2.Evaluation of Orthopedic and Athletic Injuries, Chad. Starkey and Jeff Ryan. 3.
Orthopedic Physical Assessment, David J. Magee. Signs and Symptoms. • Acute.
Medial Meniscus Tear
Medial Meniscus
www.semisportmed.com/ Article/Images/200405C.jpg
Etiology Acute injury – Excessive valgus force applied to knee can tear or stretch the medial meniscus 1 • Tibial rotation and knee flexion 2
• “Most common mechanism is weight bearing combined with rotary force while the knee is extended or flexed.” – Ex) cutting motion while running 1
• Reported as knee “giving out” or “locking” 1,2
www.expertfootball.com/. ../tackle-poke.jpg 1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
Etiology cont… • Medial Meniscus has much higher risk of injury than Lateral Meniscus – Coronary Ligament attaches to the med. Meniscus peripherally which goes to the tibia and also the capsular ligament; provides less mobility in knee motion.1 – Attachment to Medial Collateral Ligament (MCL) 1,2 – Valgus forces much more common than varus forces 2 www.clevelandclinic.org/. ../Pictures/KNEE.GIF
1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
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Signs and Symptoms • Popping, clicking, or “giving out” when running1 • Slight effusion – Medial aspect – Popiliteal fossa
• • • •
2
Joint line pain Pain with squatting Possible muscle atrophy Inability to change direction quickly without pain 1
• Change in gait – Limiting full extension of knee – Carrying in a flexed position
• ROM tests – Pain – Possible decrease in ROM
• (+) McMurray’s Test – Clicking, popping, or locking
• (+) Apley’s Compression and Distraction Test – Pain with compression and relief of pain with distraction
• (-) Lachman’s Test, Anterior and Posterior Drawer Test, and Godfrey’s test 2 1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
Management • Unlocked Knee – Still shows indications of tearÆ MRI to confirm tear
• Locked Knee – Physician visit to manual manipulate and “unlock” the meniscus from the knee. – If pain, discomfort, and locking still continue then arthroscopic surgery may be required to remove part of the meniscus. 1 • Menisectomy (more common) • Meniscus repair (less common) 1.Arnheim’s Principles of Athletic Training, William E. Prentice.
Management cont… •
Site of meniscus injury will determine the rate of the healing process (the more the blood supply, the faster the rate of healing)
1. Red-Red zone- outer perimeter of meniscus; have good vascular supply. 2. Red-White zone- deep to the red-red zone and superficial to the white-white zone; has moderate supply of vascularity. 3. White-White zone- most deep; no vascular supply (avascular).1
1.Arnheim’s Principles of Athletic Training, William E. Prentice. www.tcusportsmedicine.com/ MENISCUS.JPG
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Management cont… • Therefore… – Poorly or non-vascularized areas of the meniscus will not heal well or at all on there own, even with surgery. – This explains why in meniscus surgery you want to extract as little as possible or otherwise you further the patient’s predisposition to joint degeneration. 1 1.Arnheim’s Principles of Athletic Training, William E. Prentice.
Management cont… • No surgery – Treat symptomatically • RICE, NSAID’s, modalities, etc… – Alert of joint degeneration to athlete (patient education) as time goes on. – Player’s choice… • SurgeryÆMenisectomy – Bracing not required – Crutches for about 2 weeks; patient recovery time is expedited with this surgery/ • SurgeryÆMeniscus Repair – Immobilization with full leg brace for 5 to 6 weeks – Crutches required while progressing to full weight bearing walking – Full rehab program • ROM exercises 1.Arnheim’s Principles of Athletic Training, William E. Prentice. • Strengthening exercises 1
Chondromalacia
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Etiology • Joint abnormality – Joint degeneration in Tibiofemoral and/or Patellarfemoral joint 3 • Wearing away of the articular cartilage that lines condyles and facets
• Predisposing factors – Meniscus tears – Cruciate ligament tears 2 – Increased tibial rotation 3 www.healthpages.org/.../ HLTHTOP/TKR/degknee.jpg http://www.arthroscopy.com/sp05032.htm
• Genu valgum • Pronated feet
2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan. 3.Orthopedic Physical Assessment, David J. Magee.
Signs and Symptoms • Acute – Popping, clicking, grinding, or locking in knee joint 2,3
• Chronic – Increased pain and soreness along joint line – Joint stiffness 2,3 – Joint fusion between femur and tibia (not good!)
http://gateway.associatedphysicians.com/images/knee-pain.jpg 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan. 3.Orthopedic Physical Assessment, David J. Magee.
Treatment • Surgery is necessary – ACL tearÆ reconstruct ACL – Meniscus tearÆ Menisectomy or knee replacement – PatellarfemoralÆ correct functional abnormalities, strengthen lateral and medial forces of patellar tendons, and possible knee replacement. 2,3 – Without surgical intervention joint wear’s down and leads to more negative outcomes. With surgery to replace the knee joint it allows for basic functionality of knee joint to continue. 3 “Either adjust your lifestyle to the knee injury, or adjust your knee to your lifestyle.” - Dr. Jason Bennett 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan. 3.Orthopedic Physical Assessment, David J. Magee.
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Patellar Subluxation
Etiology • Patella is forced laterally over the femoral condyle and temporarily dislocates – Excessive valgus force – Cutting outward with foot still planted • Femur internally rotates • Tibia/Fibula externally rotates 1,2
rltrainers.co.nz/ Kneecap.JPG 1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
Etiology cont… • Predisposing factors that allow for lateral deviation of the patella – – – – –
Wide pelvis Larger Q-angle Genu Valgum Pronated Feet Abnormal tightness of lateral quadriceps – Abnormal laxity in medial quadriceps – Flattened posterior surface of oregonstate.edu/hfc/ start-smart/q_angle.gif patella 1,2 www.bigfeetstore.com/ images/Pes%20Planus%20-%... www.arthroscopy.com/ nucleus/Chrondr3.jpg 1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
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www.carletonsportsmed.com/ Patella%20Subluxati...
Lateral patellar movement
Signs and Symptoms • • • • • •
Pain Swelling Echymosis Knee “gave out” Tenderness to touch Loss of knee function
• (+) Apprehension test – Patella instability
– No flexion or extension
• Sometimes patellar displacement 1,2 www.gvle.de/.../0101/ SMFBI091KJEBV0009004.gif 1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
• • • • •
•
•
Management
ICE! Immobilization – Leg splint applied Crutches NSAID’s 1st time subluxations – Refer to physician for X-ray to rule out chondral or osteochondral fracture 1,2 Rehabilitation – All musculature of the knee, thigh, and hip Æconfined to straight leg rises • Increase strength, balance, and propioception 1 Correct abnormalities – Ex) Pronation Æ Foot orthodics
www.swedeo.com/images/ Patella-Tracing-Stabili... serp.la.asu.edu/.../ health1_imag/crutches.gif www.abc-of-skiing.com/ images/lunge2.jpg www.runnersroost.com/ duinsolees.jpg www.knee.ortho-net.com/.../ imm-tri-panel-bg.jpg 1.Arnheim’s Principles of Athletic Training, William E. Prentice. 2.Evaluation of Orthopedic and Athletic Injuries, Chad Starkey and Jeff Ryan.
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