Common Knee Injuries in Athletics

ACL Injuries Can be contact or non- contact mechanisms Non-contact usually cut/pivot motion Contact – usually male Non-contact – usually female MOI – either hyperextension or valgus force+internal rotation

ACL Injuries Female non-contact injuries….thought to be a result of: Increased Q-angle Proprioceptive deficiency Weak musculature Results in valgus positioning of the knee

ACL Injuries S/S include: Hearing or feeling a “pop” Severe effusion of the knee joint (hemarthrosis). Flexed-knee position/gait. Muscle guarding/spasm Positive Lachman’s test Positive Anterior Drawer

ACL Repair Most people can’t participate in athletic activity w/o ACL Repaired arthroscopically Patellar Tendon graft Hamstring graft Cadaver graft 6-9 months of rehabilitation

B-P-B Autograft

Hamstring graft

ACL Injuries

PCL Injuries Much less common Much more debilitating Occurs from posterior force to tibia w/ flexed knee. Complete loss of stabilization Inability to function Positive Posterior Drawer

Meniscus Injuries Occur from same MOI as ACL tears. Pivot/rotation Most often occur to medial meniscus Most often occur to inner 1/3 of meniscus.

Meniscus Injuries S/S Pain, swelling, and popping within the joint Possible “locking” of the knee in certain positions Pain going up and down stairs/hills. Positive McMurray’s test

Meniscus Injuries Repair is done arthroscopically Recovery typically takes 2-4 weeks. Complications: possible arthritic changes in the knee joint over time (loss of cushion w/o meniscus).

Meniscus tear

Meniscectomy

MCL Injuries Caused by a valgus force to the knee with the foot in contact with the ground. May also be caused by internal rotation Usually a contact injury

MCL Injuries S/S: pain and swelling medially Tenderness over medial joint line Medial instability Positive valgus stress test

LCL Injuries Much less common Lateral knee joint is protected by the opposite leg. Caused by a varus force with the foot on the ground LCL is easily palpated Positive varus stress test

Chondromalacia Non-specific anterior knee pain Caused by wearing of the cartilage on end of femur and underside of patella Usually due to abnormal patellar tracking Abnormal tracking caused by….injury, inflexibility, muscle weakness, abnormal mechanics, etc.

Chondromalacia

General treatment includes cryotherapy, NSAIDS, patellar taping More specific treatment depends on the cause

Patellar Dislocation Caused by trauma Caused by contraction of quads as the knee is internally rotating. Patella is pulled laterally S/S: deformity, severe pain, possible swelling, inability to move knee Do not try to reduce!!

Patellar Tendonitis Inflammation of patellar tendon. Can occur either at inferior patella or tibial tubercle Breakdown of patellar tendon over time Many causes RICE, activity modification, shoes, NSAIDS, modality tx.

Osgood-Schlatter’s Repeated avulsion to the patellar tendon insertion at the tibial tubercle. Common in adolescent athletes. Hypothesized that bones grow faster than the muscles/tendons Causes pain/swelling at tibial tubercle Causes exostoses at tibial tubercle

Osgood-Schlatter’s