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Flashcards in Knee Injuries Deck (28)
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1

Anterior Knee Pain can be?

Patellofemoral Joint Compression Syndrome
Chondromalacia Patella (CMP)
Patellar Tendonitis (Jumper's Knee)
Plica Syndrome
Also:
- Patellar subluxation/dislocation
- Osgood Schlatter's disease
- Sinding-Larsen and Johansson Syndrome

2

Patellofemoral Joint Compression

Primary Function:
Increase the efficiency of the quadriceps muscle by increasing its lever arm.

3

Patellar Tracking

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.

4

Abnormal Tracking can lead to?

Increased compressive forces along the lateral patellar surface.

Increases the tensile stresses on the medial retinaculum of the patella.

5

Risk Factor for Abnormal Tracking Include?

Increased Q-Angle
Atrophy in the VMO
"Tight" lateral retinaculum
Tightness in the Iliotibial Band
Increased foot Pronation

6

Chondromalacia Patellae (CMP)

Chodromalacia patellae, refers to the softening/damage of the articular cartilage of the patella

7

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.

Subjective C/O
-Diffuse "retro-patellar pain"
- Pain with stairs and ramps
- "Movie Goer's Sign"

8

Patellar Tendinitis (Jumper's Knee)

A relatively common inflammatory condition that causes pain in the anterior aspect of the knee.

Subjective C/O
- Local pain and tenderness along the patellar tendon
- Increased pain with activity.

Common Treatments: Patellar Straps

9

Ruptured Patellar Tendon Presentation and Treatment

Presentation:
-Patella moves superiorly
- Palpable deficit at the anterior joint line of the knee
- Inability to extend the knee

Treatment:
- Surgical Repair

10

Plica Syndrome

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.

11

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.

Surgical management.

12

Patellar Subluxation/Dislocation

A partial or complete displacement of the patella from the trochlear groove of the femur.

MOI:
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.

13

Patellar Subluxation/Dislocation

Severe pain
Obvious deformity
Inability to flex or extend the knee
Edema

14

Osgood-Schlatter Disease

Osgood-Schlatter disease, is the most common traction apophysitis and exertion injury in the adolescent knee.

Typically Self Limiting

15

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

16

Osteochondritis Dissecans

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.

17

Baker's Cyst

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.

18

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.

19

ITBS Clinical Presentation and Treament

Clinical Presentation:
Positive Nobles Test
Positive Ober's Test

Treatment:
RICE
NSAID's
Flexibility

20

Meniscal Injury

MOI: Typically knee compression with rotation of the tibia
Signs and Symptoms:
- Joint line tenderness
- Joint Effusion
- Hx of "Locking"

Clinical Assessment
- Positive Apley's Compression Test
- Positive McMurray's Test

21

ACL Sprain

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.

22

ACL Sprain Clinical Signs

Significant joint effusion
Positive Anterior Drawer Test
Positive Lachman's Test
Positive Pivot Shift Test

23

Surgical Repair

Autograft:
-Patellar tendon graft (bone-tendon-bone)
-Hamstring Tendon (Usually sememenbranosus)

Allograft (cadaver ligament)

24

PCL Sprain

MOI: Posteriorly directed force on the tibia or forced hyperflexion.

Clinical Findings
Joint effusion
Positive Posterior Drawer Test
Positive Sage Test

Treatment: Skillful neglect.

25

Medial/Lateral Collateral Ligament Sprain

MOI:
Varus or Valgus Stress

Clinically indentified with Varus or Valgus Stress Test

Typically treated non-operatively

26

Peroneal Nerve Palsy

Characterized by:
Loss of movement (i.e. drop foot)
Decreased sensation

Common Causes:
Trauma or injury to knee
Fibular fracture
"Tight plaster" cast
Posture

27

Peroneal Nerve Palsy Treaments

PHyscial release of compression
NSAID's
Corticosteroids
Surgery
Return to play requires that the athlete be clear of any neurological findings

Other Treatments:
Analgesics
Athletic Training/Physical Therapy
Orthopedic Deviced (i.e. AFO)

28

Always Consider

Typical MOI and Risk Factors
Salient anatomical and biomechanical components
Presentation
General Treatment