1. LAWRENCE PICCIONI MD

2.  Current team physician for Delaware State University since 1993  Team physician for Wesley College 1992 to 2004  Team physician for Dover High School 1992 to 2004

3.  Familiarize you with common features of injuries  Reinforce what you already know about diagnosis and treatment  Help decision making as far as treatment or referral

4.  Reviewing pertinent anatomy, History and Physical findings  Review differences in adult and pediatric injury patterns  Give some PEARLS

7.  Bones more pertinent in pediatric group  Tendons – Patellar and Quadriceps  Cartilage – articular and meniscal  Ligaments – ACL, PCL, Medial and lLateral Collateral

8.  Cartilage is like a rock in your shoe pain and swelling the more you do the more it hurts  Ligament injuries are like walking on ice  DOES IT HURT AND GIVE OUT OR GIVEOUT AND HURT?

9.  Often minor trauma in adults due to degeneration, sometimes feel a pop  Feel a click plus or minus effusion (popliteal)  Joint line tenderness pain with rotation (McMurray, Appley, etc)  Pain and swelling with activity, low grade

10.  Usually surgical or live with it  Meniscus relatively inert and poor healing potential  Outpatient procedure, arthroscopic, 2 to 4 weeks return to many sports if motivated  Not a surgical emergency, difficult to play through

11.  “Repair” usually means taking out torn portion  Only 10% repairable (bucket and vertical tears in outer 1/3)  NFL meniscal injuries more career ending than ACL

13.  Most common in sports particularly with acceleration/deceleration  Not always a violent injury many noncontact  Classic is feel a pop followed by intense swelling within 6 hours (hemarthrosis)  Not a surgical emergency Surgery often delayed 3 or more weeks (reconstruction)

16.  May have effusion may not some walk in comfortable  Lachman’s test is most classic and STILL most useful  Often missed on MRI (femoral detachment difficult to pick up)

18.  Not always surgical initial RICE and ROM  PT for quad hamstring strengthening  Brace treatment  Coping and sport modification  Surgery

19.  Reconstruction with multiple graft choices  Who gets it? – under 40, women, buckling with daily activity, competitive level 1 sports  Outpatient surgery mostly arthroscopic return to full sport variable but 6months to one year

20.  More rare usually in the realm of orthopedist  Not a “Pulled muscle”  Many are not surgical but require detailed diagnosis (combined injuries)  Not emergency but protection with crutches and immobilizer needed

21.  Bones now important  Physeal injuries common (weaker than ligaments and cartilage)  Different age leads to different fractures ie tibial eminence 12yrs tibial tubercal 14yrs

22.  ACL eqivalent in younger age  Same mechanism of injury  May require surgery usually requires referral

25.  Typically occur during adolescence  3 types depending on severity  Only most severe (type 3) require surgery but all require referral

26.  Common in younger kids  Represents an avulsion of inferior patellar cartilage from bone  Analogous to patellar tendon rupture in adults  Can be difficult to diagnose (pain, fear etc)

28.  Usually occur during adolescence  Three types depending on severity  Only type 3 requires surgery but all require referral for treatment

30.  History and physical still the key as imaging is confirmatory.  Most injuries not a “pulled muscle”  Relax most are not surgical emergencies  Pediatric injuries tend to be physeal and more emergent