Athletic Injuries ATC 222 The Knee Chapter 16

Anatomy –bony –muscular –cartilage –ligaments –bursa –etc

Functional Anatomy Motions –flexion/extension –rotation

Evaluation History Observation Palpation Special Tests

MCL Sprain Mechanism –lateral force –external tibial rotation –hyperextension More severe and common than LCL –part of capsule –attaches to medial meniscus Signs and Symptoms –pain over MCL –none to moderate edema/effusion –possible instability –possible ROM and strength loss –pain with passive extension and external tibial rotation

MCL Sprain Treatment RICER Crutches? Immobilization? Meniscal involvement? Rehabilitation

LCL Sprain Mechanism –varus force, internal tibial rotation Less prevalent that MCL –no meniscal attachment –action of popliteus muscle –common peroneal nerve damage? Signs and Symptoms –pain over LCL –none to mild edema/effusion –possible instability –possible ROM and strength loss –pain with passive extension and internal tibial rotation Treatment

ACL Sprain Mechanism –external tibial rotation with valgus –internal tibial rotation –hyperextension –deceleration Most common knee ligament to be seriously injured Signs and Symptoms –heard/felt a “pop” –rapid effusion/hemarthrosis (1-2 hours) –knee “gives out” –instability

ACL Sprain Treatment RICER Crutches? Immobilization? Conservative vs surgical intervention –commonly associated with meniscal tear

PCL Sprain Mechanism –force to anterior tibia with knee flexed –hyperflexion –rotation Signs and Symptoms –“pop” –effusion –instability Treatment –usually non-operative

Meniscal Lesions Mechanism –rotation while weight bearing –Acute MCL or ACL sprain –chronic knee instability or degeneration Signs and Symptoms –clicking, catching, locking –slow developing effusion –pain on joint line –chronic effusion Treatment –healing rate? –Arthroscopic surgery removal vs repair

Patellar Subluxation/Dislocation Mechanism –external tibial rotation –valgus –functional/structural deviations Signs and Symptoms –deformity –positive apprehension sign –effusion –pain on medial patellar border Treatment –Reduction –immobilization and crutches? –RICER –rehabilitation

Patellofemoral Syndrome Structural/functional deviations Signs and Symptoms –medial peripatellar pain –pain with stairs –crepitus –pain with stairs/prolonged sitting Treatment –symptomatic –correct functional/structural deviations

Apophyseal Injuries (apophysitis) Apophysis = Traction Epiphysis Types –Osgood-Schlatter’s Syndrome –Sinding-Larson-Johanson Syndrome Signs and Symptoms –pain at tendon attachment –tibial tubercle enlargement –pain with prolonged sitting or pressure Treatment –symptomatic –flexibility –activity modification –straps and sleeves

Other Injuries Tendonitis Osteochondral defects ITB syndrome

Special Tests of the Knee tibial/fibular compression/percussion patellar apprehension ballotable patella and stroke test patellar excursion and compression

Other Special Considerations leg length discrepancy Mechanics of lower extremity Q-Angle –10 males, 15 females –over 20 is abnormal