Knee Injuries Taelar Shelton, MS, ATC, LAT, CES

Terminology Sprains (ligaments) Sprains (ligaments) 1 ST degree 1 ST degree 2 nd degree 2 nd degree 3 rd degree 3 rd degree MOI- mechanism of injury MOI- mechanism of injury S&S- signs and symptoms S&S- signs and symptoms Rx- treatment and management Rx- treatment and management P! means pain P! means pain Patellofemoral vs tibiofemoral Patellofemoral vs tibiofemoral

Contusion Bruise Bruise MOI- Blow to the bony tissue or muscles crossing the knee MOI- Blow to the bony tissue or muscles crossing the knee S&S- Pain, acute inflammation, swelling, discoloration S&S- Pain, acute inflammation, swelling, discoloration Rx- Rest, usually RTP in hours, RICE Rx- Rest, usually RTP in hours, RICE

Bursitis MOI- Acute, chronic or recurrent MOI- Acute, chronic or recurrent Inflammation due to: continued kneeling or overuse of patellar tendon Inflammation due to: continued kneeling or overuse of patellar tendon S&S- swelling S&S- swelling Rx- Eliminate cause, decrease inflammation Rx- Eliminate cause, decrease inflammation Aspirate if chronic Aspirate if chronic

MCL sprain (1 st, 2 nd, 3 rd deg) MOI- valgus force MOI- valgus force S&S- tender on jt line, p! during lateral movement, swelling, decrease in stability, +valgus stress test S&S- tender on jt line, p! during lateral movement, swelling, decrease in stability, +valgus stress test Rx- RICE, work on ROM, strength, crutches if they walk with a limp, brace, cryokinetics, grade 3 should be referred, not usually surgical Rx- RICE, work on ROM, strength, crutches if they walk with a limp, brace, cryokinetics, grade 3 should be referred, not usually surgical

LCL sprain (Acute lateral knee sprain) MOI- varus force; outward force to lateral capsule and LCL, leg internally rotated knee is forced outward MOI- varus force; outward force to lateral capsule and LCL, leg internally rotated knee is forced outward S&S- P! on lateral jt, some swelling, jt instability, +varus stress test S&S- P! on lateral jt, some swelling, jt instability, +varus stress test Rx- similar to MCL sprain Rx- similar to MCL sprain

ACL sprain MOI- plant and twist, forced hyperextension MOI- plant and twist, forced hyperextension S&S- pop, p!, swelling, difficulty walking, +anterior drawer and lachman’s S&S- pop, p!, swelling, difficulty walking, +anterior drawer and lachman’s Rx- test quickly, refer for MRI, RICE, surgery, brace, crutches, rehab for 6-12 months Rx- test quickly, refer for MRI, RICE, surgery, brace, crutches, rehab for 6-12 months

PCL sprain MOI- fall on flexed knee, dashboard injury, hard blow to the anterior aspect of knee, rotational force MOI- fall on flexed knee, dashboard injury, hard blow to the anterior aspect of knee, rotational force S&S- pop, tenderness on posterior knee, some swelling, + sag sign, + posterior drawer S&S- pop, tenderness on posterior knee, some swelling, + sag sign, + posterior drawer Rx- RICE, quad strengthening, referral- occasionally surgery (6 week rehab) Rx- RICE, quad strengthening, referral- occasionally surgery (6 week rehab)

Meniscal Lesions MOI- valgus force with an MCL sprain, weight bearing activity with a rotation of the tibia MOI- valgus force with an MCL sprain, weight bearing activity with a rotation of the tibia S&S- catching, locking, jt p!, effusion, muscle spasm, p! with squats, MRI, +McMurry, +Appley’s S&S- catching, locking, jt p!, effusion, muscle spasm, p! with squats, MRI, +McMurry, +Appley’s Rx- referral to a physician, MRI, surgery may be necessary (menisectomy or mensical repair), rehab Rx- referral to a physician, MRI, surgery may be necessary (menisectomy or mensical repair), rehab

Knee Plica MOI- synovial membrane folds, born with it and it wasn’t absorbed, can become pathological ~20% of population MOI- synovial membrane folds, born with it and it wasn’t absorbed, can become pathological ~20% of population S&S- catching, P! usually on medial aspect of the jt, +plica stutter test S&S- catching, P! usually on medial aspect of the jt, +plica stutter test Rx- conservatively or surgical intervention Rx- conservatively or surgical intervention

Knee Fat Pad MOI- fat pad gets wedged, hyperextension, kneeling, direct blow MOI- fat pad gets wedged, hyperextension, kneeling, direct blow S&S- hemorrhaging, p!, weakness, swelling, stiffness S&S- hemorrhaging, p!, weakness, swelling, stiffness Rx- rest, heel elevation, ice Rx- rest, heel elevation, ice

Loose Body “Joint Mice” MOI- Repeated trauma to knee, fragments of menisci or synovial tissue that move around the joint space and become lodged MOI- Repeated trauma to knee, fragments of menisci or synovial tissue that move around the joint space and become lodged S&S- locking, popping, knee giving way S&S- locking, popping, knee giving way Rx- surgical removal Rx- surgical removal