Knee Injuries

1
Knee Injuries

• Sae Yong Lee

2
Common Injuries

• Acute
• Contusions
• Sprains - instabilities
• Strains/Ruptures
• Dislocations
• Fractures
• Meniscal tears

• Chronic
• Tendonitis
• Iliotibial Band Friction
• Osetochondral
• Condromalacia
• Meniscal tears

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Mechanisms

• Acute
• Direct blow
• Compression on ipsilateral side hit
• Tension on contralateral side of joint
• Hyperextension
• Plant Twist

• Chronic
• Repetitive Stresses
• Change in training, footwear, surface
• Predisposing Conditions

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Predisposing Conditions

• Tibiofemoral Alignment
• Genu Varum
• Genu Valgum
• Genu Recurvatum
• Others such as Q-angle navicular drop are the
  focus of ongoing research.
• What types of stress do these put on the knee?
• What structures may be involved?

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Contusions

• Soft tissue
• Quadriceps
• Bony
• Medial lateral tibial plateaus
• Medial lateral femoral condyles

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Sprains - uniplanar

• Characterized by instability in one direction
• Collateral
• MCL, LCL
• Cruciate
• ACL, PCL

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Sprains - multiplanar

• Mechanism
• Abnormal internal/external rotations at
  tibiofemoral joint
• Rotational instability
• Axis of rotation changes
• Anterolateral, anteromedial, posterolateral,
  posteromedial
• Involves combination of ligamentous and other
  structures injured

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Strains

• Common to hamstrings quadriceps
• Factors affecting
• Flexibility
• Hamstring/Quadriceps ratio
• Inadequate warm-up
• Ruptures
• Patellar tendon

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Dislocations

• Patellar
• Acute
• Obvious deformity
• Lateral tightness
• Tibiofemoral knee dislocation
• EMERGENCY situation

10
Meniscal Tears

• Mechanism
• Excessive rotation/flexion
• Acute vs. Chronic
• S/S
• Clicking, locking, giving way
• Contribute to rotational instabilities

11
ITB Friction Syndrome

• Mechanism
• Repetitive flexion/extension
• Common to running cycling
• S/S
• Burning pain, RROM at 30 degrees
• Where does ITB attach? Location of pain!

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Bursitis Fat Pad Irritation

• Mechanism
• Direct blow
• Repetitive mini blows
• S/S
• Swelling present around patellar tendon

13
Synovial Plica

• Definition
• Fold of membrane most common on anteromedial
  side of knee
• S/S
• Clicking, catching
• Location of pain as it crosses femoral condyle.

14
Patellar Tendintitis

• Common to jumping and repetitive activities.
• Loc of pain
• Superior pole (jumpers knee)
• Inferior pole
• Patellar tendon
• Pain w/ resistive knee extension

15
Osteochondral defects

• Fractures to articular cartilage and bone
• Mechanism
• Compressive and shear forces

16
Chondromalacia

• Definition
• Softening of articular cartilage
• Predisposing Conditions
• Poor patellar tracking malalignment
• S/S
• Crepitus under patella

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Adolescent Injuries

• Osgood-Schlatters disease
• Excessive tibial tuberosity growth
• Sinding-Johansen-Larsen disease
• Avulsion of patellar tendon at inferior pole of
  patella