dr ali.yassaie orthopaedic surgeon. overuse knee injuries acute knee injuries
TRANSCRIPT
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