Transcript COMMON KNEE INURIES IN SPORTS

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