Soccer Knee Injuries and Exam
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Ben Kittredge,
MD
Commonwealth
Orthopaedics
Knee Anatomy
Pediatric Knee Injuries
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Acute (event occurs)
Chronic (no event)
Acute Injuries
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What happened?
Non-contact twist?
Did the knee swell up
right away?
Hear or feel a “pop” ?
Able to continue playing?
Acute Knee Injuries
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Ligament injury (ACL,
MCL)
Meniscus tear
Fracture/Bone bruise
Patellar dislocation
Knee Exam
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Inspection
Range of motion
Is there an effusion?
Joint line tenderness
Stability
Inspection
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Erythema
Cellulitis?
Septic prepatellar bursitis
Range of Motion
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Locked knee?
Effusion
Is it an effusion?
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Prepatellar bursitis
Effusion Present
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ACL tear
Patellar dislocation
Fracture or Bone bruise
No Effusion
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MCL tear
Meniscus tear
Contusion
Stability Exam: Anterior-Posterior
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Lachman’s
ACL Tear
Stability Exam: Anterior-Posterior
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Posterior drawer
PCL tear
Stability Exam- Medial and Lateral
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Valgus stress
MCL tear
Stability Exam- Medial and Lateral
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Varus Stress
LCL tear
Knee Exam
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Joint line tenderness
Meniscal tear?
Patellar Exam
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Palpate medial and lateral
patellar facets
Chondromalacia patella
Tendon Exam
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Patellar tendon
Quadriceps tendon
Iliotibial band
Tibial tubercle
Xray
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May show fracture
Growth plate status
Often normal
Xray
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Is it normal?
MRI
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ACL
Patellar Dislocation
Fracture or Bone bruise
MRI
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Quality of MRI varies
Radiologists expertise
varies
ACL Injuries
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400,000 reconstructions
per year in the US
Females 4 times more
likely to tear ACL with
non-contact injury
ACL Tears-Prevention
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High intensity
plyometrics, balance
training, and
strengthening
Neuromuscular
Feedback
Treatment-ACL Tear-Growth Plates
Closed
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Patellar tendon
Hamstring
Allograft
ACL tear-Growth Plates Open
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Brace
Physeal sparing
reconstruction
Patellar Dislocation History
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Twisting injury
Collision
May not know patella
dislocated
Immediate swelling
Can’t play
Patellar Dislocation Exam
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Big effusion
Patellar apprehension
Medial retinacular pain
Patellar Dislocation
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Xray
Patellar Dislocation
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MRI
Patellar Dislocation
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Loose Body –
Arthroscopy
Brace?
Rehab
Return to play when
comfortable
Fracture or Bone Bruise History
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Collision
Fall
Non-contact twist
Fracture or Bone Bruise Exam
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Effusion
May or may not be able
to localize pain
Inability to bear weight
Bone Bruise
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Xray normal
Diagnose by MRI
Usually back to sports in
4-6 weeks
Fracture
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Xray
Fracture Treatment
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6-12 weeks to heal
Brace?
Cast
Surgery
MCL Tear History
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Valgus injury
May or may not have
contact
Pop?
May keep playing
May not swell right away
MCL Tear Exam
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Medial joint line pain
Opening with valgus
stress
No effusion
MCL Tear Imaging
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Xray-normal
MRI
MCL Tear Treatment
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Brace for 2-6 weeks
Pass functional test to
play
Surgery if off tibia
Meniscal Tear
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History of twisting injury
Meniscus Tear Exam
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Swelling may or may not
be present
Joint line pain
Locked knee?
Meniscal Tear
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Locked knee
Urgent knee arthroscopy
Meniscus Repair
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Non-weight bearing 6
weeks
Sports in 4 months
Meniscus Resection
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Sports in 3 weeks
Chronic Injuries
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Chondromalacia patella
Osgood-Schlatter
Disease
Stress Fracture
Osteochondritis
Dissecans
Chondromalacia Patella
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Poorly localized anterior
knee pain
Dull, aching pain
Worse with jumping,
climbing, squatting
Exam
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Point tender at medial
patellar facet
View patellar tracking
Normal exam-think
about hip
Chondromalacia Diagnosis
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Xray- usually normal
MRI- usually normal
Xray pelvis?
Chondromalacia Patella Treatment
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Sports menu?
Brace
NSAIDS
Rest
Physical Therapy
MRI?
Osgood-Schlatter Disease
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Overuse injury
Traction apophysitis
Osgood-Schlatter Disease
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Jumping sportsbasketball, volleyball
Dull, aching pain
Boys 13-14
Girls 11-12
Osgood-Schlatter Disease-Exam
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Inspection
Point tender over tibial
tubercle
Osgood-Schlatter Disease
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Xray
Osgood-Schlatters Treatment
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NSAIDS
Brace
Relative rest
Full rest
Physical therapy
Knee immobilizer
Cast
Osgood-Schlatter Disease
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Goes away when
apophysis fuses
Stress Fracture History
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Abrupt increase in
activity-must elicit
Stress Fracture Exam
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May be point tender
May be difficult to
localize
Stress Fracture
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X-ray
Stress Fracture
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Bone scan
Stress Fractures
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MRI
Stress Fracture Treatment
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Rest for 3 months
Crutches?
Non-weight bearing?
Stress Fracture Healed
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Pain free 2 weeks
Run 2 miles (30 min)
twice per week
10% increase per week
Osteochondritis Dissecans
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Subchondral bone
disorder
Softening of overlying
cartilage
May fragment
Occasional cause of knee
pain
Osteochondritis Dissecans
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Overuse injury
Repetitive micro-trauma
Poorly defined aching
pain
Stress fracture
Osteochondritis Dissecans
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X-rays are key
Osteochondritis Dissecans
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MRI can be helpful
Osteochondritis Dissecans
Treatment
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Non-weight bearing at
least 3 months
Prognosis depends on
growth plate status
Osteochondritis Dissecans
Treatment
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Displaced fragmentsurgery
Pediatric Knee Injuries
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Is it the Hip?