Knee pathologies

Question 1

Meniscal Lesions

Answer 1

• often seen in athletes as a result of a sports injury and represent approximately 15% of all cases sports injuries.
• Medial tears are reported more commonly than lateral tears
• Presentations: Joint line tenderness, Mc Murray test, Thessaly test and squat test. Symptoms are popping sound and intermittent residual pain.
• Management: conservative treatment focusing on strengthening of the quadriceps muscle to prevent secondary quadriceps atrophy.

Question 2

Muscle Strain: Quadriceps

Answer 2

• A quadriceps muscle strain is an acute tearing injury of the quadriceps due to a forceful contraction or repetitive functional overloading.
• Strains are graded 1 to 3 depending on how bad the injury is, with a grade 1 being mild and a grade 3
  Management:
• NSAID’s ( nonsteroidal anti-inflammatory drugs) is still controversial, their benefit, cost and potential adverse effects may be taken into consideration. If used, it should be during the inflamatory period (48h-72h)
• RICE therapy
• Active management (3-5 days after injury): Stretching, strengthening, range of motion, maintenance of aerobic fitness, proprioceptive exercises, and functional training

Question 3

Hamstring strain

Answer 3

• caused by a rapid extensive contraction or a violent stretch of the hamstring muscle
• Graded I-III

Question 4

PT management of hamstring strain

Answer 4

Phase I (0-3 weeks): Protect healing tissue
Minimize atrophy and strength loss
Prevent motion loss
Phase II (3-12 weeks): Regain pain-free hamstring strength, progressing through full ROM
Develop neuromuscular control of trunk and pelvis with a progressive increase in movement and speed preparing for functional movements
Phase III (12+ weeks): Symptom-free during all activities. Normal concentric and eccentric strength through full ROM and speed. Improve neuromuscular control of trunk and pelvis. Integrate postural control into sport-specific movements

Question 5

Sinding Larsen Johansson Syndrome

Answer 5

Pain at the bottom of the kneecap (patella). It is caused by swelling and irritation of the growth plate there.
Usually appears in adolescence, during the growth spurt.
Symptoms: Worse with exercise, stair climbing, squatting, kneeling, jumping and running.
May report that they limp after exercise.
May be unilateral or bilateral.
Is relieved by rest

Question 6

PT management of sinding Larsson Johanssen Syndrome

Answer 6

• educate the patient on activity modification.
  -Core strengthening should be initiated as well as exercise addressing flexibility or strength issues.
  -Therapy should consist of eccentric exercises and isokinetic strengthening

Question 7

Osgood-schlatter disease

Answer 7

inflammation of the area just below the knee where the patellar tendon attaches to the tibia
Clinically, it presents as atraumatic, insidious anterior knee pain, with tenderness at the patellar tendon insertion site at the tibial tuberosity

Question 8

PT management of osgood schaltters

Answer 8

Ice application after activity reduces the anterior knee pain
Limiting the sports activity, for 6-8 weeks is advisable.
Gentle stretch to Quadricep and Hamstring muscle ,along with strengthening of Vastus Medialis Oblique muscle decreases pain.
Patellar loading is decreased by patellar tapping/ McConnel tapping, and by the use of brace.

Question 9

Patellar Tendinopathy

Answer 9

Anterior knee pain, characterised by pain localised to the inferior pole of the patella

Question 10

PT management

Answer 10

Selective rest should be provided to allow appropriate tendon healing following a period of acute overloading or unaccustomed exerciseThere should be a focus on an early return to activities.