Sports Related Knee Injuries

7/30/2019 Sports Related Knee Injuries

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Sports Related Knee Injuries

Mark S. Sanders, M.D.

www.sandersclinic.net


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Sports Related Knee

Ligament Injuries

Anatomy of the Knee

Mechanisms of Injury

Diagnosis Reconstruction

Therapy and Rehabilitation


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Frank H. Netter, Atlas of Human Anatomy 4thEd.


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Anterior Cruciate Ligament

Major stabilizing ligament in the knee

connecting the tibia to the femur

preventing pathologic anterior excursion of

the tibia on the femur

Contains mechanoreceptors which supply

the nervous system with real time

information regarding the limbs position inspace


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Mechanisms of Injury

Can be torn by a sudden violent contraction of

the quadriceps occurring on the misplanted foot

Most common cause of ACL injuries in noncontact

sports In collision sports it occurs as a result of an

externally applied force projected directly on the

medial or lateral surface of the knee

Hyperextension


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When the ACL Tears

A patient reports hearing or feeling a pop

There is a sense that the knee went out

or dislocated

The pain typically makes it impossible to

finish the day's activities

May also result in collateral ligament,articular surface, and/or meniscal cartilage

damage


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http://www.youcanbefit.com/images/ACL%20tear%20cause.bmp


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http://www.hughston.com/hha/b_11_3_2b.jpg


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http://www.weissortho.com/images/sectionimages/commoninj

uries/bodyparts/big/acltear.jpg


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http://cms.depuy.com/display?docId=20157


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Diagnosis

History

Physical Examination

Straight leg raising possible

large knee effusion

loss of active knee motion

Lachmans sign (anterior draw in mild flexion) Pivot shift sign (uncommon in acute situation)

Collateral ligament examination in full extension and 30 degrees of flexion

KT-1000

X-ray

MRI

Arthroscopy


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http://www.jfponline.com/images/5209/5209JFP_AppliedEvidence-fig2.jpg

MED i K Li


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MEDmetric Knee Ligament

ARTHROMETER Model

KT1000


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MRI

Advantages/Disadvantages?


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http://www.emedx.com/emedx/diagnosis_information/diagnosis_information_image

_files/knee_images/acl_mri_torn.JPG


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http://www.rad.washington.edu/staticpix/anatomy/ACL1.jpg


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Arthroscopy

Not typically necessary for diagnosis, whichshould be obvious from History, PhysicalExamination, KT-1000 testing, and/OR MRI

Most often MRI is not necessary for diagnosis,but can be helpful in determing the presence ofother injuries

bone contusion (bone marrow edema)

articular or meniscal cartlage injury collateral ligament injury (should be obvious

from physical exam)


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http://www.yoursurgery.com/procedures/arthroscopy/images/ACL_PCL.jpg


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http://www.genou.com/LCAnormal.jif


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http://www.emedx.com/emedx/diagnosis_information/diagnos

is_information_image_files/knee_images/acl_normal_arthros

copic_picture.JPG


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Initial Treatment Surgery NOT INDICATED

Immediate surgery leads to an unacceptable incidence ofarthrofibrosis (loss of ROM)

RICE Rest

Ice

Compression Elevation

Range of Motion exercises

Gait reeducation quickly eliminates the need for crutches

Cold/compression CryoCuff

Strengthening and flexibility program forhamstringsandquadriceps

Emphasize extension equal to the other leg

Cycling
http://sandersclinic.net/recdprgm_devic.htmlhttp://sandersclinic.net/recdprgm_devic.htmlhttp://sandersclinic.net/recdprgm_devic.html


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Options?

Non-surgical

Must be willing to give up sports with

exception of cycling and activities in a health

club Strength and conditioning program

Surgical

For people that want to return to sports andneed the stability (athletes)


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Allografts

Advantages Technically easy

Biological Considerations Greater than one year for revascularization

Rejection

Infectious transmission

Technically easy

Economic considerations Very expensive

Success Rate 80% stable knees Return to sports not before one year

Indications Non-athletic patients over 40


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Hamstring Tendon

Advantages Technically easy

Disadvantages Lack of bone to bone healing

Maturation takes one year Sacrifice of a major muscle group that provides major

posterior translation of the tibia (the hamstringtendons are the allies of the ACL)

Success rate 90% stable knees Return to sports 9 months to one year

Long term hamstring weakness present


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Bone-Patellar Ligament-Bone

GOLDStandard

Advantages

Bone to bone healing

Strongest graft

Maturation occurs rapidly

Return to sports 6 months

Disadvantage Requires attention to detail at surgery and

rehab


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Contra lateral patella tendon

(PLATINUM standard)

Less postop pain

Faster rehab

Divide the problem into two parts

ACL leg concentrates on ROM

Graft leg concentrates on Strength

No braces or crutches Return to sports 3 months

Improvement continues over first year


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Procedure

A short straight incision is made on the ACL knee superficial to thepatella and a small incision is made lateral and superficial to thedistal femur

Drill holes are placed into the knee - from the leg and thigh - into theplaces where the native ACL inserts into the femur and tibia

A similar incision is made onto the front of the healthy graft leg

The graft is harvested and the wound is closed over a drain

The new graft is then placed through the ACL knee and sutures aretied over buttons

The wounds are then closed over drains - preventing excessive fluidbuild up for optimal recovery and movement

Cold compression is applied on both legs and strengtheningmovements begin that day


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Full extension equal to the other leg necessary

on the operating table and at all other times


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Therapy and Rehabilitation

Immediate! ROM key on ACL leg!

Strengthening key on graft leg

Gait training

Jogging in 1 month

Sports specific drills 6 weeks Criteria for returning to sports

Full and equal motion in both knees

Strength equal to 80% of preop graft leg both knees

Swelling absent

Plyometrics

Neuromuscular reeducation

Average return to sports 3 months Confidence and performance continue to improve for one year


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3 Days

PostopHardin

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d andbackw

ards


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Angela hall website


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For More Information

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Sports Related Knee Injuries