Knee Injuries By Cindy Greene

Introduction • Very complex joint • Most sports place extreme stress on the knees • Very commonly injured joint

Skeletal Anatomy • 4 bones make up the knee joint: • Femur • Tibia • Fibula • Patella

Meniscus Functions: increases stability of the joint, cushions stresses •

Stabilizing Ligaments Anterior Cruciate Ligament (ACL) • Posterior Cruciate Ligament (PCL) • Medial Collateral Ligament (MCL) • Lateral Collateral Ligament (LCL) Iliotibial band (IT)

ACL ACL: • Prevents anterior translation of the tibia. • Keeps the tibia from gliding forward. • Very strong ligament • Very susceptible to injury. • Women more prone to tear ACL than

PCL PCL: • Prevents posterior translation of the tibia. • Only 90% of size of ACL. • It is the strongest of the knee

MCL MCL: • Flat, broad ligament located on the inside of the knee • Prevents a valgus stress on the knee. • Part of it attaches to the medial meniscus

LCL LCL: • Cordlike ligament located on the outside of the knee. • Prevents a varus stress on the knee

Muscles of the Upper Leg

Knee injuries Knee is most injured joint in the body. 25% of all injuries involve the knee Nearly one million knee surgeries are performed each year. A knee injury is also the most likely injury to end an athletes career.

ACL Injuries Grade I- pain with minimal damage to the ligament. Grade II-more ligament damage and mild looseness of the joint. Grade III- The ligament is completely torn and the joint is very loose or unstable.

How Does it Occur? Forced twisting motions of the knee Hyperextension of the knee Sudden stops that cause the femur to push across the shin bone

Diagnosis History Physical exam Xray MRI

Treatment (Minor Injuries) RICE R-Use crutches and knee immobolizer I- Ice knee for 20-30 minutes every 3-4 hours for 2-3 days or until pain goes away. C-Wrap an elastic bandage around your knee to keep the swelling from getting worse. E-Keep knee elevated whenever possible.

Treatment (Major) Intensive Rehabilitation Surgery

Prevention Strengthen thigh and hamstring muscles Increase flexibility. Practice exercise (Patient Advisor pg 170) Heel Slide Quadriceps Isometrics Prone Knee Bends Passive knee extension Heel raises Wall squats

LCL Injury Causes: twisting motion or a blow to the fibula. Symptoms: pain on the outer side of the knee, swollen and tender knee, and sound or feel of a pop at the time of injury. Diagnosis: history, physical, Xray, MRI Treatment: RICE it!

MCL Injury Causes: blow to the outer side of the knee or twisting of the knee Symptoms: pain on the inner side of the knee, swollen and tender knee, having the feeling that your knee is “giving way” Diagnosis: history, physical, Xray, MRI Treatment: RICE it!

Patellar Tendonitis (Jumper’s Knee) Inflammation of the patellar tendon that connects the patella to the tibia

Patellar Tendonitis Causes: too much jumping, running, walking, improper alignment of the hip, legs, knees, or hips Symptoms: pain, tenderness and swelling Diagnosis: history, physical, Xrays, MRI The doctor will check for tenderness at the patellar tendon and pain with running, jumping, or squatting

Patellar Tendonitis Treatment: RICE it! Wear infrapatellar strap or brace and special orthotics for over-pronation. Prevention: Wear proper shoes and stretch!

Patellar Tendonitis Rehab Exercises Practice exercises (Patient Advisor pg 201) Patellar mobility Standing hamstring stretch Quadricep stretch Straight leg raise Knee stabilization

Patellofemoral Pain Syndrome (Runner’s Knee) Pain behind the patella (includes patellofemoral disorder, patellar malalignment, runner’s knee, and chondromalacia)

Patellofemoral Pain Syndrome Causes: repetitive bending and straightening of the knee Symptoms: pain behind the knee cap, pain when you walk or run or sit for a long time, swelling, or snapping, popping or grinding in the knee Diagnosis: history, physical, Xray Treatment: RICE it! Wear orthotics and/or infrapatellar strap Prevention: Strengthen thigh muscles

Other Knee Injuries Dislocation of the patella Illiotibial Band Syndrome Bursitis

Sports Specific Basketball: Result from the player taking a blow to the knee from the side. Also can be caused by changing direction of running abruptly Football: Can suffer from runner’s knee, jumper’s knee, dislocated knee Terrible Triad of O’Donahue: tears to the MCL, ACL, and the medial cartilage (“blew out a knee”)

Sports Specific Gymnastic/Cheerleading: Knee injuries can occur secondary to the knee hyperextending when tumbling or dismounting Runners: Runners can suffer from runner’s knee and illiotibial band syndrome. Foot strike and mechanics plays an important role in the prevention of knee injuries.