Athletic Injuries ATC 222

1
Athletic InjuriesATC 222

• The Knee
• Chapter 16

2
Anatomy

• bony
• muscular
• cartilage
• ligaments
• bursa
• etc

3
Functional Anatomy

• Motions
• flexion/extension
• rotation

4
Evaluation

• History
• Observation
• Palpation
• Special Tests

5
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

6
MCL Sprain Treatment

• RICER
• Crutches?
• Immobilization?
• Meniscal involvement?
• Rehabilitation

7
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

8
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

9
ACL Sprain Treatment

• RICER
• Crutches?
• Immobilization?
• Conservative vs surgical intervention
• commonly associated with meniscal tear

10
PCL Sprain

• Mechanism
• force to anterior tibia with knee flexed
• hyperflexion
• rotation
• Signs and Symptoms
• pop
• effusion
• instability
• Treatment
• usually non-operative

11
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

12
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

13
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

14
Apophyseal Injuries(apophysitis)

• Apophysis Traction Epiphysis
• Types
• Osgood-Schlatters 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

15
Other Injuries

• Tendonitis
• Osteochondral defects
• ITB syndrome

16
Special Tests of the Knee

• tibial/fibular compression/percussion
• patellar apprehension
• ballotable patella and stroke test
• patellar excursion and compression

17
Other Special Considerations

• leg length discrepancy
• Mechanics of lower extremity
• Q-Angle
• 10 males, 15 females
• over 20 is abnormal