{ Common Injuries The Knee

Patellar Fractures

 MOI:  Rapid forced knee flexion (landing from a jump)  Blunt trauma (Tonya Harding)  Risk of complete fracture increases in presence of stress fx Patellar Fracture

 Possible obvious deformity (split patella)  Rapid swelling  Bruising Patellar Fracture Inspection

 AROM Extension: Severe P & decreased ROM  PROM Flexion: Severe P & decreased ROM  RROM: Cannot be performed secondary to P Patellar Fracture ROM

 At Risk population:  Athletes w/ patellar tendon autograph for ACL replacement Patellar Fractures

 Straight-leg knee immobilizer for approx 2.5 to 3 mo  Post immobilizer: regain mobility and strength lost due to immobilizer  Sx may be necessary depending on type of fracture. If Sx is performed, physical therapy will be required after immobilization  Approx 5 mo recovery time Patellar Fracture Treatment

Patellar Fracture & Dislocation

 Bazaar ER (Graphic)  Part 1  HY HY HY  Part 2  Patellar Fracture

 MOI:  Valgus blow to knee  Rapid change of direction with fixed foot  Predisposing condition:  Patella alta (high sitting patella)  Previously dislocation Patellar Dislocation

 Obvious deformity  Positioned medially with flexed knee  If examined post-reduction: massive swelling will be present Patellar Dislocation Inspection

 AROM/PROM/RROM:  Not performed due to obvious deformity and extreme pain Patellar Dislocation ROM

 Performed by a Medical Professional:  Rapid passive knee extension is performed to reduce patella.  The faster the patella is reduced, the lesser the damage to soft tissue  Knee should then be immobilized in a straight-leg immobilizer and x-rays performed. If instability follows, MRI may be recommended.  Anticipated recovery time: 1 to 2 mo Patellar Dislocation Treatment

Patellar Brace

 Animation Animation  uQ uQ uQ  Bazzar ER  Patellar Dislocation

 fM fM fM Patellar Reconstruction Sx

 Onset: Acute  Pain Characteristics: pt c/o P “inside joint”, “pressure”, “giving out” when walking (ACL/PCL only)  LCL only: P in Fig 4 position Ligamentous Injury

 ACL  Anterior Tibial Translation on Femur  MOI: Stopping, cutting, impact  PCL  AKA “Dashboard knee”  Posterior Tibial Translation on Femur  MOI: Impact, hyperextention  MCL  VALGUS stress  MOI: Impact, torsion  LCL  VARUS stress  MOI: Impact, torsion Ligamentous Injury

 Non-contact ACL  tU tU tU  Contact  …. Contact vs. Non-contact

 ACL:  Grade 1&2: Immobilization/rehab  Grade 3: Sx  PCL  Grade 1-3: Immobilization/rehab  MCL/LCL  Grade 1-3: conservative: immobilization/rehab Aggressive: Sx Tx for Lig. Injury

 Onset: Acute or Insidiuos  Symptoms: Pt c/o “giving out”, “catching”, “locking”, “clicking/popping”  MOI: Tibial rotation when knee is flexed; varus/valgus stress Meniscal Tear

Types of tears

 Conservative: Immobilization/rehab  Aggressive: Sx (Menisectomy)  Video  KI KI KI Tx for Meniscal Injury

 Traumatic, Acute Exertional, Chronic Exertional  Pain Characteristics: Severe  Other complaints: Muscle tightness, swelling, weakness, tingling, numbing (particularly between phalanges 1 and 2)  MOI: Direct Impact, prolonged activity Compartment Syndrome

 Traumatic: release of fasciia (Fasciotomy)  Acute Exertional: rest/rehab  Chronic Exertional: release of fasciia/rehab Tx for Compartment Syndrome