COMMON COMMON knee knee

INJURIESINJURIESRHS ROP - Sports Medicine

H.H.O.O.P.P.S.S. HistoryHistory

Previous injury?Previous injury? MechanismMechanism Sounds? Feelings?Sounds? Feelings? Other people’s observationsOther people’s observations

ObservationObservation Deformity? Swelling? Range of motion? Pain level?Deformity? Swelling? Range of motion? Pain level?

PalpationPalpation Special testsSpecial tests

Knee Knee CONTUSIONCONTUSION CC #1Right actions in the future are the best apologies for bad actions in the past.”Tyron Edwards – Theologian

knee contusionknee contusion

Mechanisms Direct contact Direct contact

with forcewith force The knee hits The knee hits

against a solid against a solid objectobject

A thrown object A thrown object hits the kneehits the knee

knee contusionknee contusion

SignsSigns swelling in the area of swelling in the area of

contactcontact tendernesstenderness momentary loss of feeling momentary loss of feeling

in the top of the foot is in the top of the foot is possible.possible.

discolorationdiscoloration

SymptomsSymptoms pain on movement is pain on movement is

possiblepossible area of contact may be area of contact may be

numbnumb pain on weight bearingpain on weight bearing throbbing and/or burning throbbing and/or burning

sensationsensation

Acute Care of a ContusionAcute Care of a Contusion REST:REST: Protect the area from Protect the area from

further damage Use a pad/wrap further damage Use a pad/wrap or prefabricated pad.or prefabricated pad.

ICE:ICE: Encourage the athlete to Encourage the athlete to ice the area for the first 2-3 ice the area for the first 2-3 days. Too much heat in the days. Too much heat in the beginning will increase length beginning will increase length of healing time.of healing time.

COMPRESSION:COMPRESSION: Not usually. Not usually. Only in certain cases. Check Only in certain cases. Check with LAT first.with LAT first.

ELEVATION:ELEVATION: Not necessary Not necessary unless contusion is coupled unless contusion is coupled with another injury that with another injury that requires elevation or begins to requires elevation or begins to swell.swell.

PatellarPatellartendonitistendonitis

“jumper’s knee”“jumper’s knee”

Patellar tendonitisPatellar tendonitis Inflammation of Inflammation of

the tendon that the tendon that connect the tibia to connect the tibia to the patella.the patella.

Caused by Caused by repetative repetative use/overuse.use/overuse.

Common in Common in athletes that jump athletes that jump a lot.a lot.

Signs and symptoms of Signs and symptoms of patellar tendonitispatellar tendonitis

do not writedo not write

11stst Degree Degree 22ndnd

DegreeDegree33rdrd Degree Degree

Pain after activity Pain during and after activity

Pain during and after, for extended time

Little to no swelling or puffiness

Puffiness, some swelling possible

Swollen in area of patellar tendon or attachments

No limit to activity

Activity limited by pain

No activity is preferred

Care for patellar tendonitisCare for patellar tendonitis

First step of reducing pain is to First step of reducing pain is to reduce activity level, Ice and NSAID reduce activity level, Ice and NSAID and/or replace conditioning with and/or replace conditioning with non-contact, non-impact substitutes.non-contact, non-impact substitutes.

A A knee sleeve knee sleeve might be used to keep might be used to keep the knee joint warm during activity.the knee joint warm during activity.

A A patellar tendon strap patellar tendon strap is often is often issued to those with chronic, or issued to those with chronic, or reoccurring, pain due to Patellar reoccurring, pain due to Patellar Tendonitis.Tendonitis.

patellar tendon Strappatellar tendon Strap

ACL ACL SpRAIN/TEARSpRAIN/TEAR

(ligament injury)(ligament injury)

ACL sPrain/TEARACL sPrain/TEARMechanism Mechanism

Rotation of the Femur with knee flexed and foot planted

Mechanism 2 and 3Mechanism 2 and 3 Hyperextension of

the knee Quick deceleration

Acl sprains/tearsAcl sprains/tearsSignsSigns

Plants foot, goes Plants foot, goes down immediatelydown immediately

Grabbing kneeGrabbing knee Loss of functionLoss of function Knee gives out, feels Knee gives out, feels

unstableunstable Puffiness around Puffiness around

kneecap with kneecap with tenderness in back of tenderness in back of kneeknee

Tender along joint Tender along joint line on both sidesline on both sides

Acl sprains/tearsAcl sprains/tears

SymptomsSymptoms pain with movementpain with movement pain on pain on weight bearing is possibleweight bearing is possible walks with toe down, not heel-to-walks with toe down, not heel-to-

toetoe loss of normal functionloss of normal function may have felt it may have felt it “pop” “pop” or tear or tear

(40% of the time)(40% of the time)

On-Field Care of the Injured kneeOn-Field Care of the Injured knee

JUST LISTEN!!!! DO NOT WRITEJUST LISTEN!!!! DO NOT WRITE DO NOT TAKE OFF THE KNEE PAD! Observe DO NOT TAKE OFF THE KNEE PAD! Observe

and compare the injured knee to the and compare the injured knee to the uninjured knee. You may have to “look” uninjured knee. You may have to “look” with your hands.with your hands.

Determine if there is any severe deformity Determine if there is any severe deformity of the tibia, femur or patella. Also check of the tibia, femur or patella. Also check the ankle movement, if possible.the ankle movement, if possible.

If a deformity is absolutely ruled out, move If a deformity is absolutely ruled out, move the athlete to a safe place and off to the the athlete to a safe place and off to the side of the playing area.side of the playing area.

The athlete should remain non-weight The athlete should remain non-weight bearing until the knee has been further bearing until the knee has been further evaluated.evaluated.

Acute Care of an ACL TEARAcute Care of an ACL TEAR

RESTREST: : no activity no activity until doctor visit until doctor visit

ICEICE:: 20 minutes of 20 minutes of every hr first 2-3 every hr first 2-3 days.days.

COMPRESSION:COMPRESSION: calf area to mid-calf area to mid-thigh, in an upwards thigh, in an upwards direction.direction.

ELEVATION:ELEVATION: Athlete Athlete should elevate injury as should elevate injury as much as possible, especially much as possible, especially during icing.during icing.

MCL / LCLMCL / LCLligamentligament

sprainsprain

Mcl / lcl sprainsMcl / lcl sprains

Mechanism - Mechanism -

MCL injury:MCL injury: Valgus force Valgus force

(outside to inside (outside to inside direction)direction)

With foot plantedWith foot planted Stress on inside Stress on inside

of knee jointof knee joint

Mcl / lcl sprainsMcl / lcl sprains

Mechanism - Mechanism -

LCL injury:LCL injury: With foot planted With foot planted Varus force Varus force

(_____ to ___side (_____ to ___side direction)direction)

Stress on ___side Stress on ___side of knee jointof knee joint

MEDIAL

LATERAL

INSIDE

OUT

OUT

Mcl / lcl sprainsMcl / lcl sprainsSignsSigns

•First degreeFirst degree-Minor joint stiffness--Minor joint stiffness-micro micro tears in ligamenttears in ligament

•Second DegreeSecond Degree-Moderate joint stiffness--Moderate joint stiffness-macro tear of ligamentmacro tear of ligament

•Third DegreeThird Degree-Loss of stability- -Loss of stability- complete complete tear of ligamenttear of ligament

Might have felt the knee “give out” or Might have felt the knee “give out” or “pop”“pop”

Immediate pain at time of injuryImmediate pain at time of injury Hurts more to use it than to sit stillHurts more to use it than to sit still

Mcl / lcl sprainsMcl / lcl sprains

SymptomsSymptoms

Acute Care of an mcl / lcl tearAcute Care of an mcl / lcl tear

RESTREST ICEICE COMPRESSIONCOMPRESSION ELEVATIONELEVATION Good

positioning using a cloth

wrap.

Acute Care of Acute Care of all knee ligament all knee ligament injuriesinjuries

IMMOBILIZATION:IMMOBILIZATION:Knee immobilizers are worn for Knee immobilizers are worn for

2-4 weeks following injury. 2-4 weeks following injury. This is mostly for protection This is mostly for protection from further injury and for from further injury and for support during initial pain support during initial pain phase.phase.

MCL and LCL injuries are MCL and LCL injuries are immobilized in immobilized in full knee full knee extension extension to promote healing to promote healing of the fibers of the ligament.of the fibers of the ligament.

ACL and PCL injuries are ACL and PCL injuries are immobilized with ROM braces that immobilized with ROM braces that allow some movement at the knee.allow some movement at the knee.

Patella Patella dislocationdislocation

Patellar dislocationPatellar dislocation

MechanismsMechanisms External Rotation External Rotation

of the Femurof the Femur

+ Forceful + Forceful Contraction of Contraction of the Quadricepsthe Quadriceps

+ Knee Extension+ Knee Extension Rarely caused by Rarely caused by

contactcontact

When the patellar groove When the patellar groove (posterior) is completely (posterior) is completely

displaced out of the femoral displaced out of the femoral groove.groove.

Patellar dislocationPatellar dislocationSigns and Signs and SymptomsSymptoms

Pain, pain, painPain, pain, pain Loss of function/knee Loss of function/knee

extensionextension Visible deformityVisible deformity SwellingSwelling May have heard or felt May have heard or felt

a “pop” or a “snap”.a “pop” or a “snap”.

On-Field Care for an On-Field Care for an Patellar dislocationPatellar dislocation

do not writedo not write Observe and compare the injured knee to Observe and compare the injured knee to

the uninjured knee! You may have to the uninjured knee! You may have to “look” with your hands.“look” with your hands.

Determine there is any severe deformity Determine there is any severe deformity of the tibia, femur or patella. Also check of the tibia, femur or patella. Also check the position of the lower limb, if possible.the position of the lower limb, if possible.

DO NOT MOVE THE INJURED ATHLETE. DO NOT MOVE THE INJURED ATHLETE. The athlete should remain non-weight The athlete should remain non-weight bearing until the knee has been further bearing until the knee has been further evaluated.evaluated.

Find a coach and call for LAT on-duty Find a coach and call for LAT on-duty immediately.immediately.

On-Field Care for an On-Field Care for an Patellar dislocationPatellar dislocation

Some patellar dislocations will “reduce” Some patellar dislocations will “reduce” or go back into place on their own.or go back into place on their own.

Other times, the athlete will be able to Other times, the athlete will be able to self-reduce the dislocation by self-reduce the dislocation by straightening the knee.straightening the knee.

If the athlete is unable to do this, If the athlete is unable to do this, professional help is needed.professional help is needed.