Common Knee Injuries

Meniscus Tears Knee twisted suddenly Ligaments in & around knee torn One or both menisci become trapped between femur and tibia Ligaments in & around knee torn As ages, menisci lose their rubbery consistencywill soften and fray Weakened structures torn more easily

Knee Injuries Meniscus tears/lesions Parrot beak tear Bucket handle tear Medial “C” Lateral “O”

Meniscal Tear

Meniscus Tears Signs & Symptoms Treatment Mild knee swelling over several hours or more Joint line pain Locking Giving way of knee RICE Rehab (non-surgical) Strength ROM Activity modification NSAIDS Support sleeve Surgery MRI

Knee Injuries (cont.) Knee Plica: Remaining fetal tissue in the joint exist in adults as folds in the synovial capsule Locking, popping or snapping can be experienced Squatting is especially problematic

Knee Injuries (cont.) Loose bodies (aka “joint mice”) fragments of torn tissue (lig, meniscus, bone, capsule) locking, popping, giving out Osteochondritis Dissecans: break down of articular cartilage due to poor blood supply or endocrine imbalance Ache Catch, lock Atrophy-Why? Point tenderness

Osgood-Schlatter’s Disease Also known as “Jumper’s Knee” Must have growth plates to develop aka Tibial tuberosity apophysitis

Patellofemoral Syndrome (PFS) (and Chondromalacia Patellae) PFS= patella doesn’t track right

Patellofemoral Syndrome (PFS) (and Chondromalacia Patellae) PFS= patella doesn’t track right Result: increased friction between femur and patella

Patellofemoral Syndrome (PFS) (and Chondromalacia Patellae) PFS= patella doesn’t track right Result: increased friction between femur and patella Loss of cartilage under patella=chondromalacia patella

Patellofemoral Syndrome (PFS) (and Chondromalacia Patellae) PFS= patella doesn’t track right Result: increased friction between femur and patella Loss of cartilage under patella=chondromalacia patella Results in grinding This is what the Patellar Grind test is SUPPOSED to test for

Patellofemoral Syndrome Causes Tight hamstring and calf muscles Increased Q-angle Poor foot mechanics Weak quadriceps muscle Treatment S/S Orthotics Muscle strengthening Muscle stretching Patellar tracking taping Dull ache Crepitus Pain with compression Tenderness on Patellar edge

Patellar Tendonitis Signs & Symptoms Treatment aka “Jumper’s knee” Inflammation of the patellar tendon d/t repetitive deceleration Anterior knee pain Local tenderness Local swelling Treatment Modify activity Non-impact activities Stretching/strengthening quads Ice Specialized bracing & taping NSAID’s

Knee Injuries Ligament Tears ACL PCL MCL LCL * What is the Terrible Triad?

MCL Sprain MOI Signs & Symptoms Valgus force medial tibiofemoral joint Blow to lateral aspect of knee High-energy twisting maneuver Pain & tenderness on medial aspect of knee Joint line Bony attachment sites Limited motion in full flexion and extension Swelling Varying degrees of laxity

MCL Sprain—Treatment RICE Rehab Gentle active & passive stretching Submax strengthening in subacute stage, but only if painfree Bike once gain flex 110-115 degrees Gentle active & passive stretching Avoid valgus & twisting forces Restrict activity until aymptomatic

LCL Sprain Not frequently involved in sports injuries MOI: varus stress on medial tibiofemoral joint Signs/symptoms & treatment similar to those of MCL sprain

ACL Tear Contact or non-contact Low to lateral knee Knee joint in combined position of flexion, valgus, and rotation of tibia on femur Once stretched or ruptured, will not heal Often accompanied by meniscus tears and/or MCL sprains

ACL Injuries Females who participate in soccer and basketball 4-6 times more likely than males who play same sport 70% are non-contact injuries Why incidences higher in females?

Female Factors & ACL Biomechanical factors Hormonal influences Use quads more than hamstrings Land on flat foot vs toes Hormonal influences Estrogen levels Environmental factors Anatomic risk factors

ACL Tear—Signs/Symptoms Heard or felt “pop” Rapid effusion Knee “buckles” or “gives way” F/u with orthopedist MRI to confirm

Normal ACL ACL Graft

ACL Tear—Treatment Acute: splint, ice, compressive wrap, crutches Reconstructive surgery necessary to replace ACL Patellar tendon Hamstring tendon Cadaver Comprehensive rehab (6 months)

PCL Injuries Account for 3-20% of all injuries Less researched because injured less often (compared to ACL) MOI: tibia strikes ground/object and is pushed backward Motor vehicle accident Industrial accident Fall on flexed knee with foot plantar flexed Hyperflexion of knee

PCL Signs & Symptoms Treatment Heard or felt “pop” RICE Minimal swelling Posterior tibial sag RICE Rehab Strength Quadriceps Proprioception Surgery usually avoided

Knee injuries What is wrong with this knee?

Patella Dislocation MOI Signs/Symptoms Plants foot, decelerates, change of direction Signs/Symptoms Obvious deformity Pain Swelling Loss of function Treatment RICE Immobilize ROM & strengthening Taping and bracing

Wear protective equipment Thigh Contusion MOI Severe impact to the thigh S/S Pain Loss of function Swelling Treatment Ice Compression with knee flexed Wear protective equipment

Knee Injuries Contusions: Decreased ROM, hematoma, increased pain, discoloration Bursitis: Prepatellar=“Housemaids Knee” Baker’s cyst Swelling in popliteal fossa, may be painful, may decrease ROM

INJURY: Iliotibial Band Friction Syndrome “Runner’s Knee” An overuse condition commonly occurring in runners and cyclists Irritation of the IT band on the lateral side of the knee or insertion on tibia (Gerdy's Tubercle) As the knee flexes and extends the IT band rubs over the bone creating the irritation

INJURY: IT Band Friction Syndrome (cont.) S/S: Tenderness; pain increasing during activity; mild swelling Treatment: PRICE; ice massage; warm-up & stretch

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