{Common Injuries

The Knee

Pate

llar

Fra

ctu

res

MOI: Rapid forced knee flexion (landing

from a jump) Blunt trauma (Tonya Harding)

Risk of complete fracture increases in presence of stress fx

Patellar Fracture

Possible obvious deformity (split patella)

Rapid swelling Bruising

Patellar Fracture Inspection

AROM Extension: Severe P & decreased ROM

PROM Flexion: Severe P & decreased ROM

RROM: Cannot be performed secondary to P

Patellar Fracture ROM

At Risk population: Athletes w/ patellar tendon

autograph for ACL replacement

Patellar Fractures

Straight-leg knee immobilizer for approx 2.5 to 3 mo

Post immobilizer: regain mobility and strength lost due to immobilizer

Sx may be necessary depending on type of fracture. If Sx is performed, physical therapy will be required after immobilization

Approx 5 mo recovery time

Patellar Fracture Treatment

Pate

llar

Fra

ctu

re &

D

islo

cati

on

Bazaar ER (Graphic) Part 1

https://www.youtube.com/watch?v=bTHOxHQ_mHY

Part 2 http://www.youtube.com/watch?v=FY4_CZR

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Patellar Fracture

MOI: Valgus blow to knee Rapid change of direction with fixed

foot

Predisposing condition: Patella alta (high sitting patella) Previously dislocation

Patellar Dislocation

Obvious deformity Positioned medially with flexed knee If examined post-reduction:

massive swelling will be present

Patellar Dislocation Inspection

AROM/PROM/RROM: Not performed due to obvious deformity and extreme pain

Patellar Dislocation ROM

Performed by a Medical Professional: Rapid passive knee extension is

performed to reduce patella. The faster the patella is reduced, the

lesser the damage to soft tissue

Knee should then be immobilized in a straight-leg immobilizer and x-rays performed. If instability follows, MRI may be recommended.

Anticipated recovery time: 1 to 2 mo

Patellar Dislocation Treatment

Patellar Brace

Animation http://

www.youtube.com/watch?v=vpEnUQ3NduQ

Bazzar ER https://

www.youtube.com/watch?v=6-JNFiXkXfc

Patellar Dislocation

http://www.youtube.com/watch?v=vgCEnJbFGfM

Patellar Reconstruction Sx

Onset: Acute Pain Characteristics: pt c/o P

“inside joint”, “pressure”, “giving out” when walking (ACL/PCL only) LCL only: P in Fig 4 position

Ligamentous Injury

ACL Anterior Tibial Translation on Femur

MOI: Stopping, cutting, impact PCL

AKA “Dashboard knee” Posterior Tibial Translation on Femur

MOI: Impact, hyperextention MCL

VALGUS stress MOI: Impact, torsion

LCL VARUS stress

MOI: Impact, torsion

Ligamentous Injury

Non-contact ACL https://

www.youtube.com/watch?v=cLwdK2zvKtU Contact

….

Contact vs. Non-contact

ACL: Grade 1&2: Immobilization/rehab Grade 3: Sx

PCL Grade 1-3: Immobilization/rehab

MCL/LCL Grade 1-3: conservative:

immobilization/rehabAggressive: Sx

Tx for Lig. Injury

Onset: Acute or Insidiuos Symptoms: Pt c/o “giving out”,

“catching”, “locking”, “clicking/popping” MOI: Tibial rotation when knee is flexed;

varus/valgus stress

Men

isca

l Tear

Types of tears

Conservative: Immobilization/rehab Aggressive: Sx (Menisectomy)

Video https://

www.youtube.com/watch?v=ITToEmwBhKI

Tx for Meniscal Injury

Traumatic, Acute Exertional, Chronic Exertional

Pain Characteristics: Severe Other complaints: Muscle tightness,

swelling, weakness, tingling, numbing (particularly between phalanges 1 and 2)

MOI: Direct Impact, prolonged activity

Compartment Syndrome

Traumatic: release of fasciia (Fasciotomy)

Acute Exertional: rest/rehab Chronic Exertional: release of

fasciia/rehab

Tx

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Com

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