Why is this topic important? The common knee injuries and management

Some anatomy Epidemiology Meniscal injuries ACL injuries PCL injuries Medial Collateral

Conclusions (Visual!) Quiz

To the group: Sports injuries 10-20% of ED acute injuries Most commonly knee and ankle Impact on health, life, economy Chance to consider kneeanatomy & examination

To me: Personal interest

Few studies BUT UK professional rugby players:

Part of knee injured Prevalence (%)

Meniscal 18.5

ACL 4.3

PCL 3

Medial collateral 28.9

Patellofemoral 12.3

Other (minor) 33

Adapted from Dallana et al 2007

Presentation: Immediate vs.longer duration

Symptoms: Pain, locking, clicking

O/E: locking (McMurray’s test), effusion, joint line tenderness, palpable meniscal cyst

Diagnosis: clinical, (MRI, arthroscopy)

Mechanism of injury:Landing/twisting withknee flexed (associatedwith ACL tear)

Management : Conservative – RICE & early physio Surgical – Arthroscopic repair, resection

Presentation: Acute traumatic vs. present long after with unstable knee

Symptoms: ‘pop’, ‘something goes’, pain,instability O/E: swelling (hours), tense effusion, +ve

anterior drawer, Lachmann’s, pivot shift Diagnosis: clinical, (MRI, EUA, arthoscopy)

Mechanism of injury: twisting/valgus strain with foot fixed (medial collateral, meniscal association)

Management: Conservative - RICE and physio Surgical – unstable knee/sportsmen – arthroscopic

hamstring tendon graft

Usually rare & less common than ACL Symptoms: ‘pop’, ‘something goes’, pain, less

instability O/E: swelling (less than ACL), posterior sag, +ve posterior drawer Diagnosis: clinical,(MRI, arthoscopy)

Mechanism of injury – front on impact forcing tibia backwards/hyperextension

Management: Conservative – RICE and physio – almost all Surgical – if combined injuries/knee unstable

Common – isolation or with ACL Symptoms – ‘something goes’, pain, instability O/E – NO effusion (extra-articular), tender over MCL, joint opening on valgus stress

Mechanism of injury – valgus strain (hence commonly with ACL)

Management: Conservative – brace and physio 6/52 Surgical - other injuries or chronic unstable MCL

Knee injuries common in sportsmen and ED injury admissions

Diagnosis predominantly clinical – history (mechanism of injury) and examination

More than one ligament often injured

Treatment – surgery usually required for sportsmen

Valgus

Twist

Gray’s Anatomy for students Dallalana, R.J., Brooks, J.H., Kemp, S.P., and Williams, A.M. The epidemiology of

knee injuries in English professional rugby union. American Journal of Sports Medicine 2007. 35(5) :p818-830.

http://www.orthopedicsurgerybook.com/Images/knee-menisucus-tear-surgery.jpg http://www.empowher.com/condition/anterior-cruciate-ligament-injury ACL pic http://www.kneejointsurgery.com/html/ligament/acl.html http://bestpractice.bmj.com/best-practice/monograph/575.html http://www.sportsdoc.umn.edu/Patients_Folder/Knee/pcl%20recon/PCLreconstruction.htm http://www.wheelessonline.com/image6/pcl2.jpg http://www.easyfizzy.co.il/image/users/46789/ftp/my_files/medollig.gif http://blog.oregonlive.com/pac10/2007/10/large_Patcowan.jpg http://seanlaceystrengthandconditioning.wordpress.com/ http://www.kneejointsurgery.com/html/ligament/acl.html http://www.mountsinai.org/patient-care/service-areas/bone-joint-and-

spine/areas-of-care/orthopaedic-knee