2Patellafemoral Problems One of the most challenging knee injuries for both athlete and health care provider.Typical complaint is pain in front of the knee (behind the knee cap), with gradual onset.The knee may give way and have a grinding noise.
3Patellafemoral Problems Biomechanical assessment is very importantThe patellae may face inward. This may be caused by pronated feet, low arch, weak hip external rotators, tight hip internal rotators.Patella should slide through middle of groove
4Patellar TendonitisHigh force repetitive injury usually a result of jumping and/or abrupt change of direction.AKA jumpers knee
5Patellar Tendonitis Signs and Sx: Treatment Anterior knee pain inferior to patellar tendonSmall amount of swellingSpecial Tests-Tap TestClark’s SignTreatmentModified activity to decrease impactStretch QuadsIce afterMassage/US beforeBrace and Tape
6Fat Pad Syndrome Painful condition in the infrapatellar region. Often mistaken for patellar tendonitisAvoid full knee extensionTreat with ice and anti-inflammatory medsSpecial test will differentiate.
7Medial Collateral Ligament Sprain Causes are blow to thelateral knee or high speedtwisting motion.Classified with three gradescale based on signsand symptomsMOI is important
8Medial Collateral Ligament Sprain Signs and SxLimited ROMTenderness at either insertion of MCL or along ligament length.Various levels of pain and laxity to medial kneeSpecial TestValgus Stress TestTreatmentRICE and protectIce and InterferentialStraight leg strengthening initially.Immobilize if necessary
9Lateral Collateral Ligament Sprain Not as common as the MCL sprain.Caused by a medial force to the knee joint or a twisting.Classified with 3 grades like any other sprain.
10Lateral Collateral Ligament Sprain Signs and SxLimited ROMTenderness at either insertion of LCL or along ligament length.Various levels of pain and laxity to lateral knee
11Lateral Collateral Ligament Sprain TreatmentRICE and protectIce and InterferentialStraight leg strengthening initially.Immobilize if necessarySpecial TestVarus Stress Test
12Torn Anterior Cruciate Ligament Can be a contact or non-contact injuy.Can be a blow to the lateral or posterior knee.Non-contact loadedknee in combinedflexion, valgusand rotation of thetibia on the femur.
13Torn Anterior Cruciate Ligament Signs and SxHear or feel a popRapid effusionBuckling of the kneeGuarding will occur quickly so special tests need to be done within 5 minutes of injuryTreatmentSplinting, ice, compressive wrap and crutches.Surgery for a ACL tear in necessaryNo Grades to this injury it is either torn or not.MRI is confirmation for diagnosis
14Torn Anterior Cruciate Ligament Female ACL injuries happen 4-6x more often than male ACL injuries.This is due toBiomechanical factors- use more quad than hamstring. Land flat footed-don’t know how to jumpHormonal influences-ligament may loosen during cycleAnatomic risk factors-Angle of the hips relative to knees.
15Torn Anterior Cruciate Ligament Special TestsAnterior DrawerLachman’s Maneuver
16Torn Posterior Cruciate Ligament Occurs when the person falls on a flexed knee with the foot plantarflexed.The tibia strikes first and is pushed backward.Hyperflexion can also cause a PCL tear.
17Torn Posterior Cruciate Ligament PCL tear will rarely require surgery.Strengthening will be most important for the quadriceps.Special TestsSag Test
18Meniscus TearMeniscus are cushions in the knee joint that help make it more stable.Medial meniscus is attached to posterior and medial side, it is more often injured.Lateral meniscus is more freely moving, less often injured.
19Meniscus Tear Causes of injury Twisting of knee when meniscus gets trapped.When the ligaments are torn, they are attached.As people age the rubbery meniscus fray
20Meniscus Tear Signs and Sx Popping, locking, giving way of the knee Pain in injury areaGeneral knee swelling
21Meniscus Tear Treatment Special Tests Ice and compression Crutches StrengtheningSurgery may be necessary if sx do not subside with rehabilitationParticipation may continue if tolerated.Special TestsMcMurray Test
22Epiphyseal Plate Injuries Injuries that would cause ligamentous injuries in adults cause growth plate injuries in youthUsually due to direct trauma in athletes under 14 years
23Osgood-SchlatterThe femur is growing faster than the quad muscle and creates a traction on the tibial tuberosity where the patellar tendon attaches.Affects males age 12-16Affects females age 10-14
24Osgood-Schlatter Signs and Sx Pain and swelling over tibial tuberosity Increase pain and swelling with activityWeakness of quadricepsVisible lumpPain to touch
25Osgood-Schlatter Treatment Manage pain swelling and flexibility Stretch 4x daily-emphasis on hamstringsAvoid knee extension, squats, power clean and plyoDo body weight squats, SLR, hamstring curls and calf raises.Wear knee brace if needed.
26Iliotibial Band Syndrome Inflammation of the Iliotibial Band with a possible problem with the bursaOccur due to increasein activity.Overpronation, leglength discrepancy,bowleggedness
27Iliotibial Band Syndrome Special Tests- ober’sTreatmentModification of gait or footwearIcing of the areaMassage of the areaReduce activity