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

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Presentation on theme: "Soccer Knee Injuries and Exam Ben Kittredge, MD Ben Kittredge, MD Commonwealth Orthopaedics Commonwealth Orthopaedics."— Presentation transcript:

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

2 Knee Anatomy

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

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

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

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

7 Inspection Erythema Erythema Cellulitis? Cellulitis? Septic prepatellar bursitis Septic prepatellar bursitis

8 Range of Motion Locked knee? Locked knee?

9 Effusion

10 Is it an effusion? Prepatellar bursitis Prepatellar bursitis

11 Effusion Present ACL tear ACL tear Patellar dislocation Patellar dislocation Fracture or Bone bruise Fracture or Bone bruise

12 No Effusion MCL tear MCL tear Meniscus tear Meniscus tear Contusion Contusion

13 Stability Exam: Anterior-Posterior Lachmans Lachmans ACL Tear ACL Tear

14 Stability Exam: Anterior-Posterior Posterior drawer Posterior drawer PCL tear PCL tear

15 Stability Exam- Medial and Lateral Valgus stress Valgus stress MCL tear MCL tear

16 Stability Exam- Medial and Lateral Varus Stress Varus Stress LCL tear LCL tear

17 Knee Exam Joint line tenderness Joint line tenderness Meniscal tear? Meniscal tear?

18 Patellar Exam Palpate medial and lateral patellar facets Palpate medial and lateral patellar facets Chondromalacia patella Chondromalacia patella

19 Tendon Exam Patellar tendon Patellar tendon Quadriceps tendon Quadriceps tendon Iliotibial band Iliotibial band Tibial tubercle Tibial tubercle

20 Xray May show fracture May show fracture Growth plate status Growth plate status Often normal Often normal

21 Xray Is it normal? Is it normal?

22 MRI ACL ACL Patellar Dislocation Patellar Dislocation Fracture or Bone bruise Fracture or Bone bruise

23 MRI Quality of MRI varies Quality of MRI varies Radiologists expertise varies Radiologists expertise varies

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

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

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

27 ACL tear-Growth Plates Open Brace Brace Physeal sparing reconstruction Physeal sparing reconstruction

28 Patellar Dislocation History Twisting injury Twisting injury Collision Collision May not know patella dislocated May not know patella dislocated Immediate swelling Immediate swelling Cant play Cant play

29 Patellar Dislocation Exam Big effusion Big effusion Patellar apprehension Patellar apprehension Medial retinacular pain Medial retinacular pain

30 Patellar Dislocation Xray Xray

31 Patellar Dislocation MRI MRI

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

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

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

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

36 Fracture Xray Xray

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

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

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

40 MCL Tear Imaging Xray-normal Xray-normal MRI MRI

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

42 Meniscal Tear History of twisting injury History of twisting injury

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

44 Meniscal Tear Locked knee Locked knee Urgent knee arthroscopy Urgent knee arthroscopy

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

46 Meniscus Resection Sports in 3 weeks Sports in 3 weeks

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

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

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

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

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

52 Osgood-Schlatter Disease Overuse injury Overuse injury Traction apophysitis Traction apophysitis

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

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

55 Osgood-Schlatter Disease Xray Xray

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

57 Osgood-Schlatter Disease Goes away when apophysis fuses Goes away when apophysis fuses

58 Stress Fracture History Abrupt increase in activity-must elicit Abrupt increase in activity-must elicit

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

60 Stress Fracture X-ray X-ray

61 Stress Fracture Bone scan Bone scan

62 Stress Fractures MRI MRI

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

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

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

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

67 Osteochondritis Dissecans X-rays are key X-rays are key

68 Osteochondritis Dissecans MRI can be helpful MRI can be helpful

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

70 Osteochondritis Dissecans Treatment Displaced fragment- surgery Displaced fragment- surgery

71 Pediatric Knee Injuries Pediatric Knee Injuries Is it the Hip? Is it the Hip?

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