Week 9: Knee Ligament Injuries/Tendons/Patella

incidence of ACL injury

80-250k, mainly athletes 15-25, females more than males, non contact

4 risk factors of acl injury

biomechanical, structural, neuromuscular, hormonal

contact acl injury

contact (football), clearly identified

noncontact acl injury

patterns/conditions/cutting, etc

how many acl knee injuries have instability

1/3 are minimal, 2/3 are unstable

1/3 of people also have involvement of what other kind of injury

meniscus

surgery vs non surgery for acl injury

surgery-athletes that have high instability

nonsurgery-older

ACLR (reconstruction) uses what 3 things

patellar tendon, hamstring tendon, cadaveric graft

ACLR complications

OA, patellofemoral pain, morbidity of graft, infection, bioresorbable screw

why is the screw an issue?

phagocytosis of particle from screw cause bone resorption and tunnel enlargement

ACLR rehab

extension is important, PWB for 7-10 days, closed chain exercises, exercise at low knee flexion range, return to sport 8-12 months

3 initial concerns of ACLR rehab

swelling, rom, weakness

PCL MOI

direct blow to ant tibia with forced hyperextension with foot fixed, flexed knee position with force in posterior direction (dashboard, falling on flexed knee)

PCL injury repair

grade III may need surgery but is controversial

treatment of PCL injury (grades I and II)

brace in extension for 2-4 weeks, strengthen quads and hams, ROM, recovery is quick (4-6 weeks)

MOI of quad tendon rupture

sudden, forceful contraction from quads (jump, preventing fall)

risk factors for quad tendon rupture

men over 40, diabetes, renal disease

S/s of quad tendon rupture

cant exten dknee, palpable defect above patella, swelling and loss of contour

standard care for quad tendon rupture

surgery

MOI for patella tendon rupture

direct impact to front of knee, deep lacerations, forceful quad contraction against flexed knee

key finding of patella tendon rupture

patella alta

patella tendon rupture s/s

cant extend, palpable gap below patella, hemarthrosis and swelling

standard care for patella tendon rupture

surgery

bakers cyst

accumulation of fluid behind knee

4 reasons for bakers cyst

connection of normal bursa with knee joint, posterior herniation of knee capsule (meniscus), one way valve between bursa and knee joint, intra articular patho

s/s of bakers cyst

pain with rom and wb, swelling

where is bakers cyst

large between gastroc and soleus

main treatment for bakers cyst

surgery

who gets patellar tendonitis (jumpers knee)

young athletes (15-30), males more often, jumping athletes, overuse

where is pain for patella tendonitis

inferior patella area

who gets patellofemoral pain syndrome (runners knee)

overuse, young, females more, gradual onset

where is pain in patellofemoral pain syndrome

anterior knee

what aggravates patellofemoral pain

squat, stairs, sit to stand, prolonged knee flex, worse in flexion

risk factors of petallofemoral pain syndrome

malalignment, large Q angle, VMo weakness, tight mm (quad, gastro, ham, it band)

what test has high sensitivity for patellofemoral pain syndrome

quad grinding test

managing patellofemoral pain syndrome

modify activity, flexibility and strengthening, patella tracking exercise, icing, nsaids, patellar taping, orthotics

what is Q angle

from ASIS to middle of patella and second line from mid patella to tibial tub, over 17 degrees is excessive (genu valgum)

cause of chondromalacia patella

insidious onset but increase bouts of activity or excessive loads are known to exacerbate (stairs, running), more in young females

patho of chondromalacia patella

softening/fissuring of articular cartilage of patella

stage I chondromalacia patella

swelling and softening of cartilage

stage II chondromalacia patella

fissuring within softened cartilage

stage III chondromalacia patella

fraying of cartilage almost to level of subchondra bone

stage IV chondromalacia patella

destruction of cartilage with subchondral bone exposed

S/s of chondromalacia patella

compression causes pain, crepitus, pain with hills/stairs, abnormal patellar tracking (maybe or maybe not), Q angle more than 20, positive quad grinding test

surgery for chondromalacia patella

debridement and lateral release of retinacular

chronic patella instability

dislocation of patella relative to femoral trochlea (lateral), mainly in females

risk factors of chronic patella instability

small patella, shallow trochlear groove, abnormal patella position, lig laxity

Hoffas syndrome (hoffa's fat pad impingement)

hypertrophy and edema of infrapatellar fat pad because of impingement between femoral condyles and tibial plateau in knee extension

treatment for hoffa's syndrome

rice, nsaids, corticosteroid, address hyperextension, surgery

s/s of Hoffa

locally tender, standing/walking painful, worse in extension, stand in flexion, likes heels, usually swollen