IB 128 - Final Flashcards

What percentage of all sports injuries involve the knee?

15% of all sports injured involve the knee

What percentage of knee injuries result in a visit to the Dr.’s office?

50% of knee injuries result in a visit to the Dr.’s office

What percentage of the surgeries on professional football players involve ligament tears, ACL tears, and the meniscus?

75% of the surgeries on professional football players involve ligament tears, ACL tears, and the meniscus.

What percentage of knee injuries constitute of all sports injuries?

Knee injuries constitute 15% of all sports injuries.

What percentage of visits to sports doctors are knee injuries?

Knee injuries account for approximately 50% of all visits to sports doctors.

What percentage of all injuries do knee injuries account for in pro football?

Knee injuries account for about 23% of all injuries in professional football.

What percentage of surgeries in pro football are for knee related problems?

75% of surgeries in pro football are for knee related problems?

What portion of surgeries for knee related problems are due to the medial collateral ligament tear? 

Approximately (1/3) of knee surgeries in pro football are due to medial collateral ligament tears.

What portion of surgeries for knee related problems are due to tears of the ACL?

Approximately (1/4) of knee surgeries in pro football are due to ACL tears.

What portion of surgeries for knee related problems are for meniscus injuries?

Approximately (1/4) of knee surgeries in pro football are for meniscus injuries.

What is the most common joint injury among high school athletes?

Sprains and strains of the ankle. Second is leg injuries, and third is knee injuries for males. Versus for females second is knee injuries, and third is leg injuries.

What is the most common joint injury that leads to surgery?

Tears of the ACL are the most common joint injury that results in surgical intervention.

Describe quadriceps function*

The quadriceps are the knee extensors. They also help stabilize the knee joint and assist in hip flexion.

Name 3 medial stabilizers of the knee which resist valgus stress

The three medial stabilizers of the knee that resist valgus stress are the medial collateral ligament (MCL), the pes anserine, and the medial capsular ligament. These structures work together to provide stability and prevent excessive inward movement of the knee. .

Where is the popliteal space and what vital structures does it contain?

The popliteal space is located at the back of the knee and contains vital structures such as blood vessels (popliteal artery, popliteal vein), and nerves (the sciatic nerve in particular).

What is the iliotibial tract (or band) and what is its clinical significance?

The iliotibial tract is a band of fibrous tissue that runs along the outside of the thigh from the hip to the knee. Its clinical significance lies in its role in stabilizing the knee during activities and in conditions like iliotibial band syndrome, which can cause lateral knee pain. It is one of the lateral stabilizers.

What are 5 important questions when evaluating a patient with acute or chronic knee problem and significance of the answers

1) Was there a distinct injury?

3) Was there an external force?.. valgus/vargus

4) Was the knee weight bearing at the time of the injury? — There is a greater chance of damage to internal structures if so.

6) Is/was there pain? —Pain is usually proportional to the amount of damage (except in a Grade 3 injury in which nerve fibers may be disrupted)

10) Is/was there immediate/delayed swelling? — Immediate swelling (within 1 hour) indicates blood in the joint. Delayed swelling indicates a synovial reaction.

The significance of the answers is to get as much detail about the injury as possible. The more detail you can get, the better idea you will have about what is injured. Most importantly if you know the type of force involved and position of the lower leg, you can get an idea of which structures may be injured.

Define a valgus force to the knee and what structures are placed under stress…..

A valgus force is a force from the side and it injures the medial aspects of the knee.

-Medial meniscus, medial collateral ligament, ACL. (aka the “terrible triad”)

-(*a valgus force can refer to an external force as in football, or the weight of an athlete who is moving in any sort of running sport, i.e. a soccer player who plants foot and goes to change direction).

Define a varus force of the knee and what structures are placed under stress…..

A varus force is a force from the inside and it injures the lateral structures.

-More often the knee is injured with a valgus force with external rotation of lower leg.

What are 3 functions of the knee meniscus?

1. The menisci act as a cushion and allow for proper movement/tracking between the femur and tibia

2. The menisci act as stabilizers for the bones

3. The menisci have a nutritional function because they allow synovial fluid to flow up and around the knee joint

What are 3 symptoms that suggest an old untreated meniscus tear?

1. effusion/swelling

2. joint line tenderness over the MCL (b/c the medial meniscus is attached to it)

3. quadriceps atrophy (particularly of the vastus medialis)

What is the likely mechanism of injury for a torn meniscus?

External force or twisting movement causing a tear

Diagnostic test to confirm a meniscus tear

clinical exam; MRI for confirmation. Can also use arthroscopy if necessary (arthroscopy has a high sensitivity, specificity and predictive value).

What are 3 ways in which an ACL tear may occur?

1. Valgus

2. Twisting

3. Deceleration Force

Diagnostic test for a suspected ACL tear

clinical exam/MRI

Symptoms of an ACL tear…

The symptoms of an ACL Tear include:

• Feeling or hearing a pop in your knee.

• Swelling.

• Pain (especially when you try to put weight on your knee).

• Weakness or feeling like your knee has given out.

• Losing your range of motion (how far you can move your knee).

Reasons favoring surgery over rehab in ACL Tear

• Surgery is the best way to treat an ACL injury for competitive athletes who must return to their sport at a high level¹.

• Rehabilitation is started as soon as possible in conservative treatment, but it may take months before patients feel strong and stable enough to return to their usual activities²³.

• 20% of those with an un-repaired ACL (non-surgically) suffer from a meniscus injury within 5 years

If surgery is chosen in ACL tear, what decisions are to be made:

1. It’s important to wait 4-6 weeks before doing the procedure so that the patient can get full range of motion back and therefore speed recovery

2.Take in certain factors into consideration when considering surgical ACL repair:

-Age of the patient

-Activity Level

-Are other structures injured?

-What is the person’s sport specific degree of involvement? Is using a brace a possibility?

-Is it possible to identify subjects who will do well without surgery?

What are the 3 levels of ACL injury

Level 1: sports involving jumping, pivoting, and cutting, deceleration (basketball, football, soccer) and that put the ACL and meniscus under a lot of stress. For people involved in these activities, ACL repair is important.

Level 2: Sports that involve lateral motion (baseball, racquet sports, skiing). For people involved in these activities there is more of an option between rehabilitation and reconstruction

Level 3: Activities that put little stress on the knee (jogging and swimming). For people involved in these activities, rehabilitation is an option.

What are some controversies and unsettled issues in knee injury?

1. Will ACL reconstruction prevent or delay degenerative changes?

2. What are consequences after ACL injury, with or without surgery?

3. Is there any treatment for meniscal injury?

4. What accounts for gender differences in injury rates for the ACL? Are these preventable?

5. Surgical issues: choice of graft, placement and attachment of graft, rehab after surgery

What are the theories of gender differences in ACL injury?

College female athletes have 2-4 time the risk of ACL injury in soccer, volleyball, basketball. Theories include the role of Estrogen receptors, Femoral notch geometry, Muscle firing patterns, Patterns of landing from a jump

What are 3 sources of graft for ACL reconstruction?

Graft Selection, Graft placement, Graft fixation

What is the outcome in ACL injured NFL players?

About 60-70% of players who undergo ACL reconstruction (ACLR) are able to return to play in the NFL.

The average time to return to play is typically 9-12 months post-surgery.

Players in positions that require speed, cutting, and change of direction (e.g., running backs, wide receivers, and cornerbacks) tend to experience longer recovery periods and lower return-to-play success rates.

Even after a successful surgery and rehab, performance levels may be impacted. Studies suggest that only about 60-80% of players fully return to their previous level of performance.

Players who return to the field post-ACL reconstruction have a higher risk of re-injury, both to the ACL and other areas of the knee. The re-injury rate for ACL-reconstructed players can be as high as 20% in some studies, especially in the first 2 years.

Over time, even if players return to their previous level of performance, they may experience joint degeneration or early signs of osteoarthritis due to the altered mechanics and stresses on the knee after ACL reconstruction. The long-term outlook for these athletes can be compromised, leading to potential end-of-career issues.

Define Patellofemoral syndrome

Involves the interaction between the knee cap and the bones underneath…. can be called a number of things

What are 2 anatomical factors associated with patellofemoral syndrome?

1. A large Q-angle

2. Tight lateral ligaments tending to pull the patella to the side

What are 3 biomechanical factors associated with patellofemoral syndrome?

anatomy, training, equipment