Athletic InjuriesATC 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