1. Common Knee Injuries

2. 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

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

4. Meniscal Tear

9. 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

10. 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

11. 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

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

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

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

19. 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

21. 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

22. 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

23. 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

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

25. 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

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

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

29. 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

30. 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?

31. 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

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

33. Normal ACL
ACL Graft

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

35. 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

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

39. Knee injuries
What is wrong with this knee?

40. 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

43. 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

44. 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

45. 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

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

47. QUESTIONS?