Anatomy and Injuries of the Knee Adapted from Connie Rauser Sabino Sports Medicine.
Sports Related Knee Injuries
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Transcript of Sports Related Knee Injuries
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Sports Related Knee Injuries
Mark S. Sanders, M.D.
www.sandersclinic.net
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Sports Related Knee
Ligament Injuries
Anatomy of the Knee
Mechanisms of Injury
Diagnosis Reconstruction
Therapy and Rehabilitation
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Frank H. Netter, Atlas of Human Anatomy 4thEd.
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Anterior Cruciate Ligament
Major stabilizing ligament in the knee
connecting the tibia to the femur
preventing pathologic anterior excursion of
the tibia on the femur
Contains mechanoreceptors which supply
the nervous system with real time
information regarding the limbs position inspace
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Mechanisms of Injury
Can be torn by a sudden violent contraction of
the quadriceps occurring on the misplanted foot
Most common cause of ACL injuries in noncontact
sports In collision sports it occurs as a result of an
externally applied force projected directly on the
medial or lateral surface of the knee
Hyperextension
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When the ACL Tears
A patient reports hearing or feeling a pop
There is a sense that the knee went out
or dislocated
The pain typically makes it impossible to
finish the day's activities
May also result in collateral ligament,articular surface, and/or meniscal cartilage
damage
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http://www.youcanbefit.com/images/ACL%20tear%20cause.bmp
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http://www.hughston.com/hha/b_11_3_2b.jpg
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http://www.weissortho.com/images/sectionimages/commoninj
uries/bodyparts/big/acltear.jpg
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http://cms.depuy.com/display?docId=20157
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Diagnosis
History
Physical Examination
Straight leg raising possible
large knee effusion
loss of active knee motion
Lachmans sign (anterior draw in mild flexion) Pivot shift sign (uncommon in acute situation)
Collateral ligament examination in full extension and 30 degrees of flexion
KT-1000
X-ray
MRI
Arthroscopy
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http://www.jfponline.com/images/5209/5209JFP_AppliedEvidence-fig2.jpg
MED i K Li
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MEDmetric Knee Ligament
ARTHROMETER Model
KT1000
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MRI
Advantages/Disadvantages?
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http://www.emedx.com/emedx/diagnosis_information/diagnosis_information_image
_files/knee_images/acl_mri_torn.JPG
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http://www.rad.washington.edu/staticpix/anatomy/ACL1.jpg
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Arthroscopy
Not typically necessary for diagnosis, whichshould be obvious from History, PhysicalExamination, KT-1000 testing, and/OR MRI
Most often MRI is not necessary for diagnosis,but can be helpful in determing the presence ofother injuries
bone contusion (bone marrow edema)
articular or meniscal cartlage injury collateral ligament injury (should be obvious
from physical exam)
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http://www.yoursurgery.com/procedures/arthroscopy/images/ACL_PCL.jpg
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http://www.genou.com/LCAnormal.jif
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http://www.emedx.com/emedx/diagnosis_information/diagnos
is_information_image_files/knee_images/acl_normal_arthros
copic_picture.JPG
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Initial Treatment Surgery NOT INDICATED
Immediate surgery leads to an unacceptable incidence ofarthrofibrosis (loss of ROM)
RICE Rest
Ice
Compression Elevation
Range of Motion exercises
Gait reeducation quickly eliminates the need for crutches
Cold/compression CryoCuff
Strengthening and flexibility program forhamstringsandquadriceps
Emphasize extension equal to the other leg
Cycling
http://sandersclinic.net/recdprgm_devic.htmlhttp://sandersclinic.net/recdprgm_devic.htmlhttp://sandersclinic.net/recdprgm_devic.html -
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Options?
Non-surgical
Must be willing to give up sports with
exception of cycling and activities in a health
club Strength and conditioning program
Surgical
For people that want to return to sports andneed the stability (athletes)
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Allografts
Advantages Technically easy
Biological Considerations Greater than one year for revascularization
Rejection
Infectious transmission
Technically easy
Economic considerations Very expensive
Success Rate 80% stable knees Return to sports not before one year
Indications Non-athletic patients over 40
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Hamstring Tendon
Advantages Technically easy
Disadvantages Lack of bone to bone healing
Maturation takes one year Sacrifice of a major muscle group that provides major
posterior translation of the tibia (the hamstringtendons are the allies of the ACL)
Success rate 90% stable knees Return to sports 9 months to one year
Long term hamstring weakness present
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Bone-Patellar Ligament-Bone
GOLDStandard
Advantages
Bone to bone healing
Strongest graft
Maturation occurs rapidly
Return to sports 6 months
Disadvantage Requires attention to detail at surgery and
rehab
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Contra lateral patella tendon
(PLATINUM standard)
Less postop pain
Faster rehab
Divide the problem into two parts
ACL leg concentrates on ROM
Graft leg concentrates on Strength
No braces or crutches Return to sports 3 months
Improvement continues over first year
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Procedure
A short straight incision is made on the ACL knee superficial to thepatella and a small incision is made lateral and superficial to thedistal femur
Drill holes are placed into the knee - from the leg and thigh - into theplaces where the native ACL inserts into the femur and tibia
A similar incision is made onto the front of the healthy graft leg
The graft is harvested and the wound is closed over a drain
The new graft is then placed through the ACL knee and sutures aretied over buttons
The wounds are then closed over drains - preventing excessive fluidbuild up for optimal recovery and movement
Cold compression is applied on both legs and strengtheningmovements begin that day
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Full extension equal to the other leg necessary
on the operating table and at all other times
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Therapy and Rehabilitation
Immediate! ROM key on ACL leg!
Strengthening key on graft leg
Gait training
Jogging in 1 month
Sports specific drills 6 weeks Criteria for returning to sports
Full and equal motion in both knees
Strength equal to 80% of preop graft leg both knees
Swelling absent
Plyometrics
Neuromuscular reeducation
Average return to sports 3 months Confidence and performance continue to improve for one year
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3 Days
PostopHardin
g
forwar
d andbackw
ards
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Angela hall website
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For More Information
Visit our website at www.sandersclinic.net