Knee and Hip Conditions and Injuries

Meniscus Tear Etiology: force to the knee causing translation of the tibia (any direction), twist or hyperextension S&S: popping, locking or giving out of the knee, joint inflammation Continued play on a meniscus tear can lead to shredding of the cartilage- typically requires surgery

Plica Etiology: 20% of the population fails to create 1 synovial capsule in the knee from the 3 original-this left over fold of synovial tissue can become inflamed during repetitive knee motions S&S pain, clicking, inflammation, palpable fold or ridge

Patellar tendonitis (Jumper’s knee) Etiology: repetitive resisted knee extension (jumping, kicking or running). More common in adolescents because they are still growing causing pull on the tendon. S&S: pain, inflammation, thickening of the tendon Can lead to rupture but very rare

Osgood Schlaters (tibial apophysitis) Etiology: excessive pull on a tendon insertion, in response the bone overgrows S&S: pain, swelling over insertion site, possible bony growth over insertion site *if not treated can cause an avulsion fx

Iliotibial (IT)band friction syndrome (runners knee) Etiology: tightness in the IT band causes it to rub over the lateral tibial and/or femoral condyle. More common in women with wider hips. – Can also cause “snapping hip” or runner’s hip when it rubs or snaps over the greater trochanter of the femur S&S: pain, popping on lateral knee and or greater trochanter, inflammation

“True” Knee Dislocation Etiology: blow to the distal leg with foot planted (blow from any direction more likely to see lateral or anterior tibial translation) S&S: obvious deformity, pain and inability to move joint *Medical emergency because of arteries and nerves

Anterior Cruciate Ligament (ACL) Sprain Etiology: Severe hyperextension, blow to the lateral knee with knee slightly bent (30 degrees) S&S pop pain inside the knee, swelling, laxity with anterior stress to the tibia 3 rd degree sprains require surgery

Posterior Cruciate Ligament (PCL) Sprain Etiology: Fall with full weight on the anterior tibia, hyperextension or hard blow to the anterior tibia Not as common as ACL S&S: Feel a “pop,” posterior translation of the tibia on the femur, pain and joint inflammation 3 rd degree sprain require surgery

Lateral Collateral Ligament (LCL) Sprain Etiology: blow to the medial knee or extreme internal rotation of the tibia. Rare S&S: pain and inflammation over the lateral joint line, varus laxity

Medial Collateral Ligament (MCL) Sprain Etiology: blow to the lateral knee, or severe external twisting S&S: inflammation, pain on medial joint line, medial joint line laxity with valgus stress Typically does not require surgery because of good vascular supply to the area

Patellar Dislocation Etiology: deceleration with planting and cutting or blow to the knee causing the quadriceps to pull the patella laterally S&S: deformity, inability to flex knee, pain and muscle spasm Often relocates on its own

Patellar Fracture Etiology: direct or indirect trauma (severe pull on patellar tendon when knee is semi-flexed) Signs and Symptoms: extreme inflammation, pain with movement of the knee Complication: 2-3% of the population has bipartite patella and can mimic patellar fracture

Chondromalacia (patelofemoral syndrome) Etiology: softening and deterioration of the articular cartilage on the deep portion of the patella usually due to repeated stress, leg posture or strength deficiencies Signs and symptoms: pain on anterior knee with activity especially stairs, deep squats or jumping as well as inflammation and edema

Valgus Vs Varus

Hip Anatomy

Hip Dislocation Etiology: Rare in sports, more common in car accidents. Most common when the femur is pushed posterior to the accetabulum S&S: stuck in flexed abducted position, pain and deformity *medical emergency because of neurovascular compromise

Hip Labral Tear Etiology: extreme rotation, planting on a straight leg S&S pain with extreme ROM, popping or clicking *only treatment is to tack down or remove the torn portion

Acute Femoral Fracture Etiology: more common in the elderly, direct blow, or severe twisting Signs and Symptoms: significant pain, inability to stand or walk, possible shortening of the limb Management: medical emergency due to the vascularization of the area, often require surgery to stabilize the area Special Considerations: femoral head fractures may shift (slip) mimicking a hip dislocation.

Femoral Stress Fracture Etiology: more common in the femoral neck, more common in females, due to repetitive stress and hip angle Signs and Symptoms: pain during or after activity that increases over time, x-rays may not catch this type of fracture Management: bone scan or MRI

Ischial Avulsion Etiology: sudden strong contraction of the hamstrings (hamstring tendon pulls a portion of the ischial tuberosity off) Signs and Symptoms: pain with active hip extension/knee flexion, pain when sitting on hard surfaces Management: X-ray to confirm fracture

Sacroiliac sprain Etiology: repetitive hyperextension of the hip, torsion, prolonged hip and lumbar flexion S&S: pain or SI joint, pain with hyperextension or terminal flexion of the hip. May be associated with a true or false leg length descrepancy Over time may cause inflammation of the sciatic nerve causing radiating pain down the leg and possible muscle weakness

Broken Tail Bone AKA Coccyx Fracture Etiology: Fracture of the coccyx due to fall in a seated position, direct blow, or in child birth S&S: pain especially when sitting or with direct pressure

Ricketts Softening of the bones due to decreased Vitamin D, Calcium, and/or Phosphorus Usually the result of malnutrition or famine