knee 2 - injuries Flashcards
most ACL injuries are what
(80%) non contact
what is the normal MOI of ACL
foot planted, valgus/rot load
low flexion angles
hyperext load (step in pot hole)
what are some examples of activties that lead to ACL injury
- Cutting combined with deceleration
- Landing from a jump in or near full extension
- Pivoting with knee near full extension
- Deceleration with knee internal rotation
- “Dynamic Valgus”: Femoral adduction, Knee abduction, Ankle eversion
what does a contact ACL injury look like
Posteriorly directed blow to anterior femur
blow to the lateral knee when the foot is planted
(dashboard, hyperext)
what is the general presentation of a ACL injury
popping,
giving away, buckling
- episodes of giving way with ADLs
severe pain
Continued effusion
flexed knee gait
Limited range of motion
what is quad inhibition
process in which quadriceps activation failure is caused by neural inhibition, is common following knee injury or surgery
what are the DD for ACL injuries
- Multiple ligament injuries –MCL, PCL
- Meniscal involvement
- Unhappy Triad (O’Donoghue)
- MCL, medial men, ACL
- Patella subluxation/dislocation
what is the PCL MOI
hyperflexion
Fall on a flexed knee with foot in plantarflexion
Hyperextension mechanisms
* Step in a pothole
Blow to anterior tibia (Dashboard)
what is the general presentation of a PCL MOI
posterior knee pain
less effusion compared to ACL
flexion beyond 90 may be painful
hard time descending stairs, squatting, running
less quad inhibition then ACL
what is the DD for PCL injury
- Patellofemoral pain: Patients with chronic PCL insufficiency can develop PFPS
- Need to rule out posterior lateral complex involvement
- False + Anterior Drawer Test
- Consider chondral lesions when MVA trauma is involved
- Meniscal tears at the posterior horns with hyperflexion injuries
what are chondral lesions
caused through degradation of joint cartilage, in response to metabolic, genetic, vascular and traumatic stimul
are PCL injries normally large traumatic events
no
Posterolateral Corner Injuries MOI
- Posterolateral-directed force to the anteromedial tibia
- Knee hyperextension
- Severe tibial external rotation with the knee is low angles of flexion
- Varus forces to a flexed knee
- Atraumatic may present as chronic laxity without a PCL component
what are the structures we find in the posterio-lateral corner
static: PCL, LCL, posterior horn of the lateral meniscus, PL capsule
dynamic: ITB, popliteus, biceps femoris
MCL MOI
- Controlling excessive valgus forces
- With the LCL responsible for preventing excessive Femoral IR and Tibial ER
is the MCL attached to anything else
yes - medial meniscus, and ACL
what does the MCL feel like
flat and broad
what is the main purpose of the MCL
controling knee valgus
what is the secondary purpose of the MCL
with the LCL preventing excessive femoral IR and tibial ER
what is the DD for MCL
- Medial meniscal tear
- ACL / PCL
- Epiphyseal plate injury
- Patella dislocation
is the LCL attached to anything
no - not like the mCL
what structure seperates the lateral menicus and the LCL
popliteus
what forces does the LCL prevent
resists varsus stresses
we do not get hit from the inside of the leg so this does not get injuried as often
what else does thee LCL prevent - movement-wise
lateral tibia rot
median femoral rotation
what are DD for the LCL
- ACL/PCL injuries
- Posterolateral corner
- Lateral meniscus
- ITB
- Biceps Femoris strain
- Popliteus strain
what are the signs and symptoms of collateral ligament injury
varus and valgus stress
local swelling and ecchymosis
Joint effusion if ACL or meniscal involvement
Quadriceps dysfunction
Tenderness to palpation of ligament
Difficulty with pivoting, cutting, etc.
what is ecchymosis
a bruise
when palating collateral ligament what part do we want to palpate
the insertions and then entire length of the ligament
if someone with a collateral ligament issue - what do they complain about with runinng
“I can run in a straight line, but my knee feels like it’s going to fall apart if I turn quickly”
what are risk factors for OA
age gender race
joint laxity
obesity
quad weakness
prior knee injury
what is the general presentation of knee OA
stiffness in the morning that resolves after “ moving around for a bit
stiffness after prolonged sitting
crepitus
occasional pain at night
joint line pain
quad weakness
what is the capsular pattern of the knee
flex > ext
what is crepitus
grinding, clicking, and popping in the joint
sand paper feeling
what is the the MOI mencius
twisting
sudden change in direction with the foot planted
hyperflexion
high impact compression load
ACL/MCL injury
what is the general presentation for men injury - acute
Twisting/tearing sensation at time of injury
Severe pain on injury, effusion developing 6-24 hours post injury
(less the ACL)
may have giving away
Reports of clicking, popping, catching or locking of knee
Location of pain varies
Sx worsens with deep squats and stair negotiation
ROM limited in end range
what has more effusion men of ACL
ACL
what is the general presentation of men injury - chronic
- Older population – joint/cartilage degeneration
- History of a previous knee injury
- Twisting or giving way
- clicking and locking
- Intermittent bouts of effusion
- “If I do too much standing, walking, squatting, bending, etc., it swells up on me”
- Reports of sudden sharp pain that causes knee to give way
what are the DD for men injury
- MCL/LCL
- ACL
- PFPS and other Anterior Knee Pain “options”
- PCL and Posterolateral Corner
- Articular cartilage defects
- OA
what are some risk factors for men injury
older age
male
work related kneeling/squatting
climbing greater then 30 stairs a day
D1 sport
delayed ACLR
art cart
look at notes closer
PFPS MOI
increase frequency and duration of patellofemoral loading with insufficient time for
what is the general presentation of PFPS
Anterior, retro- or peripatellar knee pain
associated with increase in activity
crepitus, clicking, popping
complains of stiffness around the patellofemoral joint
peripatellar meaning
around the pattell
what kind pain do we see with PFPS
- Diffuse
- Insidious onset (most of the time)
what are some DD for PFPS
men injury
patellar or quadrecieps tendinopathy
IT Band syndrome
lumbar spine or hip origin
what are some medical red flags that can be DD for PFPS
tumor
dislocation
septic arthritis
DVT
neurovascular compromise
what are some risk factors for PFPS
sports specialization
younger
decrease quad strength
decreased quad, hamstring, gastroc flexibility
what is patella instability
acute or chronic lateral subluxation or the patella
temporary partial dislocation
what is the MOI for patella instability
forceful quad contraction while rotating on a planted foot
valgus blow to the knee
what is the general presentation of patella instability
felt a pop
giving away of the knee
antereior knee pain the is aggrevated by activity
TTP along the medial aspect of the patella/medial patella femoral ligament
excessive lateral patella mobility
patellofemoral OA is most common where on the patella
the lateral facet
patellofemoral OA - presentation
similar to PFPS
crepitus
stiffness and pseudo locking - morning and prolonged sitting
PFPS pain gets worse with what activity
squatting
sitting/prolonged knee flexion
stair climbing
sports participation
what is Iliotibial Band Friction Syndrome
irritation of the distal ITB and underlying structures
what is the overall MOI of Iliotibial Band Friction Syndrome
overuse
overuse compression - Iliotibial Band Friction Syndrome
constant tension of the IT band compresses unnderlying nerve, blood vessels and fat pads
overuse repetitive - Iliotibial Band Friction Syndrome
the lateral fibers rub agaist the lateral femoral condyle during flex and ext
what athleteic population is Iliotibial Band Friction Syndromeoften seen in
runners, associated with the breaking phase of early stance
what is the general presentation of Iliotibial Band Friction Syndrome
gradual onset of lateral or anterolateral knee pain
aggravted by activity
TPP of the lateral femoral condyle or gerdy’s
localized swelling (not always present)
snapping and popping
what part of running concontribute to Iliotibial Band Friction Syndrome
down hill
increase in training
leg length discrepancy
is IT band tightness a risk faxctor for Iliotibial Band Friction Syndrome
no
what is Osgood-Schlatters Disease (OSD)
Apophysitis of the tibial tuberosity
what is Sinding-Larsen Johannsen (SLJ)
Apophysitis of the inferior pole of patella
what is Apophysitis
an inflammation or stress injury to the areas on or around growth plates in children and adolescents.
what population do we see Osgood-Schlatters Disease (OSD) /
Sinding-Larsen Johannsen (SLJ)
in
- Males (12-14 y.o.) > Females (10-12 y.o.)
- Early sport specialization = 4 fold inc risk
what is the general presentation of Osgood-Schlatters Disease (OSD) /
Sinding-Larsen Johannsen (SLJ)
localized pain or swelling at the tibial tuberosity or the inferior pole
TTP of the tibial tuberosity
palpable/visible swelling
pain with resisted knee extension
what are aggravating activities for Osgood-Schlatters Disease (OSD) /
Sinding-Larsen Johannsen (SLJ)
running
jumping
squatting
knee extension
what is the treatment for OSD and SLJ
progressive glutes and quads strengthing
education on activity, loading, and injury
activity ladder
what is fat pad impingement
inflammation –> hypertrophy and fiborsis of the fat pad
what is the MOI for the fat pad impingment
blunt trauma
patella dislocation/sublexation
impingement
what is the general presentation of a fat pad impingement
burning or aching deep to or on either side of the patella tendon
TTP of medial/lateral fat pad
swelling
sym seen with quad set
limited patellar mobility
Plica Syndrome is it seen often
no
it is zebra
Plica Syndrome - what is it
inflammatory process
where is hoffa’s fat pad
under the petellar tendon
under the patella
what position causes issues with pilica syndrome
knee flexion
what is the treatment for fat pad impingement
activity modification - avoid deep flexion and hyperext
tactile cueing to prevent hyperext - taping
quad strengthing 20-120 (rnage of the least compression)
patella mobs
what is the plica
band of thick, fibrotic tissue that extends from the synovial capsule of a joint
function to protect the knee
what is the MOI for plica syndrome
blunt trauma
twisting injury
rep flex/ext
what is the general presentation of plica syndrome
delayed onset of symptoms
intermittant knee pain of the ant or medial-ant knee
poping or snapping during knee flexion
palpable thickening of the pilica
what is the MOI for Pre-Patellar Bursitis
blunt trauma or prolonged kneeling
what is the general presentation of Pre-Patellar Bursitis
pain/swelling directly over the patella
Bursal warmth and redness
what should do if the patient has a fever with Bursal warmth and redness
Refer if >37.7° C (99.9° F)
- 50% of cases in immunocompromised
hamstrings MOI
overlengthening or ballistic movement
high muscle tendon forces
high velocity movements
when is the biceps femorsis more commonly injuried
high speed running
when is the Semimembranosus normally injured
jumping , kicking, when the hamstring is mac lengthened
what is the general presentation of hamstring injury - gait
stiff leg
the patient want to avoid both overstrethcing
what is the general presentation of a hamstring injury
bruise
pain with - sitting and palpation (mm belly and tendon)
hamstring injury - flexibility tests
tests are limited and symptomatic
SLR and popliteal angle
strength with hamstring injuries
limited and painful
prone knee flexion
prone hip extension
patellar tendinopathy - MOI
chronic overuse injury
not enough rest
patellar tendinopathy - general presentation
focal pain at the patella
tendon stiffness sensation - morning or after prolonged sitting
warm up effect
for patellar tendinopathy where is pain noramlly focalized
the inferior pole of the patella
what are symptom triggers for patellar tendinopathy
squatting
jumping
sprinting
dec
hills
what are sym modifiers for patella tendionopathy
rest
what pop do we normally see patellar tendinopathy in
younger
athletic
jumping athletes
what are the recommend treatments for PFPS
exercise therapy
patellar tapping (short term pain relief)
foot orthoses for pronated feet
gait retraining
patient education
do braces help with PFPS
nope
what exercise therapy do we want to include for people with PFPS
quad strengthing
strengthen hip abd/ext/ER
address other impairments up and down the chain
