Knee trauma

Question 1

Ticket muscles

Answer 1

Quads and HS

Question 2

Who does it generally affect

Answer 2

sports people participating in contact sports and fast directional changes

Question 3

Pathology

Answer 3

1. Traumatic event at the knee (closed chain, valgus force or rotation)
2. Risky activity (football, netball, skiing, skating)

• MCL injury: valgus force – particularly flexed knee
• Meniscal Injury: closed chain rotation
• ACL injury: rotation and valgus force

Question 4

Classification of injuries

Answer 4

• Knee trauma - knee jt synovitis
• MCL: mild/ partial/ complete rupture
• Meniscal: vertical/ transverse/ bucket handle
• ACL: with either MCL/ meniscal.
  Mostly full rupture of ACL

Question 5

Presentation

Answer 5

1. Acute synovitis:
   Knee ache, cardinal s
   A: end range movts, excessive general movts, still for
   too long
   E: NSAIDS, hot/ cold, gentle movt, bracing, strapping &
   support
2. MCL:
   A: valgus stress
   E: bracing, strapping
3. Medial meniscus:
   Can be older too (degenerative menisci)
   A: twisting at the knee
4. ACL:
   Swelling - intraarticular bleeding(mins to an hour),
   instability, traumatic, hear a pop

Question 6

Physical features

Answer 6

• MCL: palp MCL and valgus stress test
• Medial Meniscus: palp tibiofemoral joint line, McMurrays
  test and Apleys test
• ACL: anterior drawer test, lachmans test, sag sign test

Question 7

Prognosis

Answer 7

MCL - within 16wks for G1-2. G3 needs immobilisation which will push prognosis out by 4-6wks

Medial Meniscus - Highly variable

ACL - 9mnths is standard recovery

Question 8

Surgical intervention

Answer 8

• MCL injury – No imaging required
• Meniscal injuries – MRI
• ACL – MRI

Question 9

Initial Management

Answer 9

Optimal loading, bracing (G3 for 3w), taping (G1/2), flexion (MWM, passive knee flexion in prone, MET),
extension (MWM, passive ext mobs)
Interventions (strength & fitness):
Knee ROM (active & passive physiological movts), quads & hamis strength, CV fitness, strength of other unaffected parts

Question 10

Rehab

Answer 10

1. restore quads strength
2. restore HS strength
3. restore strength in any other impaired muscles
4. restore functional strength
5. restore spring function - running (low) and plyometrics (high)