1. RHS ROP - Sports Medicine
COMMON knee INJURIES
RHS ROP - Sports Medicine

2. H.O.P.S. History Observation Palpation Special tests Previous injury?
Mechanism
Sounds? Feelings?
Other people’s observations
Observation
Deformity? Swelling? Range of motion? Pain level?
Palpation
Special tests

3. Knee CONTUSION  CC #1 Right actions in the future are the best apologies for bad actions in the past.” Tyron Edwards – Theologian

4. knee contusion Mechanisms Direct contact with force
The knee hits against a solid object
A thrown object hits the knee

5. knee contusion Signs Symptoms swelling in the area of contact
tenderness
momentary loss of feeling in the top of the foot is possible.
discoloration
Symptoms
pain on movement is possible
area of contact may be numb
pain on weight bearing
throbbing and/or burning sensation

6. Acute Care of a Contusion
REST: Protect the area from further damage Use a pad/wrap or prefabricated pad.
ICE: Encourage the athlete to ice the area for the first 2-3 days. Too much heat in the beginning will increase length of healing time.
COMPRESSION: Not usually. Only in certain cases. Check with LAT first.
ELEVATION: Not necessary unless contusion is coupled with another injury that requires elevation or begins to swell.

7. Patellar tendonitis “jumper’s knee”

8. Patellar tendonitis
Inflammation of the tendon that connect the tibia to the patella.
Caused by repetative use/overuse.
Common in athletes that jump a lot.

9. Signs and symptoms of patellar tendonitis do not write
1st Degree
2nd
Degree
3rd Degree
Pain after activity
Pain during and after activity
Pain during and after, for extended time
Little to no swelling or puffiness
Puffiness, some swelling possible
Swollen in area of patellar tendon or attachments
No limit to activity
Activity limited by pain
No activity is preferred

10. Care for patellar tendonitis
First step of reducing pain is to reduce activity level, Ice and NSAID and/or replace conditioning with non-contact, non-impact substitutes.
A knee sleeve might be used to keep the knee joint warm during activity.
A patellar tendon strap is often issued to those with chronic, or reoccurring, pain due to Patellar Tendonitis.

11. patellar tendon Strap

12. ACL SpRAIN/TEAR (ligament injury)

13. ACL sPrain/TEAR Mechanism
Rotation of the Femur with knee flexed and foot planted
Mechanism 2 and 3
Hyperextension of the knee
Quick deceleration

14. Acl sprains/tears Signs Plants foot, goes down immediately
Grabbing knee
Loss of function
Knee gives out, feels unstable
Puffiness around kneecap with tenderness in back of knee
Tender along joint line on both sides

15. Acl sprains/tears Symptoms pain with movement
pain on weight bearing is possible
walks with toe down, not heel-to-toe
loss of normal function
may have felt it “pop” or tear (40% of the time)

16. On-Field Care of the Injured knee
JUST LISTEN!!!! DO NOT WRITE
DO NOT TAKE OFF THE KNEE PAD! Observe and compare the injured knee to the uninjured knee. You may have to “look” with your hands.
Determine if there is any severe deformity of the tibia, femur or patella. Also check the ankle movement, if possible.
If a deformity is absolutely ruled out, move the athlete to a safe place and off to the side of the playing area.
The athlete should remain non-weight bearing until the knee has been further evaluated.

17. Acute Care of an ACL TEAR
REST: no activity until doctor visit
ICE: 20 minutes of every hr first 2-3 days.
COMPRESSION: calf area to mid-thigh, in an upwards direction.
ELEVATION: Athlete should elevate injury as much as possible, especially during icing.

18. MCL / LCL ligament sprain

19. Mcl / lcl sprains Mechanism - MCL injury:
Valgus force (outside to inside direction)
With foot planted
Stress on inside of knee joint

20. Mcl / lcl sprains Mechanism - LCL injury: With foot planted
Varus force (_____ to ___side direction)
Stress on ___side of knee joint
INSIDE
OUT
OUT
LATERAL
MEDIAL

21. Mcl / lcl sprains
Signs
First degree-Minor joint stiffness-micro tears in ligament
Second Degree-Moderate joint stiffness-macro tear of ligament
Third Degree-Loss of stability- complete tear of ligament

22. Mcl / lcl sprains Symptoms
Might have felt the knee “give out” or “pop”
Immediate pain at time of injury
Hurts more to use it than to sit still

23. Acute Care of an mcl / lcl tear
REST
ICE
COMPRESSION
ELEVATION
Good positioning using a cloth wrap.

24. Acute Care of all knee ligament injuries
IMMOBILIZATION:
Knee immobilizers are worn for 2-4 weeks following injury. This is mostly for protection from further injury and for support during initial pain phase.
MCL and LCL injuries are immobilized in full knee extension to promote healing of the fibers of the ligament.
ACL and PCL injuries are immobilized with ROM braces that allow some movement at the knee.

25. Patella dislocation

26. Patellar dislocation Mechanisms External Rotation of the Femur
When the patellar groove (posterior) is completely displaced out of the femoral groove.
Mechanisms
External Rotation of the Femur
+ Forceful Contraction of the Quadriceps
+ Knee Extension
Rarely caused by contact

27. Patellar dislocation Signs and Symptoms Pain, pain, pain
Loss of function/knee extension
Visible deformity
Swelling
May have heard or felt a “pop” or a “snap”.

28. On-Field Care for an Patellar dislocation do not write
Observe and compare the injured knee to the uninjured knee! You may have to “look” with your hands.
Determine there is any severe deformity of the tibia, femur or patella. Also check the position of the lower limb, if possible.
DO NOT MOVE THE INJURED ATHLETE. The athlete should remain non-weight bearing until the knee has been further evaluated.
Find a coach and call for LAT on-duty immediately.

29. On-Field Care for an Patellar dislocation
Some patellar dislocations will “reduce” or go back into place on their own.
Other times, the athlete will be able to self-reduce the dislocation by straightening the knee.
If the athlete is unable to do this, professional help is needed.