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Knee Pain in the Work Comp Patient

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Presentation on theme: "Knee Pain in the Work Comp Patient"— Presentation transcript:

1 Knee Pain in the Work Comp Patient
William F Bennett MD Sarasota, Fl.

2 Anatomy Bones- Femur Tibia Fibula Patella

3 Tendons Rectus femoris Vastus Medialis Vastus lateralis obliquus
Patellar Ligament-Sesamoid

4 Bursae Prepatellar Bursae Pes Anserinus Bursae

5 Ligaments Anterior Cruciate Ligament Posterior Cruciate Ligament
Medial Collateral Ligament Lateral Collateral ligament

6 Cartilage Articular Cartilage-type 1 collagen Meniscus-type 2 collagen
Healing articular cartilage-type 2 collagen

7 Synovium/Capsule Synvoium-synovial fluid Hyaluronic acid complex
Baker’s Cyst- capsule

8 Knee

9 Biomechanics Knee is basically a hinge joint
More complex as its rotates as well During extension-tibia rotates externally to lock knee in what is known as a screw home mechanism

10 Patellofemoral Biomechanics
Patella glides in a groove in the distal femur Full extension-patella lays on the suprapatellar fat pad During flexion-first20-30 degrees patella jogs laterally then seats itself centrally in the groove Deep flexion places more pressure on the cartilage

11 Patellofemoral Biomechanics
With deeper flexion-patellar tendon comes into contact Contact area with flexion moves from distal to proximal and from medial to lateral Patella has a medial facet, lateral facet and median ridge

12 Pain-”itis” “itis” means inflammation
Tendonitis-inflammation of tendon Bursitis-inflammation of bursae Synovitis-inflammation of bursae Arthritis-inflammation of a joint Oops-chondromalcia- inflammation, deteriorization of the cartilage, means ‘sick cartilage”

13 Other sources of pain Trauma- Torn Ligaments Fractures-bones
Effussion-fullness achiness in the knee

14 Common Problems Falls- ladder,stairs ect. -Fractures- -femur -tibia
-tibial plateau -tibial eminence -patellar

15 Fractures Patella

16 Fractures Plateau

17 Ligament Disruptions Medial Collateral Ligament Injuries
Lateral collateral Ligament Injuries Anterior Cruciate Ligament Injuries Posterior Cruciate liagment Injuries Posterolateral Complex Injuries

18 ACL Disruptions

19 Arthroscopic ACL Reconstruction


21 Patellofemoral Problems
Kneeling/Squatting/ladders/Stairs Prepatellar Bursitis-kneeling Patellofemoral Pain-kneeling, stairs, ect Patellofemoral Chondromalacia Patellar Subluxation/Dislocation

22 Patellofemoral Chondromalcia

23 Patello- femoral Subluxation/ Dislocation

24 PF Joint Sex Differences
Female Male

25 Cartilage Problems Meniscal tears- shock absorber, twisting
Associated with ACL tears Articular Cartilage- Flaps, divots, wear chondromalcia

26 Meniscal Tears

27 Articular Cartilage Tears generalized/localized
Cortisone Injections Anti-inflammatory medicine Lubricating medicine Brace Arthroscopic Debridement A.C.I. O.A.T.S.

28 Ancillary testing Xrays MRI-
Gadolinium- absorbed into articualr cartilage defect after 3-5 hours

29 Treatment Fractures- Casts IM rods- tibia/femur
ORIF- patella fractures/tibial plateau fractures/eminence fractures

30 Treatment Ligament Disruptions MCL- brace PWB 6-8 weeks
LCL- Brace or repair ACL-Reconstruction PCL-+/- reconstruction Posterolateral complex-+/- reconstruction

31 Treatment Patellofemoral injuries
Prepatellar Bursitis- Neoprene sleeve/rest/advil/injection Patellofemoral Pain- neoprene sleeve/rest/advil/phyiscal therapy/posisble arthroscopic release Patellofemoral Chondromalacia-same as above +/- tibial tubercle transfer/VMO advancment Patellofemoral Sublux/Disloc-arthroscopic repair medial patellofemoral retinaculum/lateral release, cartilage debridment

32 Cartilage Problems Meniscal tears-
Repair young and not complex in red-red zone Fastest to work- partial menisectomy, older/compelx tears Meniscal Allograph

33 Articular Cartilage Generalized- Localized Advil rest Injections
Brace/medial or lateral Localized A.C.I. O.A.T.S.

34 Time To Work Fractures- 3-4 months Ligament Disruptions- 6-12 weeks
Patellofemoral Prepatellar- continuous PF Pain/Chondro- variable weeks Cartilage Meniscal Repair- 3 months Meniscal Resection weeks Generalized articular var 1-8 wks Localized months

35 Impairment Lower Extremity

36 Impairment Whole Body

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