Knee Sport Injury

Common Types of Sports Injuries

Muscle sprains and strains

Tears of the ligaments that hold joints together

Tears of the tendons that support joints and allow them to move

Dislocated joints

Fractured bones

Major ligaments

Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL)

Medial collateral ligament (MCL)

Lateral collateral ligament (LCL)

Grading of ligamentous injury

Grade 1 : no ligamentous tear, swelling , localized tenderness

Grade 2 : stretching and partial tear, marked swelling

Grade 3 : complete tear

Anterior cruciate ligament

• Prevent anterior displacement of tibia, hyperextension of knee joint

• Especially in contact sports and those that involve fast changes in direction and twisting and pivoting movements

• ACL has serious implications for the stability and function of the knee joint.

ACL injury

Common knee injury amongst sports people

Twisting force being applied to the knee whilst the foot is firmly planted on the ground or upon landing

Direct blow to the knee, usually the outside, during a football or rugby tackle

Combination with a medial menicus tear and MCL injury, which is termed O’Donohue triad

Signs&Symptom

audible pop or crack at the time of injury

Painful

Swelling of the knee, usually immediate and extensive

Restricted movement, especially an inability to fully straighten the leg

Positive signs in the anterior drawer test and Lachman's test.

Tenderness at the medial side of the joint

ACL Injury

Lachman test

Bend the knee to about 30 degrees. Then, stabilize the femur with one hand. Place the other hand behind the proximal tibia at the level of the joint line and then pull forward.

Grading of lachman test

Normal laxity is 0

Grade 1: Less than 0.5 cm of translation

Grade 2: 0.5-1.0 cm of translation

Grade 3: 1.0-1.5 cm of translation

Anterior drawer test

MCL injury

MCL injury

Prevent against a valgus force and external rotation

MCL injury

Most frequently injured ligament in the knee Typically due to valgus forces Usually no joint effusion

MCL injuryDegree of injuryGrade I

Swelling, localized tenderness < 5 mm valgus

Grade II

Marked swelling

5-10 mm valgus

Partial tear

Grade III > 10 mm valgus

complete tear

MCL injury

Diagnosis Approach Lower lateral thigh or upper medial leg

Bruising seen in gr III

Positive valgus stress test

Diagnostic Imaging

Pellegrini-Stieda lesion

LCL Injury

LCL Injury

Varus forces and external rotation of the tibia

LCL Injury

Typically due to varus forces Usually occur during contact sports Typically has limited joint effusion since it is

located outside of the joint capsule

LCL Injury

Diagnosis Approach

Blow to medial knee with resulting varustension forces

Positive varus stress test

PCL Injury

Functions:◦ Against posterior movement of the tibia on the femur

◦ Prevents flexion, extension, and hyperextension

PCL Injury

Two bundles◦ Anterolateral, taut in flexion◦ Posteromedial, taut in

extension

PCL larger & stronger than ACL

PCL Injury Hyper-flexion, or the

tibia being forced posteriorly on the femur

Isolated PCL Injuries unusual

Posterior Drawer Test

Posterior Sag Test

Posterior tibial translation

Tibia drops back on the femur

Godfrey’s Test

Positive test is a posterior displacement of the tibial tuberosity

Diagnostic Imaging

Meniscus

2 semilunar wedges in the knee joint positioned between the tibia and the femur

deepen the articular surfaces of flat tibialplateau to accommodate the relatively round femoral condyles

Meniscus Medial : semicircular or C-shaped

Lateral : circular or O-shaped

Meniscus

Increased joint stability, increased congruence and conformity between the femoral condyles and tibial plateaus

wedge-shaped meniscus attached to the tibia serves as a secondary stabilizer

classification of meniscal tears

longitudinal tears

radial tears

oblique flap tears

horizontal tears

complex tears

Meniscal injury

sudden twist or repeated squatting

most commonly associated ligamentous disruption is complete tear of the ACL

Sign&Symptom

Pain is usually localized to the joint line

Swelling usually occurs as a delayed symptom

Joint line tenderness

Joint Effusion

Mechanical block to motion

Limited ROM

The McMurray test

valgus stress and

rotate externally while

extending the knee→Medial meniscus

Varus stress and

rotate internally while

extending knee →Lateral meniscus

The Steinmann test

Internal rotate → Lateral meniscus

External rotate → Medial meniscus

The Apley test

Investigation

Plain x-ray : for excluding fracture, avulsion fracture or osteochondral fracture

MRI : soft tissue, ligament, meniscus or bony lesion. More useful in evaluation of severity, treatment and prognosis.

Arthroscopy : diagnostic and therapeutic investigation

Activity level

Level 1: jumping , pivoting (football, soccer)

Level 2 : heavy manual work or side to side sport (skiing, tennis)

Level 3 light manual work or noncutting sport (jogging, running)

Level 4 : sedentary activity without sport (office worker)

Non operative treatment

Operative treatment

Treatment of knee injuries

Self help

Medicines

Rehabilitaion Surgery

Treatment of knee injuries

Self help “PRICE”

Protection- Protect your injury from further harm.

Rest-Rest the injury for the first two to three days

Ice- Cold compress to help reduce swelling and bruising.

Compression- Compress the joint by bandaging it to support the injury and help decrease swelling.

Elevation- Elevate knee

Medicines

Painkillers

- Acetaminophen

- NSAIDs- Narcotic anlagesics

Rehabilitation

stretching and strengthening exercises

goal of knee rehab : prevent weakening of the muscles surrounding the knee

diminish the burden on the knee joint

strong muscles of the leg better support and control the knee joint

quadriceps, hamstring, and calf muscles

Surgery

ACL Preinjury activity level

Desire to return to high-demand sports (eg, basketball, football, soccer)

Associated injuries

Abnormal laxity

Patient's expectations

Surgery

ACL surgical intervention be delayed at least 3

weeks following injury to prevent the complication of arthrofibrosis

3 groups methods of surgical repair

Surgery

ACL Primary repair is not recommended except

for bony avulsions

Extra-articular repair prevent a pivot shift but has not decrease anterior tibialtranslation

Intra-articular reconstruction of the ACL

- Bone-patella-bone autografts

- Hamstring tendon grafts

- Synthetic grafts

- Allografts

Surgery

MCL

grade 3 tears were treated operatively but currently are routinely treated nonoperatively

bracing with a hinged knee orthosis

Surgery

LCL Grade III tears usually involve a tear in

the posterolateral capsular complex

Surgery

PCL Posterior tibial translation > 10-15

mm PDT Knee flexion 90 Bony avulsion

Surgery

Meniscus

symptoms persist

locked knee

longer than 1 cm

involve greater than 50% of the meniscal thickness

Surgery

damaged anterior cruciate ligament in athletes

more than one ligament or tissue has been damaged

torn patellar tendon

remains painful or locks after a meniscus injury

LCL Grade III tears usually involve a tear in the posterolateral capsular complex

Prevention

Do warm up exercises

Don't overdo

Cool down following vigorous sports

Wear properly fitting shoes that provide shock absorption and stability

When jumping, land with knees bent

Thank You