Knee Pathologies Flashcards
Osgood Schlatter Disease
Inflammation of tibial tubercle prior to ossifying; benign and self-limiting condition that waxes and wanes and can take months to years to resolve; common in active, skeletally immature athlete, often after a growth spurt; Males: 10-15, Females: 8-13
Sinding-Larson-Johansson Syndrome
Apophysitis of the inferior pole of the the patella at the growth plate; occurs most often ages 10-15 during period of rapid growth; more prevalent in kids who play sports that require running and jumping
Patellar Tendinitis
Inflamed patellar tendon; acute (because -itis, not -osis); quadriceps tendonitis; history of repetitive jumping, running, or over use
Fat Pad Syndrome; “Hoffa’s”
Anterior knee pain due to inflammation of the infrapatellar fat pad; due to direct trauma or chronic knee hyperextension “insideous onset”
Knee Bursitis
Prepatellar bursa, suprapatellar, Pes anserine, Superficial and deep infrapatellar, semimembranosus/Gastrocs; repetitive microtrauma causes bursal irritation; produces more fluid to to lubricate adjacent tissues at the expense of absorbing friction; results in inflammation of the bursa
Iliotibial Band Friction Syndrome
Tight ITB; hypertonic TFL?; Often over pronation at the foot, lateral knee pain and tenderness of ITB
Baker’s Cyst
Most common mass in the popliteal fossa; fluid distension of the gastroc-semimembransosus bursa; synovial cyst, usually communicates with the joint lined by synovium
Tibial Plateau Stress Fracture
Proximal 1/3 of tibia most common site for stress fractures in adolescents; in runners typically occurs near middle/distal 1/3rd; most frequent stress fracture location in military training
PFPS
Vague anterior knee pain aggravated by activities that increase compression across the PFJ; most common in young and active population; females > males 12-17 yo; most common injury in runners; high incident of recurrence and chronicity
PFJ Instability/Subluxation
Partial loss of contact between the patella and femur; lateral subluxation most common; females > males
ACL Injury
Most often non-contact injury; acceleration/deceleration at full extension or slight flexion coupled with tibial rotation (IR/Valgus without HS co contraction and excessive quad contraction); females > males
Arthofibrosis
Complication of injury or surgery; excessive scar tissue formation; intra and/or extra articuar; thought early ACL repair may increase likelihood or delay in regaining motion after surgery; marked limitation of flexion, extension, and patellar glide; widespread inflammation
PCL Injury
MVA: “Dashboard injury” (posterior blow to the tibia -tibia thrusted posteriorly- with a flexed knee)
Contact sports: fall on a bent knee with their foot plantarflexed - tibia hits the ground first and it translates posteriorly; hyperflexion in external rotation
MCL Injury
Valgus blow to knee or CKC with a plant/cut valgus stress; most common ligament strained of the knee; Most common injury in NFL/alpine skiing; second most common injury in collegiate hockey and women’s rugby; Grade III injury ~80% concomitant ligamentous injury (95% of the time = ACL)
LCL Injury
Least commonly injured knee ligament; Usually with LCL injury there’s additional soft tissue injury (soft tissue avulsion of proximal femur or bony avulsion off fibular head); seen with more extensive posterolateral corner injuries (PLC)
Meniscus
Common cause of mechanical sx at the knee; meniscal tear common; we all probably have something wrong with our menisci i.e. sometimes not symptomatic; sx indicate higher level of injury
PLC (Posterolateral Corner)
Anatomy:
Muscles = popliteus, lateral head of gastroc, short head of biceps femoris
Ligaments = fibular collateral lig, arcuate ligament
Miscellaneous = Lateral Meniscus, lateral retinaculum
Prevents: Varus, and tibial ER primarily, Secondarily assists PCL with posterior tibial translation (30 degrees) and hyperextension
One of the most common multi-lig injuries; commonly missed with ACL
Articular Cartilage Defects
Commonly at medial femoral condyle and patella articular surface; medial meniscus tears and ACL rupture most common concomitant injuries
Tibiofemoral OA
Degradation of articular cartilage at tibfem joint
Patellofemoral OA
PF pain + radiographic changes consistent with changes
Chondromalacia patella
PF OA; often indicates softening of the carilage on the posterior aspect of the patella, not common; chondral legions usually asymptomatic until bone is irritated
Patellar Tendinopathy/Tendinosis
Non-inflammatory disorder of the tendon typically occurring near the inferior pole of the patella; common among athletes involved in jumping activities
Popliteus Tendonitis
Inflammation of the popliteus tendon; common in runners
Acute tendon ruptures that happen
Quad and Patella tendon
Other possible fractures at the knee
Femur or patella fractures
Peripheral Nerve injuries possible
Saphenous (confused with pes anserine problems; medial knee pain, typically worse at night, increased with limb activity) Superficial peroneal (compression or direct blow pain, parasthesias over lateral leg, possible motor weakness)
Medial plica syndrome
Plica that has become symptomatic due to:
direct trauma/blow to plica, blunt trauma, twisting injury, activities requiring repetitive flex/ext of knee, increased activity levels, mechanism resulting in intraarticular bleeding or synovitis secondary to a loose body, osteochondritis dissecans a torn meniscus, a subluxing patella or after arthroscopy
