Flashcards in Knee Injuries Deck (28)
Anterior Knee Pain can be?
Patellofemoral Joint Compression Syndrome
Chondromalacia Patella (CMP)
Patellar Tendonitis (Jumper's Knee)
- Patellar subluxation/dislocation
- Osgood Schlatter's disease
- Sinding-Larsen and Johansson Syndrome
Patellofemoral Joint Compression
Increase the efficiency of the quadriceps muscle by increasing its lever arm.
Patella "tracks" relatively vertically in the femoral groove.
Because the patella is embedded in the patellar tendon it's movement is dictated by the forces produced by the muscles which make up the quadriceps-either individually or as a unit.
Abnormal Tracking can lead to?
Increased compressive forces along the lateral patellar surface.
Increases the tensile stresses on the medial retinaculum of the patella.
Risk Factor for Abnormal Tracking Include?
Atrophy in the VMO
"Tight" lateral retinaculum
Tightness in the Iliotibial Band
Increased foot Pronation
Chondromalacia Patellae (CMP)
Chodromalacia patellae, refers to the softening/damage of the articular cartilage of the patella
Patellofemroal Pain Syndrome (PFPS)
Patellofemoral Stress Syndrome (PFSS)
This more general term usually refers to pain under and around the patella. However the name does not implicate any specific tissue but rather refers to any number of pain producing areas associated with the patellofemoral joint.
-Diffuse "retro-patellar pain"
- Pain with stairs and ramps
- "Movie Goer's Sign"
Patellar Tendinitis (Jumper's Knee)
A relatively common inflammatory condition that causes pain in the anterior aspect of the knee.
- Local pain and tenderness along the patellar tendon
- Increased pain with activity.
Common Treatments: Patellar Straps
Ruptured Patellar Tendon Presentation and Treatment
-Patella moves superiorly
- Palpable deficit at the anterior joint line of the knee
- Inability to extend the knee
- Surgical Repair
Plica Syndrome occurs when plicae (bands of remnant synovial tissue) are irritated by overuse of injury.
The most commonly irratated band is the mediopatellar plica.
Plica Syndrome Common Managements
Structured program of stretching and strengthening exercises often leads to some improvement.
Patellar knee sleeve worn during sporting activities (usually a neoprene-type brace) may also be a useful adjunct for many athletes.
A partial or complete displacement of the patella from the trochlear groove of the femur.
Internal rotation of the femur and tibia while foot is firmly planted
Traumatically if the medial border of the patella is physically forced to the lateral side of the knee.
Inability to flex or extend the knee
Osgood-Schlatter disease, is the most common traction apophysitis and exertion injury in the adolescent knee.
Typically Self Limiting
Sinding-Larsen and Johansson Syndrome
Sinding-Larsen and Johansson Syndrome or patellar osteochondrosis, is an overuse traction apophysitis caused by repetative microtrauma atthe insertion point of the proximal patellar tendon onto the lower patellar pole
OCD is a focal area of detached or semidetached subchonrdal bone with hyaline articular cartilage on top. It is caused by blood deprivation to the subcondral bone. OCD is most commonly located on the lateral aspect of the medial femoral condyle or on the weight bearing surface of the posterior lateral femoral condyle.
A Baker's Cyst results from the knee joint swelling, which causes herniation of joint fluid and synovium through the capsule of the knee joint posteriorly, or from distention of the semimembranosus bursa.
Iliotibial Band Syndrome
ITBS is an overuse inflammatory condition due to the friction between the IT band and the lateral condyle of the femur.
Most often caused by the stress of long-term overuse.
ITBS Clinical Presentation and Treament
Positive Nobles Test
Positive Ober's Test
MOI: Typically knee compression with rotation of the tibia
Signs and Symptoms:
- Joint line tenderness
- Joint Effusion
- Hx of "Locking"
- Positive Apley's Compression Test
- Positive McMurray's Test
MOI if injury to the ACL include hip internal roation, tibial external rotation, knee flexion to about 30*, genu vlagum, foot pronation and forward movement of the center of gravity.
ACL Sprain Clinical Signs
Significant joint effusion
Positive Anterior Drawer Test
Positive Lachman's Test
Positive Pivot Shift Test
-Patellar tendon graft (bone-tendon-bone)
-Hamstring Tendon (Usually sememenbranosus)
Allograft (cadaver ligament)
MOI: Posteriorly directed force on the tibia or forced hyperflexion.
Positive Posterior Drawer Test
Positive Sage Test
Treatment: Skillful neglect.
Medial/Lateral Collateral Ligament Sprain
Varus or Valgus Stress
Clinically indentified with Varus or Valgus Stress Test
Typically treated non-operatively
Peroneal Nerve Palsy
Loss of movement (i.e. drop foot)
Trauma or injury to knee
"Tight plaster" cast
Peroneal Nerve Palsy Treaments
PHyscial release of compression
Return to play requires that the athlete be clear of any neurological findings
Athletic Training/Physical Therapy
Orthopedic Deviced (i.e. AFO)