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COMMON KNEE INURIES IN SPORTS MEDICINE

LAWRENCE PICCIONI MD. COMMON KNEE INURIES IN SPORTS MEDICINE. MY BACKROUND . Current team physician for Delaware State University since 1993 Team physician for Wesley College 1992 to 2004 Team physician for Dover High School 1992 to 2004. PURPOSE.

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COMMON KNEE INURIES IN SPORTS MEDICINE

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  1. LAWRENCE PICCIONI MD COMMON KNEE INURIES IN SPORTS MEDICINE

  2. MY BACKROUND • Current team physician for Delaware State University since 1993 • Team physician for Wesley College 1992 to 2004 • Team physician for Dover High School 1992 to 2004

  3. PURPOSE • Familiarize you with common features of injuries • Reinforce what you already know about diagnosis and treatment • Help decision making as far as treatment or referral

  4. ACCOMPLISH GOAL • Reviewing pertinent anatomy, History and Physical findings • Review differences in adult and pediatric injury patterns • Give some PEARLS

  5. ANATOMY OF KNEE • Bones more pertinent in pediatric group • Tendons – Patellar and Quadriceps • Cartilage – articular and meniscal • Ligaments – ACL, PCL, Medial and lLateral Collateral

  6. LIGAMENT VS CARTILAGE • Cartilage is like a rock in your shoe pain and swelling the more you do the more it hurts • Ligament injuries are like walking on ice • DOES IT HURT AND GIVE OUT OR GIVEOUT AND HURT?

  7. MENSICUS HISTORY AND EXAM • Often minor trauma in adults due to degeneration, sometimes feel a pop • Feel a click plus or minus effusion (popliteal) • Joint line tenderness pain with rotation (McMurray, Appley, etc) • Pain and swelling with activity, low grade

  8. MENISCUS INJURY TREATMENT • Usually surgical or live with it • Meniscus relatively inert and poor healing potential • Outpatient procedure, arthroscopic, 2 to 4 weeks return to many sports if motivated • Not a surgical emergency, difficult to play through

  9. MENISCAL SURGERY • “Repair” usually means taking out torn portion • Only 10% repairable (bucket and vertical tears in outer 1/3) • NFL meniscal injuries more career ending than ACL

  10. ANTERIOR CRUCIATE INJURIES • Most common in sports particularly with acceleration/deceleration • Not always a violent injury many noncontact • Classic is feel a pop followed by intense swelling within 6 hours (hemarthrosis) • Not a surgical emergency Surgery often delayed 3 or more weeks (reconstruction)

  11. ACL TEAR DIAGNOSIS • May have effusion may not some walk in comfortable • Lachman’s test is most classic and STILL most useful • Often missed on MRI (femoral detachment difficult to pick up)

  12. ACL TREATMENT • Not always surgical initial RICE and ROM • PT for quad hamstring strengthening • Brace treatment • Coping and sport modification • Surgery

  13. ACL SURGERY • Reconstruction with multiple graft choices • Who gets it? – under 40, women, buckling with daily activity, competitive level 1 sports • Outpatient surgery mostly arthroscopic return to full sport variable but 6months to one year

  14. PCL & COLLATERAL LIGAMENT • More rare usually in the realm of orthopedist • Not a “Pulled muscle” • Many are not surgical but require detailed diagnosis (combined injuries) • Not emergency but protection with crutches and immobilizer needed

  15. PEDIATRIC KNEE INJURIES • Bones now important • Physeal injuries common (weaker than ligaments and cartilage) • Different age leads to different fractures ietibial eminence 12yrs tibialtubercal 14yrs

  16. TIBIAL EMINENCE FRACTURE • ACL eqivalent in younger age • Same mechanism of injury • May require surgery usually requires referral

  17. TIBIAL TUBERCULE FRACTURES • Typically occur during adolescence • 3 types depending on severity • Only most severe (type 3) require surgery but all require referral

  18. PATELLAR SLEEVE FRACTURE • Common in younger kids • Represents an avulsion of inferior patellar cartilage from bone • Analogous to patellar tendon rupture in adults • Can be difficult to diagnose (pain, fear etc)

  19. TIBIAL TUBERCULE FRACTURES • Usually occur during adolescence • Three types depending on severity • Only type 3 requires surgery but all require referral for treatment

  20. CONCLUSION • History and physical still the key as imaging is confirmatory. • Most injuries not a “pulled muscle” • Relax most are not surgical emergencies • Pediatric injuries tend to be physeal and more emergent

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