Knee Pathology: Bursitis, Cysts, and Torsion

Knee Pathology Overview

• Knee pathologies encompass a range of conditions that affect different structures and functions of the knee joint.
• Understanding the specifics of each pathology, including its causes, risk factors, and treatments, is essential for creating effective rehabilitation plans.

Medial Pes Anserine Bursitis

• Inflammation of the bursa located between the tendons of the hamstring muscles (sartorius, gracilis, and semitendinosus) and the tibia.
• More common in older women with symptomatic knee osteoarthritis, diabetes, and obesity, typically aged 50-80 years old.
• Treated with medical management and modalities to relieve pain.

Meniscal Cyst (Medial or Lateral)

• Fluid-filled sac develops adjacent to a torn meniscus.
• Seen in individuals with meniscal tears.
• Treatment typically involves addressing the underlying meniscal tear, possibly through surgery.

Tibial Torsion (Medial/Lateral)

• Twisting of the tibia relative to the femur.
• Medial torsion is linked to genu varum, and lateral torsion is linked to genu valgum.
• Excessive tibial torsion can cause chondromalacia patella.
• Treatment involves addressing underlying postural alignment issues.

Patella Alta and Patella Baja

• Patella alta: High riding patella, possibly laterally displaced.
• Patella baja: Low riding patella
• Risk factors are not specified in the sources for either condition.
• Both may be associated with fixed flexion.

Boney Enlargements (Tibial Tubercle in Osgood-Schlatter)

• Abnormal bone growth at the tibial tubercle in Osgood-Schlatter disease.
• Common in active children and adolescents.
• Activity modifications to avoid pain, knee sleeve or strap support, medical management, and modalities for pain relief are treatments.

Genu Varum and Genu Valgum

• Genu varum: Bowlegs, with knees angled outwards, associated with medial tibial torsion.
• Genu valgum: Knock-knees, with knees angled inwards, associated with lateral tibial torsion.
• Risk factors are not specified in the sources for either condition.
• Treatment involves addressing underlying skeletal alignment.

Genu Recurvatum

• Hyperextension of the knee.
• Individuals with a tendency towards knee hyperextension are at risk.
• May indicate a meniscus pathology if one knee does not hyperextend normally while the other does.

Fixed Flexion

• Inability to fully extend the knee, due to contracture or patella position.
• Individuals with knee injuries or conditions limiting extension are at risk.
• Treatment addresses the underlying cause, potentially involving patellar glides to avoid scar tissue.

Patellofemoral Instability

• Tendency of the patella to sublux or dislocate, potentially related to tibial torsion.
• Individuals with anatomical predispositions or injuries affecting patellar tracking are at risk.
• Treatment involves addressing muscle imbalances or structural issues.

Fat Pad Entrapment

• Impingement of the fat pad below the patella, potentially related to tibial torsion.
• Individuals with anatomical predispositions or injuries affecting the fat pad are at risk.
• Treatment involves conservative measures or addressing underlying biomechanical issues.

Chondromalacia Patella

• Cartilage damage under the patella, potentially linked to excessive tibial torsion.
• Individuals with riskier tibial torsion are at risk.
• Treatment involves managing pain and improving biomechanics.

Patellofemoral Pain (PFP)

• Classified into overuse/overload, muscle performance deficits, muscle coordination deficits, and mobility impairments.
• Individuals with increased PFJ loading, muscle weakness, poor movement coordination, or mobility impairments are more at risk.
• Exercise therapy, patellar taping, and orthoses are used as treatments.

Iliotibial Band Syndrome (ITBS)

• Pain on the lateral side of the knee caused by friction of the iliotibial band over the lateral femoral epicondyle.
• Runners, cyclists, weightlifters, skiers, and soccer players are at high risk.
• Therapeutic exercise, manual therapy and modalities are used as treatments.

Knee Swelling

• Accumulation of fluid in the knee joint, as seen in meniscal injuries and ACL injuries.
• Individuals with knee injuries or inflammatory conditions are at risk.
• Treated with RICE (rest, ice, compression, elevation).

Knee Osteoarthritis (OA)

• Slowly evolving articular disease affecting cartilage, bones, soft tissues, and synovial fluid.
• Overall prevalence increases with age, in women, in those of African descent, with lower socioeconomic status, with obesity, and with prior knee trauma/surgery.
• Treatment considers clinical findings. It consists of patella glides post-TKA/TKR to avoid scar tissue.

Knee Ligament Sprain (General)

• Injury to one or more knee ligaments, classified Grade I (mild stretch, stable), Grade II etc..
• Treatment considerations based on clinical objective findings, for example patella glides post-TKA/TKR to avoid scar tissue.

Referral Considerations for Knee Pathologies

• Several conditions necessitate medical referral, including cellulitis and deep vein thrombosis (DVT).
• The Wells criteria are used to assess the likelihood of DVT.
• Pulmonary embolism (PE), septic arthritis, and compartment syndrome also require immediate referral.
• Fractures are evaluated using the Ottawa Knee Rule and Pittsburgh Knee Rules.
• Peripheral arterial occlusive disease (PAOD) and psychosocial issues may also warrant referral.

Knee Osteoarthritis Details

• Slow articular disease from the cartilage affecting bones, soft tissues and synovial tissue.
• 14.6 per cent prevalence.
• Increases with age affects women more than men and half of patients do not have symptoms.
• Key risk factor: age but also race, low socio economic status, obesity, trauma, imbalance, and high impact.
• Pain in morning and stationary periods improves after 15-20 minutes of joint motions, stiffness for 30+ minutes.
• Multi race prevalence.
• Range of motion loss, palpable deformity, possible varus angulation, decreased strength, limited full knee extension, and heel to toe gait issues.
• Reduce loud potential using assistive devices improve using patterns/techniques in posture avoid prolonged static positioning.
• Therapeutic exercise addressing strength and motion and strengthening and range of motion exercises.

Knee Ligaments Details

• Three grades and are classified depending on how severe.
• (ACL accounts) ACL approximately 80,000-250,00 injuries annually.
• Higher in rates in active individuals greater for young female athletes in similar age groups.
• Noncontact injuries are more common.
• Mechanism of injury is crucial.
• Hemoarthrosis develops within 912 hours.
• Knee effusion/swelling common. Includes tibiofemoral laxity with pain during ligament testes.
• Clinical findings can help diagnose ligament sprains.
• Management of depend on this the phase of rehabilitation the severity strain focus on pain.
• Restore range of motion initiate early weight bearing a safe environment may use stimulation neuromusclular gait training necessary early to late.
• Exercises focusing on optimal range of motion strength and flexibility, training to improve single leg hop testes education and on long term outcomes if patient is a candidate. In certain situations may avoid athletic supports.
• Patient should reach to and support readiness, Assessment.
• Knee examination test to look for what needs help.
• Stability coordinates to look for emphasis to screen. Determine whether physical therapy appropriate radiology in the acute cases.

Anterior Cruciate Ligaments Details

• ACL injury one common ligamentous injuries knee most common or approximately number of procedures US a large number are noncontact knee injury rate high.
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• The phases reduce, mobilise, strength Positional sense or sports tolerance test jumping home.
• Increased if patient is younger as high sport performance adapted and increasing sport

Meniscus Knee Details

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Pes Anserine Bursitis details

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Iliotibial IT Band Syndrome

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Patellofemoral Pain details

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Patellar Tendinopathy details

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Osgood-Schlatter details

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