Unit 6: Knee Injuries

Anterior Cruciate Ligament

- prevents the femur from moving posteriorly during weight bearing and limits anterior translation of tibia in non-weight bearing

- stabilizes tibia against excessive internal rotation

Posterior Cruciate Ligament

- resists internal rotation of tibia, prevents hyperextension of knee

Prevention of Knee Injuries

- total body conditioning (strength, flexibility, endurance, agility, speed & balance

- muscles around condition to maximize stability

- avoid abnormal action

Decreasing the risk of ACL injury

- focus on strength, neuromuscular control, and balance

Shoe type Affecting the Knee

- change in football footwear has drastically reduced injuries

- more short cleats do not allow the foot to become fixes, still allows for control with running

Functional and prophylactic knee braces

- Used to prevent and reduce severity of knee injuries

- protects MCL and ACL

Medial Collateral Ligament Sprain (MCL)

- result of severe blow from lateral side (valgus force)

- different grades

Grade 1 Medial Collateral Ligament Sprain

- little fiber tearing/stretching

- stable valgus test

- normal ROM

- tx: POLICE (24 hrs), crutches, cryokinetics, 3 weeks recovery

Grade 2 Medial Collateral Ligament Sprain

- complete tear of deep ligament, partial tear of superficial layer

- slight swelling, laxity at 30 degrees of flexion, joint tightness, decreased ROM

- tx: POLICE (48-72 hrs), crutches, brace/casts, gradual progression to closed kinetic chain exercises

Grade 3 Medial Collateral Ligament Sprain

- complete loss of medial stability, minimum swelling, immediate pain, loss of motion, positive valgus stress test

- tx: POLICE, limited immobilization (brace), progressive weight bearing, increased ROM

Lateral Collateral Ligament (LCL)

- result of varus force, generally with tibia internally rotated

- severe damage, pain/tenderness, swelling, irritation to fibular (peroneal) nerve

- tx: depends on severity follows the same as MCL

Anterior Cruciate Ligament (ACL) Sprain

- caused by direct contact/noncontact mechanism (80% more likely)

- experience a pop, severe pain/disability, rapid swelling

- tx: POLICE, crutches surgery depending on severity (4-6 months of rehab)

Posterior Cruciate Ligament (PCL) Sprain

- caused by fall on bent knee (most common), rotational force

- feel a pop, tenderness, swelling

- tx: POLICE, surgery (6 weeks of immobilization) (ROM after 6 weeks)

Meniscal Lesions

- medial meniscus is more common injured

- ruptured edges harden and may atrophy

- joint line pain, loss of motion, knee locking, pain squatting

- tx: unlock the knee with surgery, repair meniscus (immobilization with gradual return to activity over 12 weeks)

Knee plica

- irritation of the plica

- recurrent episodes of painful pseudolocking, possible snapping/locking, pain with bending knee, little swelling

- tx: RICE, if recurrent may require surgery

Bursitis

- prepatellar: continued kneeling

- infrapatellar: overuse of patellar tendon

- swelling above or behind knee, can be painless, little disability

- tx: RICE, steroid injection (chronic)

Patellar Fracture

- direct/indirect trauma (severe pull of tendon)

- hemorrhaging, swelling, capsular tearing, little bone separation

- tx: x-ray, RICE, splinting, immobilize for 2-3 months

Acute Patella Subluxation/Dislocation

- deceleration with simultaneous cutting in opposite direction, quad pulls patella out of alignment

- subluxation, pain, swelling, restricted ROM, tenderness, total loss of function

- tx: reduction (flex hip, move patella medially, and slowly extend knee), immobilization for 4 weeks, crutches, horseshoe pad after immobilization, muscle rehab

Chondromalacia patella

- softening/deterioration of the articular cartilage

- pain with moving knee (walking, running, stairs), swelling, pain at inferior border during palpation

- tx: RICE, orthotics, surgery

Patellofemoral Stress Syndrome

- Result of lateral deviation of patella while tracking in femoral groove

- tenderness of lateral facet, swelling, dull ache, crepitus with compression

- tx: correct imbalances (strength/flexibility), McConnell taping

Osgood-Schlatter disease

- apophysitis occurring at tibial tubercle

- resolves with aging

- swelling, hemorrhaging, gradual degeneration, point tenderness, pain (kneeling, jumping, running)

- tx: reduce stressful activity (6-12 months), possible casting, ice before/after activity

Larsen-Johansson disease

- result of excessive pulling on the inferior pole of the patella

- swelling, hemorrhaging, gradual degeneration, point tenderness, pain (kneeling, jumping, running)

- tx: reduce stressful activity (6-12 months), possible casting, ice before/after activity

Patellar tendinitis (Jumper’s/Kicker’s knee)

- placing tremendous stress/strain on patellar/quad tendon, sudden or repetitive extension

- pain, tenderness, goes through pain phases

- tx: ice, exercise, patellar tendon bracing, transverse friction massage

Patellar Tendon Rupture

- sudden/powerful quad contraction (occurs commonly at point of attachment

- generally does not occur unless chronic inflammation condition results in tissue degeneration

- palpable defect, lack of knee extension, swelling, pain

- tx: surgical repair needed, proper conservative care can minimize changes of occurring

Iliotibial Band Friction Syndrome (Runner’s/Cyclist’s Knee)

- repetitive/overuse condition attributed to malalignment and structural asymmetries

- irritation at band’s insertion, positive Ober’s test

- tx: correction of malalignments, ice before/after activity, proper warmup/stretches, avoidance of activities, orthotics

Pes Anserine Tendinitis/Bursitis

- result of excessive genu valgum (knees inward) and weak vastus medialis

- occurs due to running with one leg higher than the other (slope)