KNEE INJURUES Flashcards
KNEE PAIN: Sources
→ Contractile structures
→ Referred pain
→ Non contractile structures
COMMON CAUSES OF ACUTE PAIN: Common, less common, not to be missed
C: medial meniscus tear, MDL sprain, ACL rupture, lateral meniscus tear, articular cartilage injury, PCL sprain, patellar dislocation
LC: patellar tendon, quadriceps tendon rupture, LCL sprain, bursal haemotoma, acute fat pad impingement, sup tibiofibular JT injury & avulsion of biceps femoris
NTBM: tibial plateau fracture, avulsion fracture of tibial spine, osteochondrosis dissecans, complex regional pain syndrome & quadriceps muscle rupture
ACL: anatomy, fct, proprioceptive organ, mechanism of injury, at risk population, assessment
A: = Passive restraint to anterior tibial translation
- Assisted actively by hamstrings
≠ with ACL: swelling in medial side while for ACL swelling in joint
F: Prevent excessive anterior tibial translation, Provide proprioceptive inputs, Work with hamstring muscles
PO: - Contains mechanoreceptors
- When ruptured: Altered neuromuscular control at knee
- Affects motor control, muscle strength, muscle recruitment & movement patterns
- High risk for re-injury if neuromuscular fct not rehabilitated
MoI: schema
R: - Females 2-8x more likely than males
- 15-40 years of age
- Cutting non-contact sports: handball, soccer, volleyball - Non-contact up to 78%
A: Subjective
-Sudden onset
- Rapid moderate to severe swelling - Feeling of instability
- Pain
Objective
- Swelling
- Positive Lachman’s
- Anterior Drawer, Lever’s sign
- Can have associated positive MCL & medial meniscus tests
PCL RUPTURE: fct, mechanism of injury & assessment
F: - Prevent posterior tibial translation - Work with quadriceps muscles
MoI: Far less common than ACL rupture
- Usually results from direct blow to tibia in posterior direction
- Mild to moderate effusion & pain
- May not realize they have ruptured their PCL (no pop/snap)
A: Clinical tests include:
- Positive posterior sag test - Positive posterior drawer
MCL TEAR: anatomy, mechanism of injury & assessment
A: ≠ with ACL: swelling in medial side while for ACL swelling in joint
MoI: - During rapid valgus motions, usually with flexed knee (consider MOI of ACL)
- Typically injured while cutting/landing/ jumping
- Frequently occur in combination with ACL & medial meniscus due to MOI & attachment of MCL to medial meniscus (‘Terrible triad’)
A: Valgus stress test => pain and/or laxity
- Palpation medial joint line => Pain across MCL fibers
- Instability => episode of giving way
LCL TEAR: mechanism of injury & assessment
MoI: Not as common as MCL injuries
- Same grading scale can be applied - Normally involve direct trauma/ force to medial knee joint forcing knee into varus
A: Clinical signs:
- Pain over lateral knee joint - Positive varus stress test
MENISCAL TEARS: mechanism of injury, at risk population, assessment & subjective/ objective info
MoI: Twisting/pivoting motions + knee flexion, compression & femoral rotation
- Medial often injured with ACL ruptures due to attachment to MCL & medial capsule
R: Young athletic people & Older degenerative knee’s
A: Turning, change of direction, jumping => Painful, particularly with rotation/twisting
- Clicking => Present or not
- McMurrays => Painful and/or clicking
- Thessalys => Painful and/or clicking - Knee ROM => Decreased depending where lesion located/painful with overpressure
- Joint line palpation => Painful medial/laterally if anterior lesion in medial/lateral side
I: Possible tearing feeling at time of injury
- Pain & swelling increases over 24 hours
- Swelling come & go
- Intermittent locking
- Joint line tenderness (medial or lateral)
Non acute causes: ant, post, med & lat
Tableau
PATELLOFEMORAL PAIN: incidence, description, risk factors & assessment
I: 2-10 times females > males
D: Mild to moderate pain over PFJ that diffuse or vague - Develops from chronic overload (excessive running load), poor knee biomechanics, abnormal anatomical alignment
RF: Runners with combination of increased: - Hip adduction
- Hip IR
- Hip extension
- Knee valgus
- Knee IR
- Foot pronation - Ankle DF
A: Squatting, Stair climbing, running, jogging and/or hopping => Pain (anterior knee/PFJ)
- Patella palpation=> Pain on palpation
- Knee extensor strength => < 1.5 BW (1 rep max) & pain
PATELLA TENDINOPATHY: description, risk factors & assessment
D: - Pain at patella tendon (commonly incorrectly referred to as ‘tendonitis’)
- Sometimes hard to distinguish from PFP & may co-exist
RF: Common in repetitive jumping activities/ sports
- Common among athletes & people who increase activity too quickly
A: Jumping, running, jogging and/or hopping => Pain localised to patella tendon
- VISA Questionnaire <80
- Ultrasound => Positive changes on Doppler imaging
- Knee extensor strength < 1.5 BW (1 rep max)/ pain
KNEE OA: incidence, description, risk factors & assessment
I: - 4% of population - Women > men
D: Large public health cost (billions) across various countries
- 11th highest contributor to disability
- Currently no cure, must be managed
- More frequent in medial compartment than lateral - Higher risk of developing condition if previous ACL and/or meniscal injury
RF: Patient with previous ACL or meniscal injury - Obesity
A: STS, walking and/or stair climbing => Pain and difficulty as disease progresses
- Stiffness in AM => Present or not
- Palpation => Feel cold/hard (presence of osteophytes) - Effusion => Present or not
- Knee ROM => Decreased flex/ext & pain with overpressure (meniscal degeneration)
- X-ray >1 Kellgren & Lawrence
OSGOOD-SCHLATTER DISEASE: incidence, description & assessment
I: Adolescent injury (Boys ≈12-13 y)
D: Traction Apophysitis (inflammation) tibial tuberosity
A: Clinical signs/tests:
- Pain with palpation of tibial tuberosity - Swelling
- Pain with loaded knee extension
- Rule out PFP and/or referred pain
≠ PFPS & patellar tendinopathy
Tableau
