knee injuries sports medicine 2. knee structures hinge joint stability comes from ligamentous...
TRANSCRIPT
Knee Structures
Hinge Joint Stability comes from ligamentous support Femur, tibia, fibula, patella Menisci
~ 2 oval fibrocartilages
Ligaments
ACL~ Prevents the tibia from moving anteriorly or the femur from moving posteriorly
PCL~ Prevents posterior movement of the tibia on the femur, hyperextension
MCL~ Prevents valgus motion
LCL~ Prevents varus force
ACL Tears
Cause: Direct lateral or valgus blow with the knee flexed and tibia externally rotated, lower leg rotated with the foot planted, or flexion deceleration injury
S/S: Hears/feels a ‘pop’ in the knee followed by immediate disability. Laxity of joint.
TX: RICE Surgery Rehabilitation
ST: Anterior Drawer test, Lachman test
MCL Tears
Cause: Result of a medially directed valgus force from lateral side or from external rotation of the tibia
S/S: Swelling, point tenderness, laxity on the medial side
TX: RICE Crutches if unable to walk Bracing Surgery worse case
ST: Valgus Stress Test, anterior drawer test
LCL Tears
Cause: Result of a laterally directed varus force from the medial side or from internal rotation of the tibia. “Rarely ever will you have an isolated LCL tear”
S/S: Pain and tenderness over the ligament, swelling, effusion, joint laxity
TX: RICE Crutches if unable to walk Surgery if bad enough Brace
ST: Varus Stress Test
PCL Tears
Cause: A full weight bearing fall on a hyper flexed knee. Dashboard injury
S/S: Feels a ‘pop’ in the back of the knee. Tenderness and little swelling in popliteal fossa. Laxity may be noted.
TX: RICE Quadricep strengthening on non-operative knees Surgery in highly active Brace
ST: Posterior Drawer test
Meniscal Tear
Cause: A weight bearing combined with a rotational force while extending of flexing the knee. Medial more common than lateral.
Acute vs. Chronic S/S: Effusion on joint line, loss of motion, joint
locking, and pain when squatting. TX: RICE
quad sets Surgery possible
ST: McMurray’s, Apley’s compression test
Patellar Tendonitis
Cause: Jumping, kicking, or running. S/S: Vague pain indicated, tenderness
around bottom of patella, Point tenderness over tibial tuberosity
TX: RICE (ice cups) NSAIDS Cho-pat strap Rehabilitation
ST: Strength test, ROM test
Osgood-Schlatter’s Disease
Cause: common in immature athletes. Repeated pull of the patellar tendon at the tibial tubercle.
S/S: Swelling, hemorrhage, and gradual degeneration of tubercle (causing deformity)
TX: Conservative: RICE (ice cups) Out for 6 months to 1 year Rehabilitation
ST: X-Ray
Patellar Tendon Rupture
Cause: Sudden powerful contraction of quads with weight of the body applied to affected leg ***Steroid injections to this area increase
likelihood of rupture S/S: Patella moves upward, noticeable
defect, and athlete cannot extend knee TX: Conservative: Surgical repair
NSAIDS
ST: X-Ray, MRI