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Soccer Knee Injuries and Exam

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Presentation on theme: "Soccer Knee Injuries and Exam"— Presentation transcript:

1 Soccer Knee Injuries and Exam
Ben Kittredge, MD Commonwealth Orthopaedics

2 Knee Anatomy

3 Pediatric Knee Injuries
Acute (event occurs) Chronic (no event)

4 Acute Injuries What happened? Non-contact twist?
Did the knee swell up right away? Hear or feel a “pop” ? Able to continue playing?

5 Acute Knee Injuries Ligament injury (ACL, MCL) Meniscus tear
Fracture/Bone bruise Patellar dislocation

6 Knee Exam Inspection Range of motion Is there an effusion?
Joint line tenderness Stability

7 Inspection Erythema Cellulitis? Septic prepatellar bursitis

8 Range of Motion Locked knee?

9 Effusion

10 Is it an effusion? Prepatellar bursitis

11 Effusion Present ACL tear Patellar dislocation Fracture or Bone bruise

12 No Effusion MCL tear Meniscus tear Contusion

13 Stability Exam: Anterior-Posterior
Lachman’s ACL Tear

14 Stability Exam: Anterior-Posterior
Posterior drawer PCL tear

15 Stability Exam- Medial and Lateral
Valgus stress MCL tear

16 Stability Exam- Medial and Lateral
Varus Stress LCL tear

17 Knee Exam Joint line tenderness Meniscal tear?

18 Patellar Exam Palpate medial and lateral patellar facets
Chondromalacia patella

19 Tendon Exam Patellar tendon Quadriceps tendon Iliotibial band
Tibial tubercle

20 Xray May show fracture Growth plate status Often normal

21 Xray Is it normal?

22 MRI ACL Patellar Dislocation Fracture or Bone bruise

23 MRI Quality of MRI varies Radiologists expertise varies

24 ACL Injuries 400,000 reconstructions per year in the US
Females 4 times more likely to tear ACL with non-contact injury

25 ACL Tears-Prevention High intensity plyometrics, balance training, and strengthening Neuromuscular Feedback

26 Treatment-ACL Tear-Growth Plates Closed
Patellar tendon Hamstring Allograft

27 ACL tear-Growth Plates Open
Brace Physeal sparing reconstruction

28 Patellar Dislocation History
Twisting injury Collision May not know patella dislocated Immediate swelling Can’t play

29 Patellar Dislocation Exam
Big effusion Patellar apprehension Medial retinacular pain

30 Patellar Dislocation Xray

31 Patellar Dislocation MRI

32 Patellar Dislocation Loose Body – Arthroscopy Brace? Rehab
Return to play when comfortable

33 Fracture or Bone Bruise History
Collision Fall Non-contact twist

34 Fracture or Bone Bruise Exam
Effusion May or may not be able to localize pain Inability to bear weight

35 Bone Bruise Xray normal Diagnose by MRI
Usually back to sports in 4-6 weeks

36 Fracture Xray

37 Fracture Treatment 6-12 weeks to heal Brace? Cast Surgery

38 MCL Tear History Valgus injury May or may not have contact Pop?
May keep playing May not swell right away

39 MCL Tear Exam Medial joint line pain Opening with valgus stress
No effusion

40 MCL Tear Imaging Xray-normal MRI

41 MCL Tear Treatment Brace for 2-6 weeks Pass functional test to play
Surgery if off tibia

42 Meniscal Tear History of twisting injury

43 Meniscus Tear Exam Swelling may or may not be present Joint line pain
Locked knee?

44 Meniscal Tear Locked knee Urgent knee arthroscopy

45 Meniscus Repair Non-weight bearing 6 weeks Sports in 4 months

46 Meniscus Resection Sports in 3 weeks

47 Chronic Injuries Chondromalacia patella Osgood-Schlatter Disease
Stress Fracture Osteochondritis Dissecans

48 Chondromalacia Patella
Poorly localized anterior knee pain Dull, aching pain Worse with jumping, climbing, squatting

49 Exam Point tender at medial patellar facet View patellar tracking
Normal exam-think about hip

50 Chondromalacia Diagnosis
Xray- usually normal MRI- usually normal Xray pelvis?

51 Chondromalacia Patella Treatment
Sports menu? Brace NSAIDS Rest Physical Therapy MRI?

52 Osgood-Schlatter Disease
Overuse injury Traction apophysitis

53 Osgood-Schlatter Disease
Jumping sports-basketball, volleyball Dull, aching pain Boys 13-14 Girls 11-12

54 Osgood-Schlatter Disease-Exam
Inspection Point tender over tibial tubercle

55 Osgood-Schlatter Disease

56 Osgood-Schlatters Treatment
NSAIDS Brace Relative rest Full rest Physical therapy Knee immobilizer Cast

57 Osgood-Schlatter Disease
Goes away when apophysis fuses

58 Stress Fracture History
Abrupt increase in activity-must elicit

59 Stress Fracture Exam May be point tender May be difficult to localize

60 Stress Fracture X-ray

61 Stress Fracture Bone scan

62 Stress Fractures MRI

63 Stress Fracture Treatment
Rest for 3 months Crutches? Non-weight bearing?

64 Stress Fracture Healed
Pain free 2 weeks Run 2 miles (30 min) twice per week 10% increase per week

65 Osteochondritis Dissecans
Subchondral bone disorder Softening of overlying cartilage May fragment Occasional cause of knee pain

66 Osteochondritis Dissecans
Overuse injury Repetitive micro-trauma Poorly defined aching pain Stress fracture

67 Osteochondritis Dissecans
X-rays are key

68 Osteochondritis Dissecans
MRI can be helpful

69 Osteochondritis Dissecans Treatment
Non-weight bearing at least 3 months Prognosis depends on growth plate status

70 Osteochondritis Dissecans Treatment
Displaced fragment-surgery

71 Pediatric Knee Injuries
Is it the Hip?



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