Chronic/Overuse Knee Injuries Flashcards
What is ITB friction syndrome (ITBFS)?
Bursal inflammation at lat epicondyle of femur (usually pinpoint pain)
What tests are used for ITBFS?
- Ober’s
- Palpation of lat epicondyle of femur (one finger test)
What are the support, protect, maintain treatment principles for ITBFS?
- RICE
- Modify training (stop, no hills)
- Unload - correct mechanics (feet, tight/weak structures)
- Cross train for CV system
What are the ‘regain’ treatment principles for ITBFS?
ROM: Stretch ITB/TFL complex within symptoms, DTM, roller may help
- Control: Ensure pelvic tilt not excessive, correct foot posture as indicated
- Strength: Esp glutes
- Function: Graduated return to run, usually better 3-4 weeks
What should be considered if ITBFS is not better after 3-4 weeks?
- Cortisone injection
- SIJ contribution
- Chondral, meniscal or maybe PFJ contributions
What are Bakers cysts?
- Sign (not diagnosis) of intra-articular injury
- Lump in popliteal fossa in posterior aspect of knee
- Commonly with joint effusion
- Common in children
What intra-articular injuries can be associated with Bakers cysts?
- OA
- Osteochondral lesion
- Meniscus tear
- ACL tear
- Anywhere where swelling is evident
What should be considered if a Bakers cyst is calcified?
- Sarcoma or haemangioma (NTBM)
- Tumour if cyst does not lie medial to lat gastric (NTBM)
What is Hoffa’s syndrome?
- Intrapatella fat pad irritation
- Presents as anterior knee pain
What is the mechanism of injury for Hoffa’s syndrome?
- Hyperextension, kicking, contusion, arthroscopy
- Can occur from traumatic injury & become ongoing source of pain
- Exacerbated by extension, e.g. prolonged standing, straight leg raise
How is Hoffa’s syndrome treated?
- Rest (avoid direct contact & active hyperextension)
- NSAIDs
- Taping (V)
- Usually recovers quickly
What is Osgood-Schlatter’s disease?
Apophysitis of tibial tuberosity
What are some of the common tendinopathies of the knee?
- Inferior pole of patella
- Midportion patella tendon
- Quads tendon
- Biceps femoris
- Pes Anserinus (enthesiopathy)
What is plicas?
- Embryonic remnant - fold of synovium
- Presents as anterior knee pain
What is the treatment for plicas?
- Settle inflammation
- Surgical excision if persistent
What is patellofemoral syndrome (PFS)?
- Maltracking of patella
- Syndrome may include some or all components:
- Chondromalacia patella
- Excessive lateral pressure
- VMO weakness/timing
- Biomechanical issues - increased Q angle, overpronation
- ITB tightness
- TFL overuse
- Weak glutes
- Overweight, adolescent female
What are the treatments for PFS?
- Soft tissue therapy: ITB/TFL release
- Joint mobilisation medially
- McConnell taping
- Strengthening: VMO retraining, glutes strengthening
- Orthotics (for excessive pronation)
What is a common surgery for chondral defects in the knee?
OATS - osteochondral allograft transplant surgery (aka mosaicplasty)
- Take plugs from non-WB portions of femur and insert into WB area
What is a new/developing surgery for chondral defects in the knee?
Autologous chondrocyte transfer
- Stem cells/stabilised chondrocytes harvested & cultured
- Implanted under protective barrier
- Immobilised to permit establishment of cells
- Cells grow new hyaline cartilage
What are the support, protect, maintain treatment principles for chondral injury?
- Treat symptomatically esp joint effusion
- Protect from further injury
- Maintain healthy cartilage, muscle bulk & strength with low joint compression
What are the ‘regain’ treatment principles for chondral injury?
- ROM: Usually OKC to begin or low joint compression, avoid sustained holds
- Control: Protect joint by teaching dynamic motor control/stability (cocontraction)
- Strength: As required by muscle testing
- Function: Re-training, evidence suggests high muscle loads, low joint loads
What are the characteristics of patellofemoral pain?
- Insidious or secondary to another knee injury/trauma
- Diffuse ache, agg by loaded activities, prolonged sitting
- History of recurrent crepitus
What’s is patella tendinopathy also known as?
Jumper’s knee
What are the clinical features of patella tendinopathy?
- Anterior knee pain
- Agg by jumping, changing direction, deceleration
- Tenderness on palpation
- Thickening of the tendon
What is the most common site of patella tendinopathy?
Deep attachment of the tendon to the inferior pole of the patella
How should a patella tendinopathy be examined?
- Palpation
- Reproduce pain with functional tests, e.g. squats, hopping
- Assess lower limb strength
- Ultrasound/MRI
What is the treatment for patella tendinopathy?
- Load reduction (reduce training hours, amount of jumping/sprinting)
- Correct biomechanics (landing technique)
- Soft tissue therapy (hamstrings, quads, calf)
- Strength/motor control exercises (glutes, quads, calf)
What is the mechanism of Osgood-Schlatter’s disease?
- Excessive traction on soft apophysis of tibia tuberosity by patellar tendon
- High levels of activity during rapid period of growth
What is the mechanism of quads tendinopathy?
- Common in older sports people
- Weightlifters - tendon loaded in deeper squat
Which bursa is most commonly affected by bursitis?
Pre-patellar bursa
What is the treatment for bursitis?
- NSAIDs
- Aspiration/infiltration (more severe)
What is Sinding-Larsen-Johansson syndrome?
- Lesion on the inferior pole of patella at attachment of patella tendon
- Less common than Osgood-Schlatters (managed the same)
What is a discoid lateral meniscus?
- Disc-shaped anatomical abnormality reported in children
- Can present as chronic snapping knee syndrome
What are the clinical features of a degenerative lateral meniscus?
- Gradual onset of lateral knee pain
- Quads atrophy
- Painful/non-painful lump at lateral joint line
What are the risk factors of knee OA?
- Meniscal injury
- Knee malalignment
- Obesity
- Sports participation (wrestling, weight lifting, soccer, football)
- Previous knee injury
- Genetic predisposition
What is excessive lateral pressure syndrome?
- Excessive pressure on lateral patellofemoral joint
- Due to tight lateral retinaculum
- Affects joint capsule, PF joint, ITB & quads
What can excessive lateral pressure syndrome lead to?
- Vertical stress fracture
- Separation of lateral patellar fragment
What is the treatment for excessive lateral pressure syndrome?
- PF mobilisation
- Soft tissue therapy on retinaculum
- Surgical release of retinaculum
What is the mechanism of biceps femoris tendinopathy?
- Excessive acceleration & deceleration
- Ass. with running & cycling
What are the clinical features of biceps femoris tendinopathy?
- P/L pain
- Settles after activity
- Morning stiffness
- Pain with palpation & resisted flexion esp eccentric
- Tightness of hamstrings & glutes
What muscles need to be strengthened in treatment of biceps femoris tendinopathy?
- Eccentric strengthening of hamstrings
- Gluteus maximus
What needs to be ruled out of a superior tib/fib joint dislocation?
- Peroneal nerve injury
- Popliteus tendon injury
- Posterolateral corner injury
- PCL injury
What are the clinical features of a superior tib/fib joint dislocation?
- Prominent fibula head
- Lateral knee pain
- Swelling around joint
- Popping/clicking
- Agg by ankle movements & WB
How are superior tib/fib joint dislocations managed?
- Immobilisation 2-3/52
- Strengthening of hamstrings & calfs
What are the characteristics of medial meniscus abnormality/degeneration?
- Patient generally sport person over 35 yrs
- Clicking & pain with twisting activities
- Joint line tenderness, positive McMurray’s
What is the pes anserinus?
Combined tendinous insertion of sartorial, gracilis & semitendinosus onto tibia
What are the mechanisms of pes anserinus tendinopathy?
- Uncommon
- Swimmers (particularly breaststroke)
- Cyclists
- Runners
What is the mechanism of gastroc tendinopathy?
- Medial gastroc at posterior femoral condyle
- Excessive hill running/rapid increase in distance
