1. Knee Pain in the Work Comp Patient
William F Bennett MD
Sarasota, Fl.

2. Anatomy
Bones-
Femur
Tibia
Fibula
Patella

3. Tendons Rectus femoris Vastus Medialis Vastus lateralis obliquus
Patellar Ligament-Sesamoid

4. Bursae
Prepatellar Bursae
Pes Anserinus Bursae

5. Ligaments Anterior Cruciate Ligament Posterior Cruciate Ligament
Medial Collateral Ligament
Lateral Collateral ligament

6. Cartilage Articular Cartilage-type 1 collagen Meniscus-type 2 collagen
Healing articular cartilage-type 2 collagen

7. Synovium/Capsule Synvoium-synovial fluid Hyaluronic acid complex
Baker’s Cyst-
capsule

8. Knee

9. Biomechanics Knee is basically a hinge joint
More complex as its rotates as well
During extension-tibia rotates externally to lock knee in what is known as a screw home mechanism

10. Patellofemoral Biomechanics
Patella glides in a groove in the distal femur
Full extension-patella lays on the suprapatellar fat pad
During flexion-first20-30 degrees patella jogs laterally then seats itself centrally in the groove
Deep flexion places more pressure on the cartilage

11. Patellofemoral Biomechanics
With deeper flexion-patellar tendon comes into contact
Contact area with flexion moves from distal to proximal and from medial to lateral
Patella has a medial facet, lateral facet and median ridge

12. Pain-”itis” “itis” means inflammation
Tendonitis-inflammation of tendon
Bursitis-inflammation of bursae
Synovitis-inflammation of bursae
Arthritis-inflammation of a joint
Oops-chondromalcia- inflammation, deteriorization of the cartilage, means ‘sick cartilage”

13. Other sources of pain Trauma- Torn Ligaments Fractures-bones
Effussion-fullness achiness in the knee

14. Common Problems Falls- ladder,stairs ect. -Fractures- -femur -tibia
-tibial plateau
-tibial eminence
-patellar

15. Fractures
Patella

16. Fractures
Plateau

17. Ligament Disruptions Medial Collateral Ligament Injuries
Lateral collateral Ligament Injuries
Anterior Cruciate Ligament Injuries
Posterior Cruciate liagment Injuries
Posterolateral Complex Injuries

18. ACL Disruptions

19. Arthroscopic ACL Reconstruction

20. ACL FINAL

21. Patellofemoral Problems
Kneeling/Squatting/ladders/Stairs
Prepatellar Bursitis-kneeling
Patellofemoral Pain-kneeling, stairs, ect
Patellofemoral Chondromalacia
Patellar Subluxation/Dislocation

22. Patellofemoral Chondromalcia

23. Patello- femoral Subluxation/ Dislocation

24. PF Joint Sex Differences
Female
Male

25. Cartilage Problems Meniscal tears- shock absorber, twisting
Associated with ACL tears
Articular Cartilage- Flaps, divots, wear
chondromalcia

26. Meniscal Tears

27. Articular Cartilage Tears generalized/localized
Cortisone Injections
Anti-inflammatory medicine
Lubricating medicine
Brace
Arthroscopic Debridement
A.C.I.
O.A.T.S.

28. Ancillary testing Xrays MRI-
Gadolinium- absorbed into articualr cartilage defect after 3-5 hours

29. Treatment Fractures- Casts IM rods- tibia/femur
ORIF- patella fractures/tibial plateau fractures/eminence fractures

30. Treatment Ligament Disruptions MCL- brace PWB 6-8 weeks
LCL- Brace or repair
ACL-Reconstruction
PCL-+/- reconstruction
Posterolateral complex-+/- reconstruction

31. Treatment Patellofemoral injuries
Prepatellar Bursitis- Neoprene sleeve/rest/advil/injection
Patellofemoral Pain- neoprene sleeve/rest/advil/phyiscal therapy/posisble arthroscopic release
Patellofemoral Chondromalacia-same as above +/- tibial tubercle transfer/VMO advancment
Patellofemoral Sublux/Disloc-arthroscopic repair medial patellofemoral retinaculum/lateral release, cartilage debridment

32. Cartilage Problems Meniscal tears-
Repair young and not complex in red-red zone
Fastest to work- partial menisectomy, older/compelx tears
Meniscal Allograph

33. Articular Cartilage Generalized- Localized Advil rest Injections
Brace/medial or lateral
Localized
A.C.I.
O.A.T.S.

34. Time To Work Fractures- 3-4 months Ligament Disruptions- 6-12 weeks
Patellofemoral
Prepatellar- continuous
PF Pain/Chondro- variable weeks
Cartilage
Meniscal Repair- 3 months
Meniscal Resection weeks
Generalized articular var 1-8 wks
Localized months

35. Impairment Lower Extremity

36. Impairment Whole Body