KNEE INJURIES IN ATHLETES

Dr Ali.Yassaie

Orthopaedic surgeon

KNEE INJURIES

OVERUSE KNEE INJURIES

ACUTE KNEE INJURIES

OVERUSE INJURIES ILIOTIBIAL BAND FRICTION SYNDROME

POPLITEUS TENDINITIS

PATELLOFEMORAL JOINT PAIN SYNDROME

PATELLOFEMORAL SYNOVIAL PLICA

INFRAPATELLAR FAT PAD SYNDROME

PATELLAR TENDINITIS(JUMPER’S KNEE)

PES ANSERINUS BURSITIS

ILIOTIBIAL BAND FRICTION SYNDROME

Caused by tight ITB rubbing over lateral epicondyle of femur when running

Sharp pain over lateral knee when running or cycling

Occassional swelling

CAUSES:1- SINGLE LONG HARD RUN2- RAPID INCREASE IN TRAINING

DISTANCES3- BANKED SURFACES RUN: BEACH OR

SHOULDER OF ROAD4- EXCESSIVE HILL RUNNING

TREATMENT:1- REDUCTION OF TRAINING DISTANCE,

NSAIDS, DAILY STRETCHING ITB2- STRENGTHEN IPSILATERAL HIP

ABDUCTORS 3- LOCAL INFILTRATION OF

CORTICOSTEROID4- SURGERY

POPLITEUS TENDINITIS SURROUNDS POSTER.LATERAL ASPECT

OF KNEE STABILIZER IN FLEXION BY RESISTING

FORWARD DISPLACEMENT OF THE FEMUR ON THE TIBIA

LESS COMMON BUT SAME CAUSES AS ITB

TREATMENT:1- REDUCTION TRAINING DISTANCE2-NSAIDS3-STRETCHING KNEE FLEXORS 4-ELECTROTHERAPY5-CORTICOSTEROID INJECTION

PFJ PAIN SYNDROME PAIN UNDER “KNEE CAPS” WORSEN BY

CLIMBING OR DESCENDING HILLS OR STAIRS

PAIN AFTER SITTING DOWN FOR LONG PERIODS

FEMALES MORE THAN MALES MOST OFTEN SEEN IN ATHLETES

PRESENTING IN ADOLESCENCE AND INTO THE 4th AND 5th DECADES

CREPITUS IRRITABILITY OF PFJ SMALL SWELLING QUADRICEPS WEAKNESS AND WASTING

(VASTUS MEDIALIS )

Overuse1-jogging2-squatting3-stairs4-sudden change(intensity,duration)5-improper technique or equipment6-change in footwear or playing surface

Patellar malalignment1-malalignment of the legs:

(bowleg,knockknee,patella alta)2-muscular imbalance or weakness

Activity change(swimming,biking) Losing weight Rice

method(rest,ice,compression,elevation) Medication Physical therapy surgeory

Prevention:1-appropriate shoes2-warming up3-streching and flexibility exercises of

quadriceps and hamstring4-increase training gradually5-reduce any activity that hurt your in the

past6-proper weight

PATELLOFEMORAL SYNOVIAL PLICA REMNANTS OF THE SEPTA OF

EMBRYONIC JOINT USUALLY PRESENT BUT ASYMPTOMATIC MEDIAL PATELLAR PLICA RUNS FROM

SUPRAPATELLAR POUCH TO THE INFRAPATELLAR FAT PAD

IMPINGMENT OF THE MEDIAL FEMORAL CONDYLE AND PFJ IN FLEXION

ACHING ON SITTING DOWN ANTERIORLY INTENSE THE FIRST WALKING STEPS IN

THE MORNING FELT BANDS MEDIALLY MILD EFFUSION PAIN ON RESISTED KNEE EXTENSION

MADE WORSE BY GLIDING PATELLA MEDIALLY

REST NSAIDS CORTICOSTEROID INJECTION IF MEDIAL

PLICA PALPABLE ARTHROSCOPIC EXCISION

INFRAPATELLAR FAT PAD SYNDROME REPETITIVE HYPEREXTENTION INJURIES SURGICAL INTERVENTION PAIN ON HYPEREXTENTION OVER

ANTERIOR KNEE REGION REST FROM HYPEREXTENTION (MARTIAL

ARTS ) , NSAIDS, ELECTROTHERAPY

PATELLAR TENDINITIS( JUMPER’S KNEE ) REPETITIVE EXTENSOR ACTION OF THE

KNEE WITH A GENERATION OF LARGE ECCENTRIC FORCES

JUMPING AND LOADING FORCES APPLY THE GREATEST TENSILE FORCES IN THE PATELLAR TENDON WHEN IN LANDING

GRADUAL ONSET PAIN LOWER POLE OF PATELLA

ASSOCIATED WITH INCREASED TRAINING LOAD

ACUTE EXACERBATIOUS TENDERNESS SWELLING CREPITUS LOCALLY OVER TENDON

TREATMENT:ACUTE EXACERBATION: ACTIVE REST, ICE, NSAIDS, 6 WEEKS

RECOVERYCHRONIC: A) THERMAL (HEAT RETAINING) SLEEVEB) ECCENTRIC EXERCISES, DROP-SQUAT

PROGRAMMEC) STRENGTHEN SYNERGISTS OF

QUADRICEPS

PES ANSERINUS BURSITIS BURSA INFLAMMATION AT MEDIAL

ASPECT OF UPPER TIBIA BURNING LOCALIZED PAIN WHEN

RUNNING TIGHT HAMSTRINGS,INADEQUATE

STRETCHING, PREVIOUS HAMSTRING INJURY

STRETCHING HAMSTRINGS NSAIDS REST WHEN ACUTE LOCAL INFILTRATIONS ORTHOTICS

ACUTE KNEE INJURIES 1) ANTERIOR CRUCIATE LIGAMENT

RUPTURE (ACL) 2) POSTERIOR CRUCIATE LIGAMENT

RUPTURE (PCL) 3) MEDIAL COLLATERAL LIGAMENT TEAR

(MCL) 4) LATERAL COLLATERAL LIGAMENT

TEAR (LCL) 5) INJURIES TO THE MENISCI 6) OSTEOCHONDRAL PROBLEMS 7) PATELLOFEMORAL INSTABILITY

ACL RUPTURE 30 NEW CASES PER 100.000

POPULATION PER YEAR FOOTBALL, BASKETBALL, SKI,...

Mechanism:1-Twisting2-Pivoting3-Sudden stop

PAIN EFFUSION LACHMAN’S TEST PIVOT SHIFT TEST ACUTE HAEMARTHOSIS Giving way

CONSERVATIVE TREATMENT:RICEBRACEPHYSICAL THERAPY

SURGICAL TREATMENT:FAILURE>50% CONSERVATIE TREATMENTARTHROSCOPIC REPAIR

PCL RUPTURE TWICE STRONGER THAN ACL RESISTS ANTERIOR SLIDE OF FEMUR

WHEN WEIGHT BEARING RESISTS HYPEREXTENSION CONTRIBUTES TO MEDIAL STABILITY OF

KNEE

MECHANISMS: 1-DIRECT BLOW OVER UPPER TIBIA WITH

KNEE IN FLEXION2-HYPEREXTENSION OF THE KNEE

PFJ PAIN “GIVING WAY” RUNNING DOWNHILL POSTERIOR “SAG”INCREASED

RECURVATUM OF THE KNEE PROBLEMS WITH LONG DISTANCE

RUNNING,”STOP-START” SPORTS,SQUASH

TREATMENT: 1-CONSERVATIVE WHEN ISOLATED

RUPTURE (80% SUCCESS)2-ARTHROSCOPIC REPAIR

MCL INJURY DIRECT VALGUS FORCE EXTERNAL TIBIAL ROTATION FORCE THREE DEGREES OF SEVERITY INJURIES

TREATMENT: GRADE I: 6 WEEKS RECOVERY, 8 WEEKS

TO SPORT GRADE II: 6 WEEKS CRUTCHES, 12 WEEKS

TO RECOVER GRADE III: ARTHROSCOPY (OTHER

INJURIES ACL ETC )

LCL INJURY RARE, DIRECT VARUS FORCE PART OF POSTEROLATERAL CORNER

STABILITY COMBINED WITH ACL, PCL RUPTURES CONSERVATIVE OR RECONSTRUCTION

MENISCI INJURIES SHOCK-BEARING STRUCTURES OR “SHOCK ABSORBERS”

REDUCE DISPARITY BETWEEN FEMORAL AND TIBIAL SURFACES, SO INCREASE STABILITY

ASSIST IN ARTICULAR CARTILAGE NUTRITION

CUSHION HYPEREXTENSION AND HYPERFLEXION

MECHANISM: KNEE FORCED IN FLEXION AND ROTATION WHILE WEIGHT-BEARING

MEDIAL MENISCUS: POSTERIOR THIRD TEARS MORE COMMON

LATERAL MENISCUS: MIDDLE THIRD TEARS MORE COMMON

JOINT LINE PAIN LOCKING GIVING WAY SMALL SWELLING - McMURRAY’S TEST APLEY’S TEST MENISCUS CYSTS ARTHROGRAM MRI

ACUTE INJURY:1-RICE2-PHYSIOTHERAPY3-REFER IF NOT SETTLED IN 3 WEEKS

CHRONIC INJURY1-INVESTIGATE2-PARTIAL MENISCECTOMY3-REPAIR

OSTEOCHONDRAL PROBLEMS OSTEOCHONDRAL FRACTURE ( MIMIC

MENISCAL TEARS ) OSTEOCHONDRITIS DISSECANS

( SEPARATED SEGMENT )

ARTICULAR CARTILAGE TEAR• Acute trauma• Wear and tear• Pain• Swelling

Non Surgical: Activity Modification, Pain Medications, Injections

Surgical: Arthroscopic debridement and removal

of lose fragments Procedures to restore weight bearing

surface

PATELLOFEMORAL INSTABILITY DISLOCATIONS: ATHLETE TWISTS ON FIXED TIBIA IMMEDIATE DEFORMITY AND PAIN DISLOCATION MAY REDUCE ITSELF

DISLOCATION: REDUCTION: FLEX THE HIP AND

GRADUALLY EXTEND THE KNEE X-RAYS TO EXCLUDE OSTEOCHONDRAL

FRACTURES, LOOSE BODIES

DISLOCATION: 3 WEEKS FULL EXTENSION BRACE FOR 6 WEEKS BRACE AT THE FIRST RETURN TO SPORT

(PROPRIOCEPTION)SURGERY IF RECURRENT PROBLEM

SUBLUXATION: SUSPECTED WITH INSTABILITY PAIN WHEN TURNING ON THE LEG ELICIT A POSITIVE APPREHENSION TEST RISK ANATOMICAL FACTORS TO BE

CONSIDERED CONSERVATIVE TREATMENT OR

SURGICAL ANATOMICAL CORRECTION

THANK YOU