Knee Injuries Flashcards
Anterior Knee Pain can be?
Patellofemoral Joint Compression Syndrome Chondromalacia Patella (CMP) Patellar Tendonitis (Jumper's Knee) Plica Syndrome Also: - Patellar subluxation/dislocation - Osgood Schlatter's disease - Sinding-Larsen and Johansson Syndrome
Patellofemoral Joint Compression
Primary Function:
Increase the efficiency of the quadriceps muscle by increasing its lever arm.
Patellar Tracking
Patella “tracks” relatively vertically in the femoral groove.
Because the patella is embedded in the patellar tendon it’s movement is dictated by the forces produced by the muscles which make up the quadriceps-either individually or as a unit.
Abnormal Tracking can lead to?
Increased compressive forces along the lateral patellar surface.
Increases the tensile stresses on the medial retinaculum of the patella.
Risk Factor for Abnormal Tracking Include?
Increased Q-Angle Atrophy in the VMO "Tight" lateral retinaculum Tightness in the Iliotibial Band Increased foot Pronation
Chondromalacia Patellae (CMP)
Chodromalacia patellae, refers to the softening/damage of the articular cartilage of the patella
Patellofemroal Pain Syndrome (PFPS)
Patellofemoral Stress Syndrome (PFSS)
This more general term usually refers to pain under and around the patella. However the name does not implicate any specific tissue but rather refers to any number of pain producing areas associated with the patellofemoral joint.
Subjective C/O
- Diffuse “retro-patellar pain”
- Pain with stairs and ramps
- “Movie Goer’s Sign”
Patellar Tendinitis (Jumper’s Knee)
A relatively common inflammatory condition that causes pain in the anterior aspect of the knee.
Subjective C/O
- Local pain and tenderness along the patellar tendon
- Increased pain with activity.
Common Treatments: Patellar Straps
Ruptured Patellar Tendon Presentation and Treatment
Presentation:
- Patella moves superiorly
- Palpable deficit at the anterior joint line of the knee
- Inability to extend the knee
Treatment:
- Surgical Repair
Plica Syndrome
Plica Syndrome occurs when plicae (bands of remnant synovial tissue) are irritated by overuse of injury.
The most commonly irratated band is the mediopatellar plica.
Plica Syndrome Common Managements
Structured program of stretching and strengthening exercises often leads to some improvement.
Patellar knee sleeve worn during sporting activities (usually a neoprene-type brace) may also be a useful adjunct for many athletes.
Surgical management.
Patellar Subluxation/Dislocation
A partial or complete displacement of the patella from the trochlear groove of the femur.
MOI:
Internal rotation of the femur and tibia while foot is firmly planted
Traumatically if the medial border of the patella is physically forced to the lateral side of the knee.
Patellar Subluxation/Dislocation
Severe pain
Obvious deformity
Inability to flex or extend the knee
Edema
Osgood-Schlatter Disease
Osgood-Schlatter disease, is the most common traction apophysitis and exertion injury in the adolescent knee.
Typically Self Limiting
Sinding-Larsen and Johansson Syndrome
Sinding-Larsen and Johansson Syndrome or patellar osteochondrosis, is an overuse traction apophysitis caused by repetative microtrauma atthe insertion point of the proximal patellar tendon onto the lower patellar pole
Osteochondritis Dissecans
OCD is a focal area of detached or semidetached subchonrdal bone with hyaline articular cartilage on top. It is caused by blood deprivation to the subcondral bone. OCD is most commonly located on the lateral aspect of the medial femoral condyle or on the weight bearing surface of the posterior lateral femoral condyle.
Baker’s Cyst
A Baker’s Cyst results from the knee joint swelling, which causes herniation of joint fluid and synovium through the capsule of the knee joint posteriorly, or from distention of the semimembranosus bursa.
Iliotibial Band Syndrome
ITBS is an overuse inflammatory condition due to the friction between the IT band and the lateral condyle of the femur.
Most often caused by the stress of long-term overuse.
ITBS Clinical Presentation and Treament
Clinical Presentation:
Positive Nobles Test
Positive Ober’s Test
Treatment:
RICE
NSAID’s
Flexibility
Meniscal Injury
MOI: Typically knee compression with rotation of the tibia Signs and Symptoms: - Joint line tenderness - Joint Effusion - Hx of "Locking"
Clinical Assessment
- Positive Apley’s Compression Test
- Positive McMurray’s Test
ACL Sprain
MOI if injury to the ACL include hip internal roation, tibial external rotation, knee flexion to about 30*, genu vlagum, foot pronation and forward movement of the center of gravity.
ACL Sprain Clinical Signs
Significant joint effusion
Positive Anterior Drawer Test
Positive Lachman’s Test
Positive Pivot Shift Test
Surgical Repair
Autograft:
- Patellar tendon graft (bone-tendon-bone)
- Hamstring Tendon (Usually sememenbranosus)
Allograft (cadaver ligament)
PCL Sprain
MOI: Posteriorly directed force on the tibia or forced hyperflexion.
Clinical Findings
Joint effusion
Positive Posterior Drawer Test
Positive Sage Test
Treatment: Skillful neglect.
Medial/Lateral Collateral Ligament Sprain
MOI:
Varus or Valgus Stress
Clinically indentified with Varus or Valgus Stress Test
Typically treated non-operatively
Peroneal Nerve Palsy
Characterized by:
Loss of movement (i.e. drop foot)
Decreased sensation
Common Causes: Trauma or injury to knee Fibular fracture "Tight plaster" cast Posture
Peroneal Nerve Palsy Treaments
PHyscial release of compression NSAID's Corticosteroids Surgery Return to play requires that the athlete be clear of any neurological findings
Other Treatments:
Analgesics
Athletic Training/Physical Therapy
Orthopedic Deviced (i.e. AFO)
Always Consider
Typical MOI and Risk Factors
Salient anatomical and biomechanical components
Presentation
General Treatment
