Knee Pain in the Work
Comp Patient
William F Bennett MD
Sarasota, Fl.
Anatomy
BonesFemur
 Tibia
 Fibula
 Patella

Tendons
Rectus femoris
Vastus Medialis

obliquus
Vastus lateralis
Obliquus
 Patellar Ligament-Sesamoid

Bursae
Prepatellar Bursae
Pes Anserinus Bursae
Ligaments
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Collateral Ligament
Lateral Collateral ligament
Cartilage
Articular Cartilage-type 1 collagen
Meniscus-type 2 collagen
Healing articular cartilage-type 2
collagen
Synovium/Capsule
Synvoium-synovial fluid

Hyaluronic acid complex
Baker’s Cystcapsule
Knee
Biomechanics
Knee is basically a hinge joint
More complex as its rotates as well
During extension-tibia rotates externally
to lock knee in what is known as a
screw home mechanism
Patellofemoral
Biomechanics
Patella glides in a groove in the distal femur
Full extension-patella lays on the
suprapatellar fat pad
During flexion-first20-30 degrees patella jogs
laterally then seats itself centrally in the
groove
Deep flexion places more pressure on the
cartilage
Patellofemoral
Biomechanics
With deeper flexion-patellar tendon
comes into contact
Contact area with flexion moves from
distal to proximal and from medial to
lateral
Patella has a medial facet, lateral facet
and median ridge
Pain-”itis”
“itis” means inflammation
Tendonitis-inflammation of tendon
Bursitis-inflammation of bursae
Synovitis-inflammation of bursae
Arthritis-inflammation of a joint
Oops-chondromalcia- inflammation,
deteriorization of the cartilage, means
‘sick cartilage”
Other sources of pain
TraumaTorn Ligaments
Fractures-bones
Effussion-fullness achiness in the knee
Common Problems
Falls- ladder,stairs ect.
-Fractures-femur
-tibia
-tibial plateau
-tibial eminence
-patellar
Fractures
Patella
Fractures
Plateau
Ligament Disruptions
Medial Collateral Ligament Injuries
Lateral collateral Ligament Injuries
Anterior Cruciate Ligament Injuries
Posterior Cruciate liagment Injuries
Posterolateral Complex Injuries
ACL Disruptions
Arthroscopic ACL
Reconstruction
ACL FINAL
Patellofemoral Problems
Kneeling/Squatting/ladders/Stairs
Prepatellar Bursitis-kneeling
 Patellofemoral Pain-kneeling, stairs, ect
 Patellofemoral Chondromalacia
 Patellar Subluxation/Dislocation

Patellofemoral
Chondromalcia
Patellofemoral
Subluxation/
Dislocation
PF Joint Sex Differences
Female
Male
Cartilage Problems
Meniscal tears- shock absorber, twisting

Associated with ACL tears
Articular Cartilage- Flaps, divots, wear

chondromalcia
Meniscal Tears
Articular Cartilage
Tears
generalized/localized
Cortisone Injections
Anti-inflammatory medicine
Lubricating medicine
Brace
Arthroscopic Debridement
A.C.I.
O.A.T.S.
Ancillary testing
Xrays
MRI
Gadolinium- absorbed into articualr
cartilage defect after 3-5 hours
Treatment
FracturesCasts
 IM rods- tibia/femur
 ORIF- patella fractures/tibial plateau
fractures/eminence fractures

Treatment
Ligament Disruptions
MCL- brace PWB 6-8 weeks
 LCL- Brace or repair
 ACL-Reconstruction
 PCL-+/- reconstruction
 Posterolateral complex-+/- reconstruction

Treatment
Patellofemoral injuries




Prepatellar Bursitis- Neoprene
sleeve/rest/advil/injection
Patellofemoral Pain- neoprene
sleeve/rest/advil/phyiscal therapy/posisble
arthroscopic release
Patellofemoral Chondromalacia-same as above
+/- tibial tubercle transfer/VMO advancment
Patellofemoral Sublux/Disloc-arthroscopic repair
medial patellofemoral retinaculum/lateral release,
cartilage debridment
Cartilage Problems
Meniscal tearsRepair young and not complex in red-red
zone
 Fastest to work- partial menisectomy,
older/compelx tears
 Meniscal Allograph

Articular Cartilage
GeneralizedAdvil
 rest
 Injections
 Brace/medial or lateral

Localized
A.C.I.
 O.A.T.S.

Time To Work
FracturesLigament DisruptionsPatellofemoral

Prepatellar-

PF Pain/Chondro- variable-
3-4 months
6-12 weeks
continuous
6-8 weeks
Cartilage

Meniscal Repair-

Meniscal Resection-
Generalized articular
 Localized

3 months
6 weeks
var 1-8 wks
3-4 months
Impairment
Lower
Extremity
Impairment
Whole
Body