knee pain in the work comp patient william f bennett md sarasota, fl
TRANSCRIPT
Knee Pain in the Work Comp Patient
William F Bennett MD
Sarasota, Fl.
Anatomy
Bones-FemurTibiaFibulaPatella
Tendons
Rectus femoris
Vastus Medialis obliquus
Vastus lateralisObliquusPatellar Ligament-Sesamoid
Bursae
Prepatellar Bursae
Pes Anserinus Bursae
Ligaments
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Collateral Ligament
Lateral Collateral ligament
Cartilage
Articular Cartilage-type 1 collagen
Meniscus-type 2 collagen
Healing articular cartilage-type 2 collagen
Synovium/Capsule
Synvoium-synovial fluidHyaluronic acid complex
Baker’s Cyst-
capsule
Knee
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
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
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
Pain-”itis”
“itis” means inflammationTendonitis-inflammation of tendonBursitis-inflammation of bursaeSynovitis-inflammation of bursaeArthritis-inflammation of a jointOops-chondromalcia- inflammation, deteriorization of the cartilage, means ‘sick cartilage”
Other sources of pain
Trauma-
Torn Ligaments
Fractures-bones
Effussion-fullness achiness in the knee
Common Problems
Falls- ladder,stairs ect.
-Fractures-
-femur
-tibia
-tibial plateau
-tibial eminence
-patellar
Fractures
Patella
Fractures
Plateau
Ligament Disruptions
Medial Collateral Ligament Injuries
Lateral collateral Ligament Injuries
Anterior Cruciate Ligament Injuries
Posterior Cruciate liagment Injuries
Posterolateral Complex Injuries
ACL Disruptions
Arthroscopic ACL Reconstruction
ACL FINAL
Patellofemoral Problems
Kneeling/Squatting/ladders/Stairs
Prepatellar Bursitis-kneelingPatellofemoral Pain-kneeling, stairs, ectPatellofemoral ChondromalaciaPatellar Subluxation/Dislocation
Patellofemoral Chondromalcia
Patello-femoralSubluxation/Dislocation
PF Joint Sex Differences
Female Male
Cartilage Problems
Meniscal tears- shock absorber, twistingAssociated with ACL tears
Articular Cartilage- Flaps, divots, wearchondromalcia
Meniscal Tears
Articular Cartilage Tearsgeneralized/localized
Cortisone InjectionsAnti-inflammatory medicineLubricating medicineBraceArthroscopic DebridementA.C.I.O.A.T.S.
Ancillary testing
Xrays
MRI-Gadolinium- absorbed into articualr
cartilage defect after 3-5 hours
Treatment
Fractures-Casts IM rods- tibia/femurORIF- patella fractures/tibial plateau
fractures/eminence fractures
Treatment
Ligament DisruptionsMCL- brace PWB 6-8 weeksLCL- Brace or repairACL-ReconstructionPCL-+/- reconstructionPosterolateral complex-+/- reconstruction
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
Cartilage Problems
Meniscal tears-Repair young and not complex in red-red
zoneFastest to work- partial menisectomy,
older/compelx tearsMeniscal Allograph
Articular Cartilage
Generalized-Advil rest InjectionsBrace/medial or lateral
LocalizedA.C.I.O.A.T.S.
Time To WorkFractures- 3-4 monthsLigament Disruptions- 6-12 weeksPatellofemoral Prepatellar- continuous PF Pain/Chondro- variable- 6-8 weeks
Cartilage Meniscal Repair- 3 months Meniscal Resection- 6 weeksGeneralized articular var 1-8 wksLocalized 3-4 months
ImpairmentLowerExtremity
ImpairmentWholeBody