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

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