Derbyshire Sports Injuries Clinic presents

Derbyshire Sports Injuries Clinic presentsThe Knee1Anatomy- 1st layer

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The knee jointMade up of two joints:Tibiofemoral joint:Hinge jointCollateral ligamentsCruciate ligamentsMenisciPatellofemoral joint:Medial retinaculumPatellar tendon3Anatomy-ligaments

ACL PCLMCLLCLPopliteal ligamentsMeniscofemoral ligamentTransverse ligament 4Anatomy-medial view

5Anatomy- lateral view

6Anatomy-posterior view

7Anatomy- bursae

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Movements of the kneeFlexion ExtensionAccessory movements in certain positions can take place with external forces:Valgus VarusExternal rotationInternal rotation9Patient walks in c/o knee painWhat is the mechanism of injury?A planted foot with a valgus force and/ or twisting movement is a serious position of danger for the kneeWas there a noise?Did the knee swell up immediately?Is there any bruising?Was the patient able to play on?Is the patient able to weightbear?Is there any clicking/ giving way/ locking now?

10Patient walks in c/o knee painAcute, chronic or sub-acute?Does pain increase or decrease with activity?Patients job and leisure activities and any possible contributing factors?Gait? Limping or normal walking? Able to cope with stairs?Does the patient have any hip pain?Any back pain? Leg pain? Could this be an L3 Nerve root compression?11Where is the pain?

12Causes of haemarthrosisACL tearPCL tearPatella dislocationOsteochondral fracturePeripheral tear of the meniscus (more commonly medial)Hoffas syndrome (acute fat pad impingement)

13More clinical pearlsThere is little effusion with collateral ligament tearsAn effusion that develops after a few hours or the next day is a feature of meniscal and chondral injuries Assume everything with a pop or a snap is an ACL tearAssume all clicking and locking is meniscal... Especially loss of extensionIf the knee locks in extension and flexion is difficult it is likely to be patellofemoral painGiving way can be indicative of ACL or meniscal injury, but if this is longstanding with no injury, it may be muscle weakness14Ottawa Knee rulesAge 55> or 15ml of fluid will switch off VMO (major stabiliser of the knee) increasing the risk of adverse knee mechanics and therefore PFPSAssess the patella position relative to the painfree side30

Patella tendinopathyMostly involves jumping/ multidirectional sportsSignificantly more painful with eccentric loading rather than any other type of loadingPain is inferior pole of the patella, or the tendonPain is always bad in the morningChronic tendinopathy can take 3-6 months to settleSurgery is only indicated after a considered and lengthy conservative programme has failed

31Lateral knee painMostly due to Ilitobial band friction syndrome (ITBFS)Repeated flexion/ extension at the knee causes ITB to rub on the lateral epicondyleTraining errors and biomechanical problems are the major causes of ITBFSOccasionally biceps femoris tendon can become inflamed and tenderSuperior tib-fib joint can also give lateral knee painOA of the lateral compartmentNerve root irritation/ entrapment

32Medial knee painPFPSMedial meniscal injuryOA of the medial compartmentPes anserinus bursitisReferred pain

33Posterior knee painBiceps femoris, gastrocnemius or popliteus tendinopathyReferred painBakers cystPosterolateral corner injuryDVTClaudication

34Advice to you as GPsIf its swollen, refer to orthopaedicsIf its anterior knee pain, always refer to physioIf its giving way, refer to orthopaedicsA painless click is not a problem, as long as no locking or giving way is associated.Kids with Osgoods should rest when sore, and try to get strong when condition is stableRest will NEVER fix an injury. Cycling (not standing on the pedals) is generally a knee friendly sport. Running is not.

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