Athletic Injuries ATC 222 The Knee Chapter 16

Athletic Injuries ATC 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