The Sporting Knee. Research. Education. Dr Lingaraj Krishna Consultant Division of Hip and Knee Surgery National University Hospital

Transcription

1 The Sporting Knee Dr Lingaraj Krishna Consultant Division of Hip and Knee Surgery National University Hospital Assistant Professor Department of Orthopaedic Surgery National University of Singapore Clinical Care Education Research Topic goes here Project number Copyright 2008 National University Health System

2 Sports Injuries Injuries that result from repetitive stress or acute trauma associated with athletic activities Weekend warriors, students NS-men Knee joint commonly injured during sports Soccer Basketball Rugby Often seen in primary care setting

3 Anatomy of the knee Bones and Cartilage Ligaments and Menisci Muscles and Tendons Bursae

4 Anatomy of the knee Bones and Cartilage

5 Anatomy of the knee Ligaments and Menisci

6 Anatomy of the knee Muscles and Tendons

7 Anatomy of the knee Bursae

8 Approach to Knee Injuries Overuse Injuries Traumatic Injuries Less pain and swelling Simple imaging is sufficient Conservative treatment in primary care setting Marked swelling and pain Usually require further imaging and referral to hospital Surgical treatment RICE therapy

9 Approach to Knee Injuries Overuse Injuries Patellar tendonitis Quadriceps tendonitis Hamstring tendonitis Apophysitis Pes anserinus bursitis Lateral patellar compression syndrome Bone stress injuries Traumatic Injuries Ligament tears Meniscal tears Patellar dislocation Chondral injuries Osteochondral injuries Fractures Patellar tendon ruptures Quads tendon ruptures Muscle tears

10 Overuse Injuries Patellar tendonitis - Pain after running - Localized tenderness at inferior pole of patella - Xrays normal - Rest - NSAID s - Physiotherapy

11 Overuse Injuries Apophysitis (Osgood-Schlatter s disease) - Adolescents and young adults - Localized tenderness and swelling at tibial tuberosity - Xrays show characteristic ossicle - Rest - NSAID s - Physiotherapy

12 Overuse Injuries Pes anserinus bursitis - All ages groups - Localized swelling at pes anserinus insertion - Rest - NSAID s - Physiotherapy

13 Overuse Injuries Lateral patellar compression syndrome - Young adults - Tight lateral retinaculum - Possible retropatellar tenderness and effusion - Rest - NSAID s - Physiotherapy

14 Overuse Injuries Bone stress injuries - NS-men (usually recruits) - Most commonly affects medial tibial plateau or medial femoral condyle - MRI shows marrow oedema - Prolonged rest - Physiotherapy

15 Approach to Knee Injuries Overuse Injuries Patellar tendonitis Quadriceps tendonitis Hamstring tendonitis Apophysitis Pes anserinus bursitis Lateral patellar compression syndrome Bone stress injuries Traumatic Injuries Ligament tears Meniscal tears Patellar dislocation Chondral injuries Osteochondral injuries Fractures Patellar tendon ruptures Quads tendon ruptures Muscle tears

16 Traumatic Injuries Meniscal injuries - Most common knee injury requiring surgery - Medial meniscus tears are 3 times more common - MRI is diagnostic - Initially non-surgical unless repairable tear or knee locked - Surgery Partial meniscectomy, Meniscal repair

17 Traumatic Injuries Ligament injuries - Can involve ACL, PCL, MCL, LCL and posterolateral corner - Can occur in isolation or in combination - ACL most commonly injured ligament - Physical examination is important - MRI is diagnostic

18 Traumatic Injuries Ligament injuries - Treatment depends on : - Age of patient - Activity level - Acute vs chronic injury - Associated injuries - Non-surgical treatment - Physiotherapy - Activity modification - Surgical treatment - Reconstruction - Repair

19 Traumatic Injuries Patellar dislocation - Adolescents and young adults - Swelling and tenderness over medial retinaculum - MRI to exclude osteochondral injury - Non-surgical treatment for first dislocation - Surgery for recurrent dislocation

20 Traumatic Injuries Chondral and osteochondral injuries - May present with pain, swelling and locking - MRI is necessary to assess location and extent - Surgical treatment often necessary - Internal fixation - Microfracture - Cell therapy - Mosaicplasty

21 Traumatic Injuries Fractures - May be missed unless imaging done - Lateral tibial plateau most commonly involved - Surgery involves internal fixation

22 Traumatic Injuries Patellar tendon ruptures - Uncommon injury - Inability to perform SLR - Palpable gap in patellar tendon - Surgery involves reattachment of the tendon

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24 Thank you for your attention Topic goes here Project number Copyright 2008 National University Health System