M. Shane Smith, M.D. Athens Orthopedic Clinic Assistant Professor University of Georgia Health Sciences Center Philadelphia College of Osteopathic Medicine

No Financial Disclosures

Orthopedic Surgeon Sports Medicine Knee, Shoulder, Elbow Surgery Trauma/ Fracture Surgery

ORTHOPEDIC SURGEON!!??

Common Knee Conditions

Knee Joint Anatomy

Knee Joint Anatomy

Knee Injuries Acute injury Overuse injury Chronic underlying condition meniscal tear, ligament rupture, fracture Overuse injury tendonitis, bursitis Chronic underlying condition arthritis, untreated old injury Traumatic vs Atraumatic

Traumatic Injuries

Atraumatic Injuries

“Other” Injuries

Traumatic Knee Injury Ligament (ACL, MCL, PCL, LCL) Tendon (Patellar, Quad, Hamstring) Meniscus (Medial/Lateral) Articular Cartilage (OCD, Loose body) Fracture/ Dislocation (Patellar inst)

History Acute Swelling  Ligament or Tendon tear Delayed Swelling  Articular or meniscal cartilage injury Instability (“my knee popped out”) patellar instability

Mechanism of Injury Twisting, Non-contact: Landing/ Planting: meniscus, ACL Landing/ Planting: ACL Landing on bent knee: PCL Eccentric Loading (pushing off): Quad or patellar tendon tear

ACL Tear Non-contact twisting injury Feel a pop Immediate swelling +Lachmans, +Anterior Drawer sign Xrays, MRI Tx: ACL Reconstruction “Pre-hab”, ROM

Meniscus Tear Twisting/bending usually in a weight bearing maneuver Sometimes popping sensation, giving way, “locked knee” Exam: +joint line TTP; +McMurrays test, +effusion Xrays usually negative MRI confirms DX Tx: Conservative vs Surgical (Arthroscopy)

Patellar Dislocation Twisting + valgus position “My Knee Popped Out” Exam: +TTP over medial patellar; +apprehension; +hemarthrosis/effusion Xrays: Merchant view +subluxation, tilt, alta, osteochondral fx/LB MRI confirms DX Tx: Conservative vs Surgical

Patellar Dislocation

Patellar/Quad Tendon Tears Jumping/landing Eccentric loading Usually a loud pop, inability to ambulate. Exam: +TTP over defect above or below patella +hemarthrosis/effusion INABILITY TO EXTEND KNEE!! Xrays: patella alta/baha MRI not necessary but helpful is other knee injury suspected Tx: Surgical Patellar tendon tear Quad Tendon tear

Atraumatic Knee Injury Tendonitis(Patellar, Pes, Quad) Bursitis (Prepatellar, Pes) IT Band Friction Syndrome Patellofemoral Syndrome Chondromalacia/Arthritis

Patellar/Quad Tendinitis Runners, skiers, repetitive lunging/squatting Pain, no injury, change in activity Exam: Tender over tendon insertion; rarely tender at the joint line; usually no effusion Xray: usually negative Tx: NSAIDS, PT, activity mod

Knee Bursitis Runners, overuse Pain, no injury, change/increase activity. Exam: +TTP over bursa; +/- bursal effusion; watch for secondary infection Xray: negative Tx: NSAIDS, PT, activity modification, occasionally surgery

Knee IT Band Syndrome Runners, overuse Pain lateral knee; no injury, change/increase activity Exam: +TTP over Lateral knee; no effusion, +IT band tightness; look for hip bursitis Xray: negative Tx: NSAIDS, PT, activity modification

Knee Chondromalacia/Arthritis

Treatment Options NSAIDS PT INJECTIONS ARTHROSCOPY ARTHROPLASTY

Injections Corticosteroids Viscosupplements: Synvisc, Orthovisc, Supartz, etc. PRP/Stem Cell Injections?????????

Thank you!!