Soccer Knee Injuries and Exam Ben Kittredge, MD Ben Kittredge, MD Commonwealth Orthopaedics...
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Transcript of Soccer Knee Injuries and Exam Ben Kittredge, MD Ben Kittredge, MD Commonwealth Orthopaedics...
Soccer Knee Injuries and Soccer Knee Injuries and ExamExam
Ben Ben Kittredge, Kittredge, MDMD
CommonwealCommonwealth th OrthopaedicsOrthopaedics
Knee AnatomyKnee Anatomy
Pediatric Knee InjuriesPediatric Knee Injuries
Acute (event Acute (event occurs)occurs)
Chronic (no event)Chronic (no event)
Acute InjuriesAcute Injuries
What happened?What happened? Non-contact twist?Non-contact twist? Did the knee swell Did the knee swell
up right away?up right away? Hear or feel a Hear or feel a
“pop” ?“pop” ? Able to continue Able to continue
playing?playing?
Acute Knee InjuriesAcute Knee Injuries
Ligament injury Ligament injury (ACL, MCL)(ACL, MCL)
Meniscus tearMeniscus tear Fracture/Bone Fracture/Bone
bruisebruise Patellar dislocationPatellar dislocation
Knee ExamKnee Exam
InspectionInspection Range of motionRange of motion Is there an Is there an
effusion?effusion? Joint line Joint line
tendernesstenderness StabilityStability
InspectionInspection
ErythemaErythema Cellulitis?Cellulitis? Septic prepatellar Septic prepatellar
bursitisbursitis
Range of MotionRange of Motion
Locked knee?Locked knee?
EffusionEffusion
Is it an effusion?Is it an effusion?
Prepatellar bursitis Prepatellar bursitis
Effusion PresentEffusion Present
ACL tearACL tear Patellar dislocationPatellar dislocation Fracture or Bone Fracture or Bone
bruisebruise
No EffusionNo Effusion
MCL tearMCL tear Meniscus tearMeniscus tear ContusionContusion
Stability Exam: Anterior-Stability Exam: Anterior-PosteriorPosterior
Lachman’s Lachman’s ACL TearACL Tear
Stability Exam: Anterior-Stability Exam: Anterior-PosteriorPosterior
Posterior drawerPosterior drawer PCL tearPCL tear
Stability Exam- Medial and Stability Exam- Medial and LateralLateral
Valgus stressValgus stress MCL tearMCL tear
Stability Exam- Medial and Stability Exam- Medial and LateralLateral
Varus StressVarus Stress LCL tearLCL tear
Knee ExamKnee Exam
Joint line Joint line tendernesstenderness
Meniscal tear?Meniscal tear?
Patellar ExamPatellar Exam
Palpate medial and Palpate medial and lateral patellar lateral patellar facetsfacets
Chondromalacia Chondromalacia patellapatella
Tendon ExamTendon Exam
Patellar tendonPatellar tendon Quadriceps tendonQuadriceps tendon Iliotibial bandIliotibial band Tibial tubercleTibial tubercle
XrayXray
May show fractureMay show fracture Growth plate Growth plate
statusstatus Often normalOften normal
XrayXray
Is it normal?Is it normal?
MRIMRI
ACLACL Patellar Patellar
DislocationDislocation Fracture or Bone Fracture or Bone
bruisebruise
MRIMRI
Quality of MRI Quality of MRI variesvaries
Radiologists Radiologists expertise variesexpertise varies
ACL InjuriesACL Injuries
400,000 400,000 reconstructions reconstructions per year in the USper year in the US
Females 4 times Females 4 times more likely to tear more likely to tear ACL with non-ACL with non-contact injurycontact injury
ACL Tears-PreventionACL Tears-Prevention
High intensity High intensity plyometrics, plyometrics, balance training, balance training, and strengtheningand strengthening
Neuromuscular Neuromuscular FeedbackFeedback
Treatment-ACL Tear-Treatment-ACL Tear-Growth Plates ClosedGrowth Plates Closed
Patellar tendonPatellar tendon HamstringHamstring AllograftAllograft
ACL tear-Growth Plates ACL tear-Growth Plates OpenOpen
BraceBrace Physeal sparing Physeal sparing
reconstructionreconstruction
Patellar Dislocation Patellar Dislocation HistoryHistory
Twisting injuryTwisting injury CollisionCollision May not know May not know
patella dislocatedpatella dislocated Immediate Immediate
swellingswelling Can’t playCan’t play
Patellar Dislocation Patellar Dislocation ExamExam
Big effusionBig effusion Patellar Patellar
apprehensionapprehension Medial retinacular Medial retinacular
painpain
Patellar DislocationPatellar Dislocation
XrayXray
Patellar DislocationPatellar Dislocation
MRIMRI
Patellar DislocationPatellar Dislocation
Loose Body – Loose Body – ArthroscopyArthroscopy
Brace?Brace? RehabRehab Return to play Return to play
when comfortablewhen comfortable
Fracture or Bone Bruise Fracture or Bone Bruise HistoryHistory
CollisionCollision FallFall Non-contact twistNon-contact twist
Fracture or Bone Bruise Fracture or Bone Bruise ExamExam
EffusionEffusion May or may not be May or may not be
able to localize able to localize painpain
Inability to bear Inability to bear weightweight
Bone BruiseBone Bruise
Xray normalXray normal Diagnose by MRIDiagnose by MRI Usually back to Usually back to
sports in 4-6 weekssports in 4-6 weeks
FractureFracture
XrayXray
Fracture TreatmentFracture Treatment
6-12 weeks to heal 6-12 weeks to heal Brace?Brace? Cast Cast SurgerySurgery
MCL Tear HistoryMCL Tear History
Valgus injuryValgus injury May or may not May or may not
have contacthave contact Pop?Pop? May keep playingMay keep playing May not swell right May not swell right
awayaway
MCL Tear ExamMCL Tear Exam
Medial joint line Medial joint line painpain
Opening with Opening with valgus stressvalgus stress
No effusionNo effusion
MCL Tear ImagingMCL Tear Imaging
Xray-normalXray-normal MRIMRI
MCL Tear TreatmentMCL Tear Treatment
Brace for 2-6 Brace for 2-6 weeksweeks
Pass functional Pass functional test to playtest to play
Surgery if off tibiaSurgery if off tibia
Meniscal TearMeniscal Tear
History of twisting History of twisting injuryinjury
Meniscus Tear ExamMeniscus Tear Exam
Swelling may or Swelling may or may not be presentmay not be present
Joint line painJoint line pain Locked knee?Locked knee?
Meniscal TearMeniscal Tear
Locked kneeLocked knee Urgent knee Urgent knee
arthroscopyarthroscopy
Meniscus RepairMeniscus Repair
Non-weight Non-weight bearing 6 weeksbearing 6 weeks
Sports in 4 monthsSports in 4 months
Meniscus ResectionMeniscus Resection
Sports in 3 weeksSports in 3 weeks
Chronic InjuriesChronic Injuries
Chondromalacia Chondromalacia patellapatella
Osgood-Schlatter Osgood-Schlatter DiseaseDisease
Stress FractureStress Fracture Osteochondritis Osteochondritis
Dissecans Dissecans
Chondromalacia PatellaChondromalacia Patella
Poorly localized Poorly localized anterior knee painanterior knee pain
Dull, aching painDull, aching pain Worse with Worse with
jumping, climbing, jumping, climbing, squattingsquatting
ExamExam
Point tender at Point tender at medial patellar medial patellar facetfacet
View patellar View patellar trackingtracking
Normal exam-think Normal exam-think about hipabout hip
Chondromalacia DiagnosisChondromalacia Diagnosis
Xray- usually Xray- usually normalnormal
MRI- usually MRI- usually normalnormal
Xray pelvis?Xray pelvis?
Chondromalacia Patella Chondromalacia Patella TreatmentTreatment
Sports menu?Sports menu? BraceBrace NSAIDSNSAIDS RestRest Physical TherapyPhysical Therapy MRI?MRI?
Osgood-Schlatter Osgood-Schlatter DiseaseDisease
Overuse injuryOveruse injury Traction Traction
apophysitisapophysitis
Osgood-Schlatter Osgood-Schlatter DiseaseDisease
Jumping sports-Jumping sports-basketball, basketball, volleyballvolleyball
Dull, aching painDull, aching pain Boys 13-14Boys 13-14 Girls 11-12Girls 11-12
Osgood-Schlatter Disease-Osgood-Schlatter Disease-ExamExam
InspectionInspection Point tender over Point tender over
tibial tubercletibial tubercle
Osgood-Schlatter Osgood-Schlatter DiseaseDisease
XrayXray
Osgood-Schlatters Osgood-Schlatters TreatmentTreatment
NSAIDSNSAIDS BraceBrace Relative restRelative rest Full restFull rest Physical therapyPhysical therapy Knee immobilizerKnee immobilizer CastCast
Osgood-Schlatter Osgood-Schlatter DiseaseDisease
Goes away when Goes away when apophysis fusesapophysis fuses
Stress Fracture HistoryStress Fracture History
Abrupt increase in Abrupt increase in activity-must elicitactivity-must elicit
Stress Fracture ExamStress Fracture Exam
May be point May be point tendertender
May be difficult to May be difficult to localizelocalize
Stress FractureStress Fracture
X-rayX-ray
Stress FractureStress Fracture
Bone scanBone scan
Stress FracturesStress Fractures
MRIMRI
Stress Fracture Stress Fracture TreatmentTreatment
Rest for 3 monthsRest for 3 months Crutches?Crutches? Non-weight Non-weight
bearing?bearing?
Stress Fracture HealedStress Fracture Healed
Pain free 2 weeksPain free 2 weeks Run 2 miles (30 Run 2 miles (30
min) twice per min) twice per weekweek
10% increase per 10% increase per weekweek
Osteochondritis Osteochondritis DissecansDissecans
Subchondral bone Subchondral bone disorderdisorder
Softening of Softening of overlying cartilageoverlying cartilage
May fragmentMay fragment Occasional cause Occasional cause
of knee painof knee pain
Osteochondritis Osteochondritis DissecansDissecans
Overuse injuryOveruse injury Repetitive micro-Repetitive micro-
traumatrauma Poorly defined Poorly defined
aching painaching pain Stress fractureStress fracture
Osteochondritis Osteochondritis DissecansDissecans
X-rays are keyX-rays are key
Osteochondritis Osteochondritis DissecansDissecans
MRI can be helpfulMRI can be helpful
Osteochondritis Dissecans Osteochondritis Dissecans TreatmentTreatment
Non-weight Non-weight bearing at least 3 bearing at least 3 monthsmonths
Prognosis depends Prognosis depends on growth plate on growth plate statusstatus
Osteochondritis Dissecans Osteochondritis Dissecans TreatmentTreatment
Displaced Displaced fragment-surgeryfragment-surgery
Pediatric Knee InjuriesPediatric Knee Injuries
Is it the Hip?Is it the Hip?