Soccer Knee Injuries and Exam

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					    Soccer Knee Injuries and Exam

   Ben Kittredge,
    MD
   Commonwealth
    Orthopaedics
Knee Anatomy
          Pediatric Knee Injuries
   Acute (event occurs)
   Chronic (no event)
                  Acute Injuries
   What happened?
   Non-contact twist?
   Did the knee swell up
    right away?
   Hear or feel a “pop” ?
   Able to continue playing?
             Acute Knee Injuries
   Ligament injury (ACL,
    MCL)
   Meniscus tear
   Fracture/Bone bruise
   Patellar dislocation
                      Knee Exam

   Inspection
   Range of motion
   Is there an effusion?
   Joint line tenderness
   Stability
                      Inspection
   Erythema
   Cellulitis?
   Septic prepatellar bursitis
              Range of Motion
   Locked knee?
Effusion
               Is it an effusion?
   Prepatellar bursitis
               Effusion Present
   ACL tear
   Patellar dislocation
   Fracture or Bone bruise
                    No Effusion
   MCL tear
   Meniscus tear
   Contusion
Stability Exam: Anterior-Posterior
   Lachman’s
   ACL Tear
Stability Exam: Anterior-Posterior
   Posterior drawer
   PCL tear
    Stability Exam- Medial and Lateral
   Valgus stress
   MCL tear
    Stability Exam- Medial and Lateral
   Varus Stress
   LCL tear
                     Knee Exam
   Joint line tenderness
   Meniscal tear?
                  Patellar Exam
   Palpate medial and lateral
    patellar facets
   Chondromalacia patella
                Tendon Exam
   Patellar tendon
   Quadriceps tendon
   Iliotibial band
   Tibial tubercle
                          Xray
   May show fracture
   Growth plate status
   Often normal
                    Xray
   Is it normal?
                         MRI
   ACL
   Patellar Dislocation
   Fracture or Bone bruise
                             MRI
   Quality of MRI varies
   Radiologists expertise
    varies
                  ACL Injuries
   400,000 reconstructions
    per year in the US
   Females 4 times more
    likely to tear ACL with
    non-contact injury
           ACL Tears-Prevention
   High intensity
    plyometrics, balance
    training, and
    strengthening
   Neuromuscular
    Feedback
Treatment-ACL Tear-Growth Plates
            Closed
   Patellar tendon
   Hamstring
   Allograft
    ACL tear-Growth Plates Open
   Brace
   Physeal sparing
    reconstruction
      Patellar Dislocation History
   Twisting injury
   Collision
   May not know patella
    dislocated
   Immediate swelling
   Can’t play
        Patellar Dislocation Exam
   Big effusion
   Patellar apprehension
   Medial retinacular pain
           Patellar Dislocation
   Xray
          Patellar Dislocation
   MRI
             Patellar Dislocation
   Loose Body –
    Arthroscopy
   Brace?
   Rehab
   Return to play when
    comfortable
    Fracture or Bone Bruise History
   Collision
   Fall
   Non-contact twist
    Fracture or Bone Bruise Exam
   Effusion
   May or may not be able
    to localize pain
   Inability to bear weight
                    Bone Bruise
   Xray normal
   Diagnose by MRI
   Usually back to sports in
    4-6 weeks
           Fracture
   Xray
             Fracture Treatment
   6-12 weeks to heal
   Brace?
   Cast
   Surgery
              MCL Tear History
   Valgus injury
   May or may not have
    contact
   Pop?
   May keep playing
   May not swell right away
                MCL Tear Exam
   Medial joint line pain
   Opening with valgus
    stress
   No effusion
            MCL Tear Imaging
   Xray-normal
   MRI
            MCL Tear Treatment
   Brace for 2-6 weeks
   Pass functional test to
    play
   Surgery if off tibia
                  Meniscal Tear
   History of twisting injury
           Meniscus Tear Exam
   Swelling may or may not
    be present
   Joint line pain
   Locked knee?
                 Meniscal Tear
   Locked knee
   Urgent knee arthroscopy
               Meniscus Repair
   Non-weight bearing 6
    weeks
   Sports in 4 months
             Meniscus Resection
   Sports in 3 weeks
               Chronic Injuries
   Chondromalacia patella
   Osgood-Schlatter
    Disease
   Stress Fracture
   Osteochondritis
    Dissecans
          Chondromalacia Patella
   Poorly localized anterior
    knee pain
   Dull, aching pain
   Worse with jumping,
    climbing, squatting
                         Exam
   Point tender at medial
    patellar facet
   View patellar tracking
   Normal exam-think
    about hip
         Chondromalacia Diagnosis

   Xray- usually normal
   MRI- usually normal
   Xray pelvis?
    Chondromalacia Patella Treatment
   Sports menu?
   Brace
   NSAIDS
   Rest
   Physical Therapy
   MRI?
        Osgood-Schlatter Disease
   Overuse injury
   Traction apophysitis
        Osgood-Schlatter Disease
   Jumping sports-
    basketball, volleyball
   Dull, aching pain
   Boys 13-14
   Girls 11-12
     Osgood-Schlatter Disease-Exam
   Inspection
   Point tender over tibial
    tubercle
       Osgood-Schlatter Disease
   Xray
     Osgood-Schlatters Treatment
   NSAIDS
   Brace
   Relative rest
   Full rest
   Physical therapy
   Knee immobilizer
   Cast
       Osgood-Schlatter Disease
   Goes away when
    apophysis fuses
           Stress Fracture History
   Abrupt increase in
    activity-must elicit
           Stress Fracture Exam
   May be point tender
   May be difficult to
    localize
            Stress Fracture
   X-ray
                Stress Fracture
   Bone scan
          Stress Fractures
   MRI
       Stress Fracture Treatment
   Rest for 3 months
   Crutches?
   Non-weight bearing?
          Stress Fracture Healed
   Pain free 2 weeks
   Run 2 miles (30 min)
    twice per week
   10% increase per week
       Osteochondritis Dissecans
   Subchondral bone
    disorder
   Softening of overlying
    cartilage
   May fragment
   Occasional cause of knee
    pain
       Osteochondritis Dissecans
   Overuse injury
   Repetitive micro-trauma
   Poorly defined aching
    pain
   Stress fracture
       Osteochondritis Dissecans
   X-rays are key
       Osteochondritis Dissecans
   MRI can be helpful
         Osteochondritis Dissecans
                Treatment
   Non-weight bearing at
    least 3 months
   Prognosis depends on
    growth plate status
         Osteochondritis Dissecans
                Treatment
   Displaced fragment-
    surgery
            Pediatric Knee Injuries
   Is it the Hip?

				
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posted:12/5/2011
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