~ Prevents valgus motion

LCL~ Prevents varus force

ACL Tears

Cause: Direct lateral or valgus blow with the knee flexed and tibia externally rotated, lower leg rotated with the foot planted, or flexion deceleration injury

S/S: Hears/feels a ‘pop’ in the knee followed by immediate disability. Laxity of joint.

TX: RICE Surgery Rehabilitation

ST: Anterior Drawer test, Lachman test

Normal ACL Torn ACL

Restructured ACL

MCL Tears

Cause: Result of a medially directed valgus force from lateral side or from external rotation of the tibia

S/S: Swelling, point tenderness, laxity on the medial side

TX: RICE Crutches if unable to walk Bracing Surgery worse case

ST: Valgus Stress Test, anterior drawer test

LCL Tears

Cause: Result of a laterally directed varus force from the medial side or from internal rotation of the tibia. “Rarely ever will you have an isolated LCL tear”

S/S: Pain and tenderness over the ligament, swelling, effusion, joint laxity

TX: RICE Crutches if unable to walk Surgery if bad enough Brace

ST: Varus Stress Test

PCL Tears

Cause: A full weight bearing fall on a hyper flexed knee. Dashboard injury

S/S: Feels a ‘pop’ in the back of the knee. Tenderness and little swelling in popliteal fossa. Laxity may be noted.

TX: RICE Quadricep strengthening on non-operative knees Surgery in highly active Brace

ST: Posterior Drawer test

Meniscal Tear

Cause: A weight bearing combined with a rotational force while extending of flexing the knee. Medial more common than lateral.

Acute vs. Chronic S/S: Effusion on joint line, loss of motion, joint

locking, and pain when squatting. TX: RICE

quad sets Surgery possible

ST: McMurray’s, Apley’s compression test

Meniscal Blood Supply

Patellar Tendonitis

Cause: Jumping, kicking, or running. S/S: Vague pain indicated, tenderness

around bottom of patella, Point tenderness over tibial tuberosity

TX: RICE (ice cups) NSAIDS Cho-pat strap Rehabilitation

ST: Strength test, ROM test

Osgood-Schlatter’s Disease

Cause: common in immature athletes. Repeated pull of the patellar tendon at the tibial tubercle.

S/S: Swelling, hemorrhage, and gradual degeneration of tubercle (causing deformity)

TX: Conservative: RICE (ice cups) Out for 6 months to 1 year Rehabilitation

ST: X-Ray

Larsen-Johansson Disease

Same as Osgood-Schlatter Disease but occurs at inferior pole of patella

Patellar Tendon Rupture

Cause: Sudden powerful contraction of quads with weight of the body applied to affected leg ***Steroid injections to this area increase

likelihood of rupture S/S: Patella moves upward, noticeable

defect, and athlete cannot extend knee TX: Conservative: Surgical repair

NSAIDS

ST: X-Ray, MRI

Chondromalacia Patella

Cause: wearing away of articular cartilage on the posterior aspect of patella

S/S: Pain while walking or deep bending Going up stairs Crepitation

TX: RICE Avoid painful activities Rhb NSAIDS Surgery

ST: History, Clarks sign, Patella grind test