Knee Injuries

Patellafemoral Problems One of the most challenging knee injuries for both athlete and health care provider. 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. 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. The knee may give way and have a grinding noise.

Patellafemoral Problems Biomechanical assessment is very important Biomechanical assessment is very important The patellae may face inward. This may be caused by pronated feet, low arch, weak hip external rotators, tight hip internal rotators. The 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 Patella should slide through middle of groove

Patellar Tendonitis High force repetitive injury usually a result of jumping and/or abrupt change of direction. High force repetitive injury usually a result of jumping and/or abrupt change of direction. AKA jumpers knee AKA jumpers knee

Patellar Tendonitis Signs and Sx: Signs and Sx: Anterior knee pain inferior to patellar tendon Anterior knee pain inferior to patellar tendon Small amount of swelling Small amount of swelling Special Tests- Tap Test Clark’s Sign Treatment Modified activity to decrease impact Stretch Quads Ice after Massage/US before Brace and Tape

Fat Pad Syndrome Painful condition in the infrapatellar region. Painful condition in the infrapatellar region. Often mistaken for patellar tendonitis Often mistaken for patellar tendonitis Avoid full knee extension Avoid full knee extension Treat with ice and anti- inflammatory meds Treat with ice and anti- inflammatory meds Special test will differentiate. Special test will differentiate.

Medial Collateral Ligament Sprain Causes are blow to the Causes are blow to the lateral knee or high speed twisting motion. Classified with three grade Classified with three grade scale based on signs and symptoms and symptoms MOI is important MOI is important

Medial Collateral Ligament Sprain Signs and Sx Signs and Sx Limited ROM Limited ROM Tenderness at either insertion of MCL or along ligament length. Tenderness at either insertion of MCL or along ligament length. Various levels of pain and laxity to medial knee Various levels of pain and laxity to medial knee Special Test Valgus Stress Test Treatment RICE and protect Ice and Interferential Straight leg strengthening initially. Immobilize if necessary

Lateral Collateral Ligament Sprain Not as common as the MCL sprain. Not as common as the MCL sprain. Caused by a medial force to the knee joint or a twisting. Caused by a medial force to the knee joint or a twisting. Classified with 3 grades like any other sprain. Classified with 3 grades like any other sprain.

Lateral Collateral Ligament Sprain Signs and Sx Signs and Sx Limited ROM Limited ROM Tenderness at either insertion of LCL or along ligament length. Tenderness at either insertion of LCL or along ligament length. Various levels of pain and laxity to lateral knee Various levels of pain and laxity to lateral knee

Lateral Collateral Ligament Sprain Treatment Treatment RICE and protect RICE and protect Ice and Interferential Ice and Interferential Straight leg strengthening initially. Straight leg strengthening initially. Immobilize if necessary Immobilize if necessary Special Test Varus Stress Test

Torn Anterior Cruciate Ligament Can be a contact or non-contact injuy. Can be a contact or non-contact injuy. Can be a blow to the lateral or posterior knee. Can be a blow to the lateral or posterior knee. Non-contact loaded Non-contact loaded knee in combined flexion, valgus flexion, valgus and rotation of the tibia on the femur.

Torn Anterior Cruciate Ligament Signs and Sx Signs and Sx Hear or feel a pop Hear or feel a pop Rapid effusion Rapid effusion Buckling of the knee Buckling of the knee Guarding will occur quickly so special tests need to be done within 5 minutes of injury Guarding will occur quickly so special tests need to be done within 5 minutes of injury Treatment Splinting, ice, compressive wrap and crutches. Surgery for a ACL tear in necessary Not typically seen with grades, but they do occur MRI is confirmation for diagnosis

Torn Anterior Cruciate Ligament Female ACL injuries happen 4-6x more often than male ACL injuries. Female ACL injuries happen 4-6x more often than male ACL injuries. This is due to This is due to Biomechanical factors- use more quad than hamstring. Land flat footed-don’t know how to jump Biomechanical factors- use more quad than hamstring. Land flat footed-don’t know how to jump Hormonal influences-ligament may loosen during cycle Hormonal influences-ligament may loosen during cycle Anatomic risk factors-Angle of the hips relative to knees. Anatomic risk factors-Angle of the hips relative to knees.

Female ACL Prevention Avoiding vulnerable positions Increasing flexibility Increasing strength Including plyometric exercises in training Increasing proprioception

PEP Program   Optimally the program should be performed at least 2-3 times per week during the season. warm-up, stretching, strengthening, plyometrics, and sport specific agility training. It is important to use proper technique during jumping moves (jump straight up and down jumps without excessive side-to-side movement), and aim for soft landings.

Torn Anterior Cruciate Ligament Special Tests Special Tests Anterior Drawer Anterior Drawer Lachman’s Maneuver Lachman’s Maneuver

Torn Posterior Cruciate Ligament Occurs when the person falls on a flexed knee with the foot plantarflexed. Occurs when the person falls on a flexed knee with the foot plantarflexed. The tibia strikes first and is pushed backward. The tibia strikes first and is pushed backward. Hyperflexion can also cause a PCL tear. Hyperflexion can also cause a PCL tear.

Torn Posterior Cruciate Ligament PCL tear will rarely require surgery. PCL tear will rarely require surgery. Strengthening will be most important for the quadriceps. Strengthening will be most important for the quadriceps. Special Tests Special Tests Sag Test Sag Test

Meniscus Tear Meniscus are cushions in the knee joint that help make it more stable. Meniscus 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. Medial meniscus is attached to posterior and medial side, it is more often injured. Lateral meniscus is more freely moving, less often injured. Lateral meniscus is more freely moving, less often injured.

Meniscus Tear Causes of injury Causes of injury Twisting of knee when meniscus gets trapped. Twisting of knee when meniscus gets trapped. When the ligaments are torn, they are attached. When the ligaments are torn, they are attached. As people age the rubbery meniscus fray As people age the rubbery meniscus fray

Meniscus Tear Signs and Sx Popping, locking, giving way of the knee Pain in injury area General knee swelling

Meniscus Tear Treatment Treatment Ice and compression Ice and compression Crutches Crutches Strengthening Strengthening Surgery may be necessary if sx do not subside with rehabilitation Surgery may be necessary if sx do not subside with rehabilitation Participation may continue if tolerated. Participation may continue if tolerated. Special Tests McMurray Test

Epiphyseal Plate Injuries Injuries that would cause ligamentous injuries in adults cause growth plate injuries in youth Injuries that would cause ligamentous injuries in adults cause growth plate injuries in youth Usually due to direct trauma in athletes under 14 years Usually due to direct trauma in athletes under 14 years

Patellar Dislocation Patellar Dislocation-MOI is a blow to the knee or a twisting of the knee with foot planted. Patellar Dislocation-MOI is a blow to the knee or a twisting of the knee with foot planted. To relocate straighten the knee into extension. To relocate straighten the knee into extension.

Patellar Dislocation Treatment Treatment Immobilize for 2 weeks Immobilize for 2 weeks Ice and interferential Ice and interferential Xray to rule out fx Xray to rule out fx Special test is apprehension test Special test is apprehension test

Osgood-Schlatter The femur is growing faster than the quad muscle and creates a traction on the tibial tuberosity where the patellar tendon attaches. The femur is growing faster than the quad muscle and creates a traction on the tibial tuberosity where the patellar tendon attaches. Affects males age Affects males age Affects females age Affects females age 10-14

Osgood-Schlatter Signs and Sx Signs and Sx Pain and swelling over tibial tuberosity Pain and swelling over tibial tuberosity Increase pain and swelling with activity Increase pain and swelling with activity Weakness of quadriceps Weakness of quadriceps Visible lump Visible lump Pain to touch Pain to touch

Osgood-Schlatter Treatment Treatment Manage pain swelling and flexibility Manage pain swelling and flexibility Stretch 4x daily-emphasis on hamstrings Stretch 4x daily-emphasis on hamstrings Avoid knee extension, squats, power clean and plyo Avoid knee extension, squats, power clean and plyo Do body weight squats, SLR, hamstring curls and calf raises. Do body weight squats, SLR, hamstring curls and calf raises. Wear knee brace if needed. Wear knee brace if needed.

Iliotibial Band Syndrome Inflammation of the Iliotibial Band with a possible problem with the bursa Inflammation of the Iliotibial Band with a possible problem with the bursa Occur due to increase Occur due to increase in activity. Overpronation, leg Overpronation, leg length discrepancy, bowleggedness

Iliotibial Band Syndrome Special Tests- ober’s Special Tests- ober’s Treatment Treatment Modification of gait or footwear Modification of gait or footwear Icing of the area Icing of the area Massage of the area Massage of the area Reduce activity Reduce activity