COMMON KNEE INURIES IN SPORTS MEDICINELAWRENCE PICCIONI MD
MY BACKROUND
Current team physician for Delaware State University since 1993
Team physician for Wesley College 1992 to 2004
Team physician for Dover High School 1992 to 2004
PURPOSE
Familiarize you with common features of injuries
Reinforce what you already know about diagnosis and treatment
Help decision making as far as treatment or referral
ACCOMPLISH GOAL
Reviewing pertinent anatomy, History and Physical findings
Review differences in adult and pediatric injury patterns
Give some PEARLS
ANATOMY OF KNEE
Bones more pertinent in pediatric group
Tendons – Patellar and Quadriceps
Cartilage – articular and meniscal
Ligaments – ACL, PCL, Medial and lLateral Collateral
LIGAMENT VS CARTILAGE
Cartilage is like a rock in your shoe pain and swelling the more you do the more it hurts
Ligament injuries are like walking on ice
DOES IT HURT AND GIVE OUT OR GIVEOUT AND HURT?
MENSICUS HISTORY AND EXAM
Often minor trauma in adults due to degeneration, sometimes feel a pop
Feel a click plus or minus effusion (popliteal)
Joint line tenderness pain with rotation (McMurray, Appley, etc)
Pain and swelling with activity, low grade
MENISCUS INJURY TREATMENT
Usually surgical or live with it
Meniscus relatively inert and poor healing potential
Outpatient procedure, arthroscopic, 2 to 4 weeks return to many sports if motivated
Not a surgical emergency, difficult to play through
MENISCAL SURGERY
“Repair” usually means taking out torn portion
Only 10% repairable (bucket and vertical tears in outer 1/3)
NFL meniscal injuries more career ending than ACL
ANTERIOR CRUCIATE INJURIES
Most common in sports particularly with acceleration/deceleration
Not always a violent injury many noncontact
Classic is feel a pop followed by intense swelling within 6 hours (hemarthrosis)
Not a surgical emergency Surgery often delayed 3 or more weeks (reconstruction)
ACL TEAR DIAGNOSIS
May have effusion may not some walk in comfortable
Lachman’s test is most classic and STILL most useful
Often missed on MRI (femoral detachment difficult to pick up)
ACL TREATMENT
Not always surgical initial RICE and ROM
PT for quad hamstring strengthening
Brace treatment
Coping and sport modification
Surgery
ACL SURGERY
Reconstruction with multiple graft choices
Who gets it? – under 40, women, buckling with daily activity, competitive level 1 sports
Outpatient surgery mostly arthroscopic return to full sport variable but 6months to one year
PCL & COLLATERAL LIGAMENT
More rare usually in the realm of orthopedist
Not a “Pulled muscle”
Many are not surgical but require detailed diagnosis (combined injuries)
Not emergency but protection with crutches and immobilizer needed
PEDIATRIC KNEE INJURIES
Bones now important
Physeal injuries common (weaker than ligaments and cartilage)
Different age leads to different fractures ie tibial eminence 12yrs tibial tubercal 14yrs
TIBIAL EMINENCE FRACTURE
ACL eqivalent in younger age
Same mechanism of injury
May require surgery usually requires referral
TIBIAL TUBERCULE FRACTURES
Typically occur during adolescence
3 types depending on severity
Only most severe (type 3) require surgery but all require referral
PATELLAR SLEEVE FRACTURE
Common in younger kids
Represents an avulsion of inferior patellar cartilage from bone
Analogous to patellar tendon rupture in adults
Can be difficult to diagnose (pain, fear etc)
TIBIAL TUBERCULE FRACTURES
Usually occur during adolescence
Three types depending on severity
Only type 3 requires surgery but all require referral for treatment
CONCLUSION
History and physical still the key as imaging is confirmatory.
Most injuries not a “pulled muscle”
Relax most are not surgical emergencies
Pediatric injuries tend to be physeal and more emergent