1. Knee Injuries

2. ACL Tear Involved Structures: ACL MOI: Changing direction rapidly
Stopping suddenly
Slowing down while running
Landing from a jump incorrectly
Direct contact or collision, such as a football tackle

3. ACL Injury

4. ACL Tear Predisposing factors = HUGE area for current research!
More likely to occur in females than males
Hormonal?
Anatomical factors?
Level of conditioning?
Jump landing
Landing with knees more extended

5. ACL Tear S/S: Observation: Palpation: Tender along joint line
Feel and hear a “pop”
Severe pain and disability
Initial pain may subside in a few minutes
Observation:
Rapid joint line swelling
Palpation: Tender along joint line
Special Tests:
Decreased ROM
Positive Lachman’s test
MRI Confirmation

6. MRI of ACL
Normal ACL in RED
Torn ACL

7. ACL Tear Care RICE Crutches
No surgery = increased risk of knee joint degeneration
Surgery = ACL Reconstruction using graft
4-6 months of rehab following surgery
Use of knee brace = little evidence exists but still recommended by many physicians

8. Surgery = Arthroscopy
Intact ACL
Torn ACL

9. ACL Reconstruction
Graft may be made of patellar tendon or hamstring tendon

10. PCL Sprain Involved Structures: PCL
MOI: Fall with full weight on front of a bent knee
Also could be a rotational force
S/S: Feel a pop in the back of the knee

11. PCL Sprain
MOI = Fall on a bent knee

12. PCL Sprain Observation: Palpation: Special Tests:
Minimal swelling in back of knee
Palpation:
Tenderness in back of knee
Special Tests:
Positive posterior sag test
MRI Confirmation

13. MRI of PCL
Normal PCL
Torn PCL

14. Posterior Sag from PCL rupture

15. PCL Sprain
Care:
RICE
Grade 1-2= Non-operative rehabilitation focusing on quadriceps and hamstrings
Grade 3= May require surgery

16. MCL Sprain Involved Structures: MCL
Can also involved medial joint capsule and medial meniscus because of attachment
MOI: Result of direct blow to outside of knee or a twisting force of knee
VALGUS force

17. MCL Sprain
MOI twisting or direct blow = VALGUS force

18. MCL Sprain S/S: Observation:
Pain along medial aspect of knee
Observation:
Swelling around MCL
Palpation: Tender along medial aspect of knee
Special Tests:
Positive valgus stress test

19. MCL Sprain Care RICE Crutches Rehabilitation Progression
Focus on quadriceps strengthening
Heals well  Surgery usually not necessary

20. LCL Sprain Involved Structures: LCL MOI: Result of a varus force
Direct blow is rare

21. LCL Sprain
MOI  Direct blow to inside of knee or twisting = VARUS force

22. LCL Sprain S/S: Observation: Palpation: Care:
Pain over lateral aspect of knee
Observation:
Swelling around LCL
Palpation:
Pain and tenderness over LCL
Special Tests:
Positive varus stress test
Care:
RICE
Crutches
Rehabilitation Progression
Focus on quadriceps strengthening

23. Meniscus Injuries Involved Structures:
Medial meniscus more common because it attaches to MCL
Lateral meniscus not attached and therefore can “move out of the way”
MOI: Rotational force while weight bearing

24. Meniscus Injuries S/S: Observation: Palpation: Special Tests:
Intermittent locking, clicking, and giving way
Pain- increase with squatting
Observation:
Swelling may be present
Palpation:
Point tender along joint line
Special Tests:
Loss of ROM
Positive McMurray Test
MRI Confirmation

25. Meniscus Injuries
Care: Location/size of tear determines need for surgery
Disability, pain, and locking may mean surgery is required
2 Surgery Options:
1.) Menisectomy = remove part of meniscus
Quick recovery!
2.) Meniscus Repair = suture to repair torn portion
Long recovery!

26. Meniscal Tears

27. Surgical Treatment of Meniscal Tears
Menisectomy
Suture/ Repair

28. Tibiofemoral Dislocation
Involved Structures:
Tibia
Femur
Poplietal Artery
Knee Ligaments
MOI:
High velocity impact
Car accident
Direct blow during contact sport
Up to 40 percent of patients with knee dislocations sustain an associated vascular injury

29. Tibiofemoral Dislocation
S/S: Pain, instability, and deformity
Observation: Obvious deformity
Special Tests:
X-Ray and MRI
Nerve and Vascular tests to assess damage

30. Tibiofemoral Dislocation
Care:
Immobilization- splint on field to prevent further damage
Surgical emergencies
Without rapid identification and repair, associated vascular injuries may jeopardize the leg.
Immediate reduction followed by careful neurovascular assessment is necessary.
Eventual repair of ligaments

31. Tibial Plateau Fracture
Involved Structures:
Tibial plateau
Femoral condyles
MOI:
Fall with knee extended Axial load
Twisting

32. Tibial Plateau Fracture
S/S:
Pain with weight bearing
Observation:
Swelling
Palpation:
Point tender near joint line
Special Tests:
X-ray and MRI to confirm
Care:
Non-displaced = brace and rehabilitation
Displaced = surgery

33. Patellar Dislocation Involved Structures: MOI: Patella
Patellofemoral Groove
Medial Retinaculum
Lateral dislocation is most common!
MOI:
Direct blow
Rapid change of direction
Twisting of knee

34. Patellar Dislocation S/S: Observation Palpation Special Tests:
Total loss of function
Pain
Unstable
Observation
Obvious Deformity
Rapid Swelling
Palpation
Obvious deformity
Pain along medial aspect of knee
Special Tests:
Limited ROM
Positive Apprehension Test
X-ray

35. Patellar Dislocation Care: Immobilize RICE
Rehabilitation program focusing on quadriceps
Surgery may be required for repeated dislocations
Taping/Bracing
McConnell Tape
Knee Brace

36. Patellar Fracture Involved Structures:
Quadriceps tendon
Patellar tendon
MOI: Direct or indirect trauma (severe pull of tendon)
Forcible contraction, falling, jumping or running

37. Patellar Fracture S/S: Pain, swelling
Observation: Swelling, possible deformity
Palpation:
Tender over patella
Palpable deformity may be present
Special Tests:
Limited ROM
X-ray necessary for confirmation of findings

38. Patellar Fracture Care: Splint- prevent further injury RICE
Immobilize for 2-3 months for bone healing

39. Cartilage Defect Involved Structures: MOI:
Articular cartilage
Behind patella
Femoral Condyle
Tibial Plateau
MOI:
Acute= rotational force
Chronic= Degeneration of cartilage
S/S: Pain with weight bearing

40. Cartilage Defect Observation: Swelling may be present
Palpation: May or may not be tender depending on location of defect
Special Tests:
X-ray and MRI to confirm
ROM may be limited
Care: May or may not need surgery depending on location and size of defect

41. Patellar Tendonitis Involved Structures: Patella Patellar tendon
Tibial Tuberosity
MOI: Jumping or kicking - placing tremendous stress and strain on patellar or quadriceps tendon
Sudden or repetitive extension may lead to inflammatory process
S/S: Pain and tenderness at inferior pole of patella, along tendon, or at tibial tuberosity

42. Patellar Tendonitis Observation: Special Tests: May affect gait
Redness/bruising could occur
Palpation: Pain and tenderness at
inferior pole of patella
patellar tendon
tibial tuberosity
Special Tests:
ROM and strength testing (flexion and extension)
Increased pain with extension
MRI possibly

43. Patellar Tendonitis Care: Avoid aggravating activities Ice cup massage
Anti-inflammatory medicine
Flexibility of quads and hamstrings
Patellar tendon bracing: off load the patellar tendon to decrease stress
Cho Pat Brace/Strap
Pre-wrap roll

44. IT Band Syndrome
Involved Structures: IT band insertion over lateral femoral condyle
MOI:
Overuse: increased friction during flexion and extension
IT band slides over lateral femoral condyle
Leads to irritation of bursa
Common in runners and cyclists
Malalignments and structural asymmetries of foot and lower leg

46. IT Band Syndrome
S/S: Tenderness, warmth, swelling, and redness over lateral femoral condyle
Pain with activity
Observation: Could be mild swelling, redness but typically observation is normal
Palpation: Tender over IT band insertion; Increased warmth
Special Tests:
ROM: increased pain with flexion and extension
Positive Noble’s Compression Test

47. IT Band Syndrome Care: Correction of mal-alignments ICE and NSAIDs
Stretching and light foam rolling of IT band
Avoidance of aggravating activities
Taping/Bracing
Compression sleeve
Cho Pat / Pre-wrap rolled over insertion

48. Pes Anserine Bursitis Involved Structures: MOI: Pes Anserine Gracilis
Sartorius
Semitendinosus
Bursa
Anterior medial aspect of tibia
MOI:
Overuse
Common in runners
Improper training/technique
Knee malalignments
Could also be caused by a direct blow to the anterior medial aspect of tibia

49. Pes Anserine S/S: Pain at bursa
Observation: Mild swelling/redness could occur
Palpation: Point tender over pes anserine
Special Tests:
Flexibility testing  Hamstring tightness
Care:
Rest / avoid activities that increase pain
Ice cup massage
Anti-inflammatory medicine
Increase flexibility of hamstrings with stretching and foam rolling

50. Patellofemoral Pain Syndrome
Involved Structures:
Patella
Patellofemoral Groove
Quadriceps muscles
MOI: Overuse patella tracking wrong within the patellofemoral groove
Muscle imbalances
Knee malalignments

51. Patellofemoral Pain Syndrome
S/S:
Feel like patella is “slipping”
Pain around edges or underneath patella
May report “clicking” or “crunching” sensation
Crepitus!
Symptoms increase going up and down stairs
Observation:
Knee malalignments
Patella malalignments
Palpation:
May or may not be point tender around patellofemoral joint

52. Patellofemoral Pain Syndrome
Special Tests:
X-rays can help determine alignment problems
Flexibility testing
ROM and strength testing
Positive Patellar Grind Test
Patella Mal-tracking

53. Patellofemoral Pain Syndrome
Care:
Rest  Avoid aggravating activity
Ice and anti-inflammatory medicine
Correct malalignments, if possible
Rehab exercises to correct muscle imbalances
Bracing:
Knee Brace to correct lateral glide of patella