Ortho Knee Injuries: ACL, PCL, OA

Name Summary Tear in the ligament that prevents anterior movement of the knee over the tibia ACL Tear Instability Etiology Twisting Hyperextension "Plant, pivot" motions (atheletics) Signs/Symptoms Overall: - ↓ ROM - Instability while weight bearing - Tenderness - Hemarthrosis Special Tests GOLD: (+...

Name Summary Tear in the ligament that prevents anterior movement of the knee over the tibia ACL Tear Instability Etiology Twisting Hyperextension "Plant, pivot" motions (atheletics) Signs/Symptoms Overall: - ↓ ROM - Instability while weight bearing - Tenderness - Hemarthrosis Special Tests GOLD: (+) Lachman's (+) Anterior Drawer (+) Pivot shift Tests XRAY: - R/O fracture CONFIRMATORY: MRI MC Knee Ligament Tear PCL Tear Tear in the ligament that prevents posterior movement of the knee over the tibia "Dashboard injury" Fall onto flexed knee with foot plantarflexed Instability Degenerative Joint Disease Knee Osteoarthritis (OA) Medial Knee Pain Obesity Genetics Wear/tear MC Arthritis in the knee Osteochondritis Dessicans (OCD) Prepatellar Bursitis Loose body of chondral tissue in joint space Direct blow to flexed knee MC Femoral condyle Inflammation of the bursa between the skin and patella Anterior Knee Pain Direct blow to the knee Fall directly onto the knee Repeated weight directly on the knee Overall: - ↓ ROM - Instability while weight bearing - Tenderness - Hemarthrosis Overall: - +/- ↓ ROM - Pain with movement - +/- crepitus (+) Posterior Drawer (+) Distal NV status Overall XRAY: - R/O fracture - Pre-hab PT for 3-6 wk before surgery (prevents quad atrophy) - Surgical repair - Post-op PT Unhappy Triad: - ACL tear - Medial meniscus injury - MCL (lateral blow) Conservative: - NSAIDs (oral and topical) - Rest - Activity modification - Supportive brace for activity CONFIRMATORY: MRI Surgery is optional: * Do not always have to be fixed * Genu varus Genu valgus Jointline tenderness Overall: - Catching/locking - Intermittent swelling post-use - Small effusion - Tenderness over MFC/LFC Overall: - Swollen area on the knee - No heat/redness Treatment REFER! XRAY: - Weight-bearing XRAY - Fairbanks Changes: - Flattened tibial plateau - ↓ Joint space - Osteophytes - Subchondral cysts XRAY first MRI: most helpful - Make sure it's not septic Clinical Conservative: - NSAIDs (oral and topical) - PT - CS joint injections - Supportive brace for varus/valgus Surgery is optional, but definitive: - Total knee replacement (TKA) - Partial knee replacement - Patellofemoral arthroplasty Limited long term success with surgery - Microfracture technique Conservative: - NSAIDs (oral and topical) - Rest - Activity modification - Compression Septic: - Aspirate and do ABX Patellar Tendonitis (Osgood Schlatter's Syndrome; "Jumper's Knee") Tenderness at inferior pole of patella due to repeated stress Repetitive activity (eg running) Overall: - Pain with resisted full extension - Pain with full flexion - +/- intrapatellar bursitis - Usually one-sided Clinical Conservative: - NSAIDs (voltaren) - PT education/refer - Rest (3 days - 6 weeks) - Activity modification - Chopat strap Repetitive activity (eg running) Overall: - Pain with resisted full extension - Pain with full flexion - +/- intrapatellar bursitis - Usually one-sided Clinical Conservative: - NSAIDs (voltaren) - PT education/refer - Rest (3 days - 6 weeks) - Activity modification Anatomical predisposition Trauma Injury John falling in the bathroom at 2AM Overall: - Pain - Loss of motion/ROM - Obvious deformity - Hemarthrosis Anterior Knee Pain Likely low yield Quadricep Tendonitis Anterior Knee Pain Usually lateral displacement Patellar Dislocation (Instability) Patellar/Quadricep Tendon Tear Anterior Knee Pain Inclusive of: abnormal patellar motion over trochlea, recurrent subluxation, true dislocation Disruption of the extensor mechanism of the knee Anterior Knee Pain 30-60YO Fall on partially flexed knee It broke Patellar Fracture Fall directly onto knee Anterior Knee Pain Lateral Knee Pain Lateral Meniscal Tear Less common than medial Twisting injury Chronic: Degenerative Medial Knee Pain Medial Meniscal Tear Most common area! Majority of tears are on inner ring where the blood supply is terrible Twisting injury Chronic: Degenerative (+) Apprehension exam Laxity with passive subluxation Surgery as last resort or in multiple recurrences Overall: - Large joint effusion - Palpable tendon defect - Inability to straight leg raise - Usually one-sided Overall: - Tenderness/swelling directly over the patella - Difficulty with flexion - +/- SLR ability Overall: - Locking/catching - Pain when weight bearing - Lateral jointline tenderness - Hemarthrosis Overall: - Locking/catching - Pain when weight bearing - Medial jointline tenderness - Hemarthrosis XRAY: - 3-view Conservative: - NSAIDs - PT (isometric strengthen quad) - Lateral J Brace - Kinesio Taping XRAY: - Patellar location can tell you if it's an inferior or superior-patellar rupture XRAY: - R/O bipartite patella! - Identify location/severity GOLD: Surgical repair Immobilize the knee until they get there GOLD: Refer to ortho - Surgical repair - Knee immobilizer Dependings on severity of fracture (+) McMurray MRI (+) Apley Conservative: - NSAIDs - PT - Activity modification Arthroscopy if severe (+) McMurray MRI Conservative: - NSAIDs - PT - Activity modification (+) Apley Arthroscopy if in inner ring (partial meniscectomy) Osgood Schlatter's is the teenage version of this: - Tight quad pulls on patellar tendon putting stress on the still-forming tibial tuberosity - Tx the same Name Medial Collateral Ligament Injury/Tear (MCL) Summary Etiology Medial Knee Pain Athletics (soccer, hockey) MC Collateral Ligament Injury Signs/Symptoms Overall: - Medial pain - Pain with valgus stress - Pain at, above, and below joint line Special Tests Tests (+) Valgus Stress Test Grade I: no opening, painful Grade II: opening with defined end point Grade III: no endpoint (full tear) MRI Treatment Conservative: - NSAIDs - Long brace (4 wk) - RICE - PT progression - RTA in 6 wk, usually with residual valgus instability Arthroscopy/repair if severe Lateral Collateral Ligament Injury/Tear Varus injury Athletics (weird MOI) Lateral Knee Pain Insult from medial aspect of knee Overall: - Lateral pain - Pain with varus stress - Pain at, above, and below joint line (+) Varus Stress Test Grade I: no opening, painful Grade II: opening with defined end point Grade III: no endpoint (full tear) MRI Conservative: - NSAIDs - Long brace (4 wk) - RICE - PT progression - RTA in 6 wk, usually with residual valgus instability Arthroscopy/repair if severe Compartment Syndrome Increased pressure in an area causing resultant neurologic and vascular compromise Overall: - Pain out of proportion to exam - Paresthesias Trauma Crush injury All of it Exertional CS: - When you get too big of a pump in an area (fun fact, this can happen with PED use) Comparetment PSI measurement (needle) Fasciotomy Knee Contusion IT Band Syndrome Poor IT band flexibility from people who are too dumb to just stretch before they do long cardio (it's Cole) Being Cole Overall: - Pain at lateral knee - Tenderness at lateral knee/ along ITB - Snapping at knee or hip - +/- instability (+) Ober's Test Clinical J-tracking Clinical (+) Grind Test XRAY: - 3-view (patellar tracking) - Sunrise/merchant view Lateral Knee Pain May present with trochanteric bursitis Patellofemoral Syndrome Inflammation of the subpatellar articular cartilage caused by incorrect tracking or compression Women Valgus Flat-footed Anterior Knee Pain Overall: - Diffuse, aching pain in absence of injury - Usually bilateral - Exacerbated with: squatting, kneeling, stairs, sitting Apprehension Conservative: - Rest - PT / stretching - Orthotics - CS injection if severe Conservative: - NSAIDs (voltaren) - PT (strengthen vastus medialis) - Closed-chain kinetic quad strengthening - Rest/activity modification - Orthotics Surgery as last resort Popliteal Cyst (Baker's Cyst) Benign synovial cyst in popliteal fossa usually secondary to causative problem Meniscal tear Rheumatoid arthritis Osteoarthritis Posterior Knee Pain Plantaris Tendon Rupture Sharp pain resultant from small muscle rupture Running Posterior Knee Pain Gradual onset of pain in the anteriomedial first third of the lower leg that usually abates with rest Biomechanics Activity level Tibial Stress Fractures Hairline fracture that is painful with use/weight-bearing that is persistent Over-training The Army DoD incompetence Biomechanical oopsies Knee Fractures Patella Tibial Plateau Distal Femur (supra/condylar, combo) Ow Shin Splints ↑ ↓← → ° ± β α Overall: - Waxing/waning size - Swelling/fullness in posterior knee - Rupture: pain, DVT-like Overall: - Tender calf - Pain with any calf muscle movement - Difficulty with extension of knee Overall: - Tender to palpation along tibial crest Overall: - Point tenderness Hemarthrosis +/- Neurovascular compromise MRI: - R/O meniscus tear Treat underlying cause! XRAY: - Arthritic changes R/O Acheilles injury Conservative: - Rest - Crutches per recovery - Bracing - Reassurance XRAY: - R/O stress fracture XRAY: XRAY CT (3D imaging for surgery) Ranges on severity: - Conservative - CRPP - ORIF Overall