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

2. No Financial Disclosures

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

4. ORTHOPEDIC SURGEON!!??

5. Common Knee Conditions

6. Knee Joint Anatomy

7. Knee Joint Anatomy

8. 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

9. Traumatic Injuries

10. Atraumatic Injuries

11. “Other” Injuries

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

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

14. 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

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

16. 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)

17. 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

18. Patellar Dislocation

19. 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

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

21. 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

22. 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

23. 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

24. Knee Chondromalacia/Arthritis

25. Treatment Options
NSAIDS PT
INJECTIONS
ARTHROSCOPY
ARTHROPLASTY

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

27. Thank you!!