Sports Medicine Knee Study Guide

What is the upper thigh bone?

femur

What is the larger bone of the lower leg?

tibia

What is the smaller bone of the lower leg?

fibula

What does MCL stand for?

medial collateral ligament

What does LCL stand for?

lateral collateral ligament

What does ACL stand for?

anterior cruciate ligament

What does PCL stand for?

posterior cruciate ligament

What does the ACL connect?

femur to tibia

What does the PCL connect?

femur to tibia

What does the MCL connect?

femur to tibia

What does the LCL connect?

femur to fibula

What does the Patellar Tendon connect?

patella to tibia

How many menisci are there?

two per knee joint

Where does the meniscus sit?

on top of the tibia (tibia plateau) between the femur and tibia

What are the three parts of the meniscus?

red-red zone
red-white zone
white-white zone

What does collateral mean?

To support (ligaments that stabilize and support knee joint)

What does cruciate mean?

criss-crossed shaped ligaments

What is valgus?

A deformity where the knee joint is pushed toward the midline of the body. (knock-kneed)

What gets stretched in a varus injury?

LCL

What is the weight bearing bone of the lower leg?

tibia

What connects the tibia and fibula?

Syndesmosis

What muscles do flexion?

hamstrings

What muscles do extension?

Quadriceps

What are the hamstring muscles?

Biceps femoris
Semitendinosus
Semimemberbranosus

What are the quadriceps muscles?

Rectus Femoris (Wreck From Front)
Vastus Medialis
Vastus Lateralis
Vastus Intermedius

How do you prevent knee injuries?

Do total body conditioning
Know the Kinetic Chain (everything connects to one another)
Shoes with traction
Change shoes depending on surface
Braces if needed
Prophylactic- Preventative (used for MCL injuries in football linemen only)

What is a valgus test for?

To see if the MCL is injured or torn.

For a valgus test, place one hand on the pts ankle, and another hand lateral to their knee. Push medial to lateral while standing lateral to pt.

What is the Lachman test for?

To see if the ACL is injured or torn.

What does the Lachman test look like?

For the Lachman test, place one hand on the pt's upper thigh, and the other on their tibia or patellar tendon. Pull the tibia anterior.

What is the anterior drawer test for?

To see if there is a tear or injury in the ACL.

What is the posterior drawer test for?

To see if the PCL is injured or torn

Joint Contusion:

MOI- A direct impact to the area. (seen most in anterior/quadriceps)

S&S- p!, swelling, ecchymosis, decrease in movement

Trmt: PRICE, Cryokinetics (Icing, then doing ROM), preventing an increased injury by using a donut pad or RTP protocol.

What would cause further injury after an MCL sprain?

Instability

What can be associated with LCL sprains?

Avulsions fx (fibula head is pulled off)

What causes girls to have more ACL tears compared to boys?

Women have child-bearing hips (an increase in Qangle, Valgus)

What is the average rehab following an ACL tear?

6 months

What would indicate you need sx following an ACL tear?

If the tear is active or unstable

What are the three options for surgery post ACL tear?

1. No surgery (If it is not unstable) *Can lead to arthritis
2. Allograft (Taking tendon from Cadaevor)
3. Autograft (pt uses own tendon) Taken from the patellar tendon, hamstring, or quadriceps.

What three types of autografts are there?

Patellar Tendon
Hamstring
Quadriceps

What is another name for PCL tear?

Dashboard Injury

What are the two MOI's for a PCL tear?

Dashboard injury
Falling on a flexed knee

What injury would be associated with popping, clicking, etc?

Meniscal injures

When would you want a meniscal repair versus a meniscectomy?

Meniscal repair (if the injury is in the red-red zone)
Meniscectomy (if the injury is in the red-white or white-white zone) They cut out the injured area.

Why would you use cryokinetics following a joint contusion?

The cold will decrease pain
It will help the swelling to decrease

What is another name for runner's knee?

Ilotibial Band Friction Syndrome

What strengthening is important for runner's knee?

Strengthening the gluteus medius

What way does the patella normally dislocate?

When one foot is planted on the ground, the rest of the body moves in a different direction. Or one bone stays and the other moves.

What is another name for jumper's knee?

Patellar Tendinosis/itis

What degenerates in osgood schlatter?

The tibial turbercle

What are the 6 types of fractures?

Green Stick
Oblique
Transverse
Linear
Spiral
Communiuted

What adds bone to a bone?

Ligaments add bone to bone
(Osteoblasts are bone-forming cells.)

What breaks down bone?

Osteoclasts break down bones.

What is a closed fracture?

Not a lot of movement of the broken bone or broken skin.

What is an open fracture?

A break that is moved so much that it breaks open the skin and punctures tissues.

How long does each phase take?

IRP: 2-4 days
FRP: first hours after healing to 4-6 weeks
MRP: 3 weeks, sometimes can take years depending on injury

What are the three phases of healing?

Inflammatory Response Phase
Fibroblastic Repair Phase
Maturation-Remodeling Phase

What is osteoarthritis?

The hyaline cartilage is wearing down

What is a trigger point and how does it differ from a cramp?

Tightness in an area of tight band muscle
Cramps are involuntary movements in the whole muscle
Trigger points are a small part of contracted muscle

What happens in the IRP phase?

IRP:
Starts right after injury
Most important phase
Destruction of tissue hurts soft tissues/cells
Ruined tissue is cleaned up by Phagocytic cells
Injured cells release chemicals to start healing process
Inflammation makes area warm, red, swollen, and painful

What happens in the FRP phase?

FRP:
Regenerative & Proliferative activity fix tissue and produce scarring
Fibroplasia (scar formation) starts
Fibroplasia begins in first hours after healing
Scar helps inflammation go away

What happens in the MRP phase?

MRP:
Longest process
Remodels the scar tissue
Adjusts to the tensile forces
Collagen fibers realign & prepare for stress against area

What is osteoarthritis?

The hyaline cartilage is wearing down

What is a bursae?

Synovial membrane pieces that contain fluid

What is crepitus?

A crackling sound/feel

Caused by tendon wanting to stick to the surrounding while sliding back and forth
Sticking caused by production of chemicals that create inflammation

What is Tendinopathy?

Any tendon injury

What is tendinosis?

Tendon has failed to heal
Irritate area
Apply friction
Stop all NSAIDS
heat

What is tendonitis?

Tendon is inflamed
Needs PRICE and NSAIDS

What are signs of inflammation?

Warmth
Swelling
P!
Redness
Loss of Function in area

How fast does a nerve regenerate?

3-4 mm of nerve regeneration occurs per day.

What is neuritis?

A chronic nerve issue
Symptoms range from minor pain to paralysis
Can cause physical disability

What is Paresthesia?

Numbness or tingling occurring from a direct blow or even stretch in the area

What is hyper-esthesia?

Increased feeling or p! Or touch to the area

What is hypoesthesia?

Loss of feeling

What is DOMS? And when does it occur?

(Delayed- onset muscle soreness)

Occurs 12 hours after the exercise is finished.
It is the most extreme in the 24-48 hour mark.

It goes away after 3-4 days.

Leads to muscle tension, swelling, resistance to stretching, and stiffness.

Can come from small tears in muscle fibers or disruption with the connective tissue holding the muscle tendon fibers together.

To best avoid: start moderate exercise then increase as body gets stronger
Stretch before and after exercise

What is a cramp?

Highly painful muscle contractions
Most seen in the calf, hamstring or abdomen.
Occurs when the body is lacking water, electrolytes, or ions

What is muscle guarding and how is it different from other muscle injuries?

Muscle guarding: when the muscles around the injured area contract as a response to pain.
Also known as "splinting" not the same as muscle spasms.
It is an involuntary muscle contraction

What are the two causes of myositis ossificans?

Repeated impact to a certain area
One large impact

What is myositis ossificans?

Calcium deposits are formed by the constant trauma to an area
Calcium found in fibers of the muscle belly

Can restrict movement

To prevent this: protect the area with padding, rest the area so that the calcium and reabsorb
The quadriceps and biceps have the most contusions.

What is injured in a contusion?

Capillaries or the blood vessels and soft tissues.

What is a contusion?

A bruise

External items hit soft tissues and push them against the bone.
Hard blow = torn capillaries, bleeding into tissues.
Mild bleeding = blue/purple discoloration for many days

Can be tender to the touch
Pain goes away after a few days, the color goes away after a few weeks.

What is a first grade sprain?

Slight separation/ stretching between ligament fibers.
Little bit of instability with joint
Mild pain, swelling in area, stiff joints

What is a second grade sprain?

Some tearing between ligament fibers
Mild instability with joint
Mild to severe pain, swelling in area, stiff joints.

What is a third grade sprain?

Complete tearing of ligament fibers
Instability in joint
First it is a severe pain, then because the nerves are damaged, the pain can go away.
Large amounts of swelling, the joint is very stiff for a long time.

What is a first grade strain?

A few muscle fibers are stretched
Some mild pain/tenderness when in motion
Movement hurts, but full range of motion is possible

What is a second grade strain?

Many muscle fibers are torn or stretched
Contracting muscle causes severe pain
Divot can be found in muscle belly where it is torn
Swelling and discoloration are mild

What is a third grade strain?

Muscle fibers are completely torn
Almost a total loss of movement
First pain is harsh, then it dies down because of nerve damage and separation.

What is a sprain?

Injury to the joint or ligament that connects bone to bone.

First time dislocations should always be treated as a...

possible fracture.

What is a subluxation?

A bone is pushed fully out of its normal position, but then goes back
Most seen in the kneecap or shoulder joint

What is a dislocation?

A bone or joint is pushed fully out of its normal position
Must be surgically or manually placed back
Most seen in the elbow, shoulder, and finger
Can happen where any two bones articulate.

What is a stress fracture?

Created from overuse rather than an acute trauma

Most common fracture in physical activity
Mostly seen in legs and arms which are weight-bearing bones

The continuous force being placed on the bones causes the periosteum to be irritated, and fatigue fractures of the underlying bone form.

Pain starts dull, then it grows more, at first the pain is most prominent during the activity, but once the stress fracture is created, the pain comes on when the activity is stopped.

Does not usually show up on Xrays until osteoblasts start laying down on the bone
White line on X Ray indicates a stress fracture

Athlete must stop activity for at least 14 days and slowly ease themselves back into the activity
Do not usually need a cast, unless it is not dealt with correctly.

How long does long bones take to heal?

Long bones take about 6 weeks to heal with a cast

How long do short bones take to heal?

Short bones take 3-4 weeks to heal with a cast

What endpoint do you want for your patient when testing?

A hard endpoint