SPORT INJURY KNEE

Martinus V Tjandra
112015177

Anatomy of Knee

Anatomy of Knee

Meniscus
Weight distribution
Without menisci the
weight of the femur
would be concentrated
to one point on the
tibia
Converts the tibial
surface into a shallow
socket

Tendon and Cartilage

Patella and patellar tendon

Tibial tuberoscity
Patellofemoral groove
Patella acts like a fulcrum to
increase the force of the
quadriceps muscles
Articular cartilage
1/4 inch thick
tough and slick

Common Knee Injury

Knee Injuries

Meniscal Tear
ACL Tear
PCL Tear
Collateral Ligament Tear
Patella Fracture
Iliotibial Band Syndrome
Patellofemoral Pain

Meniscus Tear

Medial cartilage injury or cartilage

meniscus tear
Torn meniscus is a tear to the semi
circular shock absorbing cartilage in the
knee joint causing pain on the inside of
the knee. It is commonly injured through
direct impact to the outside of the knee
in contact sports or twisting but can also
occur in older athletes through
degeneration

Meniscus Tear

One of the most commonly injured parts of the knee.

Symptoms include pain, catching and buckling

Signs include tenderness and possible clicking

Meniscal tears occur during twisting motions with the knee

flexed

Also, they can occur in combination with other injuries such

as a torn ACL (anterior cruciate ligament).

Older people can injure the meniscus without any trauma as

the cartilage weakens and wears thin over time, setting the
stage for a degenerative tear.

Meniscus Tear

Signs and Symptoms

Swelling
Catching
Giving way
Locking

Tests

Apleys Compression

McMurrays test

Direct palpation of joint

line

Duck walk

Tests

Meniscus Tear

Treatments

Acute: Rest, Ice, Activity Modification,

Surgery

Meniscal tears will not normally heal

without help unless very young

Chronic: Surgical excision

ACL Injury
Can withstand
approximately 400
pounds of force
Common injury
particularly in sports (3%
of all athletic injuries)
May hear a pop sound
and feel the knee give
away

ACL Injury

Common in contact sports and especially

those that are combined with sudden
change of direction such as soccer or
football
Most cases occur with damage to other
structures within the knee such as the
cartilage or ligaments

ACL Injury
Mechanism
Twisting
Pivoting
Sudden stop
Amount of lower body strength
Footwear and surface interaction

Signs and Simptoms

Acute: swelling, pain,
instability
Chronic: frequent giving
way, pain

Tests

Drawer test
(ACL/PCL)
Modified drawer
(anteromedial and
lateral instability)
Lachman test
Pivot shift test

Lachman Test

Best acute ACL test

Best on field test (+) test is a mushy

or empty end feel

False (-) if tibia is IR or femur is not

properly stabilized

Unhappy Triad
1.
2.

3.

ACL
Medial collateral
ligament
Medial meniscus

Treatment

Non Surgical: Activity Modification,

Rehabilitation, Bracing

Surgical: Reconstruction of Ligament

Goals of Surgery: Restore normal knee

stability and function. Delay onset of
degenerative arthritis

Indication for Surgery

Complete tear, associated meniscal

pathology

Well motivated person who will do the

rehab program, physiologically young

Unwilling to change lifestyle, job and

sports require twisting

Surgery Timing

Wait at least 3-4 weeks after injury

Decrease the swelling

Decrease Quad inhibition

Decrease hamstring overfiring

Decrease scarring

Increase ROM; decrease stiffness

ACL Reconstruction

PCL Injury

Also called PCL

sprain is a tear to
the posterior
cruciate ligament in
the middle of the
joint which prevents
the knee from being
bent back the wrong
way.

PCL Tests

Treatment
Patients with PCL tears often do not
have symptoms of instability in their
knees, so surgery is not always needed
Many athletes return to activity without
significant impairment after completing
a prescribed rehabilitation program
However, if the PCL injury results in an
avulsion fracture, surgery is needed to
reattach the ligament.
Knee function after this surgery is often
quite good

Colateral Ligament Injury

Injuries to the collateral ligaments are

usually caused by a force that pushes the
knee sideways. These are often contact
injuries.
Blows to the inside of the knee that push
the knee outwards may injure the lateral
collateral ligament
Lateral collateral ligament tears occur
less frequently than other knee injuries

Colateral Ligament Injury

Colateral Ligament Injury

Accompanied by sharp pain on the
inside of the knee
If the medial collateral ligament has a
small partial tear, conservative
treatment usually works
If the medial collateral ligament is
completely torn or torn in such a way
that ligament fibers cannot heal,
surgery may needed
The lateral collateral ligament is
rarely injured

MCL Injury Grading

Patella Fracture

The most common bone

broken around the knee
is the patella
The ends of the femur
and the undersides of
the patella are covered
with a slippery
substance called
articular cartilage
Helps the bones glide
smoothly along each
other to move your leg

Patella Fracture Type

Stable fracture

Displaced fracture

Nondisplaced, the broken ends of the bones meet up

correctly and are aligned
The bones usually stay in place during healing
The broken ends are separated and do not line up
Requires surgery to put the pieces back together

Comminuted fracture
Very unstable.
The bone shatters into three or more pieces
Open fracture

The skin has been broken and exposes the bone

Involve much more damage to the surrounding muscles, tendons,
and ligaments
Higher risk for complications and take a longer time to heal

Patella Fracture Type

Patella Fracture

Patellar fractures are most commonly

caused by a direct blow, such as from a
fall or motor vehicle collision.
The patella can also be fractured
indirectly, ex: thigh muscles can contract
so violently that it pulls the patella apart

Signs and Symptoms

The major symptoms of a patellar fracture

include :

pain and swelling in the front of the knee

Bruising
Inability to straighten the knee
Inability to walk

The edges of the fracture can often be felt

through the skin, particularly if the fracture is
displaced
Check for hemarthrosis-> swelling deep inside
the joint, a result of bleeding caused by the
fracture.

Treatment

Nonsurgical Treatment

If the pieces of broken bone have not been displaced

Casts or splints may be used to keep knee straight->
keep the broken ends in proper position while they
heal
Shouldnt put any weight on your leg until the bone is
completely healed -> 6 to 8 weeks, or longer

Surgical Treatment

If the patella has been displaced

Fractured patellar bones that are not close together
often have difficulty healing or may not heal
The muscles that attach to the top of the patella can
pull the broken pieces out of place during healing

Timing of Surgery

If the skin around your fracture has not

been broken -> waiting until any
abrasions have healed before having
surgery

Open fractures ->urgently need to be

cleansed and require immediate surgery

Surgical Treatment

Transverse fracture

These two-part fractures are

most often fixed in place using
pins and wires and a "figure-ofeight" configuration tension band

Best for treating fractures that

are located near the center of the
patella

Breaks that are in many pieces

can be overcompressed by the
tension band

Another approach: secure the

bones using small screws, wires,
and pins

Surgical Treatment

Comminuted fracture

The kneecap is pulled apart from the injury, then

crushed from falling on it

Attach the loose tendon to the remaining

patellar bone

If the kneecap is broken in many pieces at its

center use a combination of wires and screws to
fix it

Removing small portions of the kneecap may

also have good results

Complete removal of the kneecap is a last resort

in treating a comminuted fracture

ITB Friction Syndrome

Common in sports with repeated knee

flexion
Aggravated by downhill running and
ascending stairs
Accounts for 5% of lower limb injuries
Pain felt over lateral femoral epicondyle
or greater trochanter

ITBS Test