RN

Common Injuries in the Knee

  • Q-Angle
    • Angle measured from the anterior superior iliac spine to the patella and from the patella to the tibial tuberosity
  • Patellar Dislocation
    • MOI: Likely to happen during high speed motions especially cutting and pivoting
    • Almost always shifts laterally
    • S&S
    • Moderate to extreme pain
    • Moderate swelling
    • Complete loss of ROM
    • Obvious deformity
    • Treatment: Reduction, xray, brace, RTP
  • Patella-Femoral Stress Syndrome (PFSS)
    • Chronic pain found in the patellar region that can be blamed on tracking issues or overuse
    • MOI: Chronic, improper lateral tracking of patella
    • S&S
    • Pain and tenderness in lateral aspect of the patella
    • Slight swelling
    • Crepitus or popping with extension
    • Treatment
    • Rehab: strengthening and stretching protocol to help muscular issues (knees and hips)
    • Tape or bracing
  • Chondromalacia
    • Roughening of the protective cartilage found on the underside of the patella
    • MOI: abnormal patellar tracking or trauma from an acute injury
    • S&S
    • Pain underneath the patella
    • Grinding or popping during motion
    • Slight chronic swelling
    • Treatment: ice therapy, quad strengthening, Anti-inflammatory medication, brace or knee sleeve, surgical intervention if necessary
  • Osgood-Schlatter’s Disease
    • MOI: Chronic condition found in adolescents, typically after a dramatic growth spurt
    • Adolescents and puberty the tendons are stronger than the bones. This discrepancy causes bone damage as the tendon microscopically pulls away from its attachment.
    • Increased repair that over time develops into an enlarged tuberosity
    • S&S
    • Pain at insertion of the patella tendon
    • Tenderness to palpation
    • Enlarged tibial tuberosity
    • Pain with jumping and running
    • Treatment
    • RICE, Anti-inflammatories, ultrasound, knee strap, surgical intervention
  • Patella Tendon Rupture
    • Rare in younger athletes more common in older professional or recreational athletes
    • MOI: strong contraction of the quad muscles during jumping or running
    • S&S
    • Extreme pain followed by a dramatic decrease in pain levels
    • Significant swelling
    • Shifting of the patella out of its normal position into the mid thigh area
    • Complete loss of knee extension
    • Previous history of tendonitis or inflammation
    • Treatment: Surgical repair, recovery 1 year
  • Meniscus Tears
    • Very common in athletics
    • MOI: twisting motion in conjunction with valgus stress (cutting movements as the athlete attempts to shift and push off the involved leg
    • S&S
    • Pain, especially when moved similarly to the MOI
    • Pain with full extension and flexion
    • Effusion (swelling in the joint)
    • Pain along the line of the joint between the femur and tibia
    • Sensation of locking or giving out
    • Clicking or popping sound with movement
    • Treatment
    • Depends on location and type of damage that meniscus has incurred
    • Surgical intervention
      • Repaired through reattachment and sutures (outer)
      • Cleaned up by removing the injured tissue (inner)
    • Types
  • Anterior Cruciate Ligament (ACL) Tear
    • ACL prevents anterior translation or shifting of the tibia in relation to the femur
    • MOI: most commonly noncontact shifting of the knee, often seen with deceleration
    • S&S
    • Pain in joint
    • Athlete complains of pop at time of injury
    • Sense of feeling “loose” in joint, giving away or shifting
    • Swelling that increases rapidly post-injury
    • Treatment
    • RICE
      • Grade I & II sprain -> rehab
      • Complete tear requires surgery
      • RTP 4-6 months (closer to 1 year)
      • Prehab very important
  • Posterior Cruciate Ligament (PCL) Sprains/Tears
    • Posterior Cruciate Ligament prevents posterior translation of the tibia in relation to the femur
    • PCL is the strongest ligament in the knee which makes injury less often than in the ACL
    • MOI: direct blow to the proximal tibia and knee while flexed at 90 degrees (ligament is at a vulnerable position)
    • S&S
    • Pain and tenderness on posterior aspect of knee
    • Slight swelling in popliteal region
    • Joint laxity
    • Loose feeling when walking
    • Treatment
    • RICE, Rehab strengthening hamstring and quads, surgery, bracing
  • Medial Collateral Ligament (MCL) Sprains/Tears
    • Very commonly injured in athletics due to the frequency of contact to the outer side of the knee forcing it medially
    • S&S
    • Pain increasing with severity
    • Joint stiffness
    • Slight to moderate swelling over ligament
    • Decreased ROM
    • Joint laxity medially
    • Treatment: RICE, isolated tear?, rehabilitation (abductors, adductors)
  • Lateral Collateral Ligament (LCL) Sprains/Tears
    • Lateral Collateral Ligament- injured much less than the MCL and less prevalent in athletics
    • MOI: varus stress to inferior of the knee
    • S&S
    • Pain over lateral aspect of the knee
    • Slight to moderate swelling over lateral aspect
    • Joint laxity laterally
    • Joint stiffness
    • Decreased ROM
    • Treatment: RICE, progressive rehab, RTP, surgery is unlikely if just isolated LCL tear