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