The Knee - ORZOorzo.union.edu/~curreyj/BNG-345_files/The Knee.pdf · Knee Injury Statistics 6.5...
Transcript of The Knee - ORZOorzo.union.edu/~curreyj/BNG-345_files/The Knee.pdf · Knee Injury Statistics 6.5...
The KneeErin Lyons, John Miller and Nick Wright
Learning Objectives- Understand how the complicated anatomy of the knee leads to large number
of possible injuries- Explain how the technology to diagnose and surgically fix knee has improved- Name different types of knee injuries and how they are treated.- Explore upcoming technologies that will continue to evolve the field
Anatomy Review: Bones and Cartilage● Femur● Tibia and Fibula● Patella● Meniscus
○ Medial and Lateral
Medial Meniscus Lateral Meniscus
Fibula
Femur
Tibia
Patella
Anatomy Review: Muscles● Quadriceps
○ 4 muscles: Rectus Femoris, Vastus lateralis, Vastus medialis, Vastus intermedius○ Pulls for extension of knee
● Hamstring○ Pulls for flexion of knee
● Calf○ Soleus, Gastrocnemius
Anatomy Review: Tendons and Ligaments● The “Big 4”
○ ACL○ MCL○ PCL○ LCL
● Quadricep Tendon○ Distal Portion: Patellar Tendon
● Hamstring Tendon
Knee Injury Statistics
● 6.5 million visits to US emergency departments from 1999-2008
● Knee sprains, strains or tears accounted for nearly 50% of injuries resulting in lost work time
● Washington State workers compensation system (1997-2007)
○ 25,000 knee injuries
○ Just under $500 million
Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes
- Focus: ACL tears in female athletes- ACL tears are 5 times more common in females than males playing the same high-risk sports
- Most common cause: noncontact
Methods/ Data Collection
ACL Injury Prevention- Sports Training- General Knowledge
- Strengthening muscles- Flexibility
ACL & PCL Tear● Most PCL and ACL
(cruciate ligament) tears occur when the foot is planted and a sudden force is applied the knee.
● Twisting (seen to the right)
Immediate Testing?● Trainers can immediately test for injuries
using the posterior and anterior drawer.
● Volunteers?
Other On-Field Tests
Diagnosis ● Why is the MRI (Magnetic Resonance
Imaging) the most effective screening method for ligament tears?
● MRI uses a magnet to align the nuclei of hydrogen atoms and creates a magnetic field to make the atoms resonate.
Diagnosis ACL ● Images show a normal and a
torn ACL of the knee
PCL MRI Image Before and After Injury
MCL/ LCL Tears ● Collateral Ligaments● Less common ● Usually happens from a planted
foot and contact from the side of the knee
● Stability Testing and immediate bruising are used to diagnose
Meniscus Tears● One of the more common knee injuries
● Usually the result of twisting or pivoting on the knee in a short burst.
● Can tear in many ways making treatment unique to every situation
MeniscusBucket Handle Tear:
● One of the many tears that can happen● The meniscus fragment can become
wedged within the knee● Causes the patient to lose the ability to
fully extend the leg● Arthroscopic surgery needed for most
cases of meniscal tears
Osgood-Schlatter DiseaseWhat: Tibia Tubercle is pulled by Patellar Tendon causing it to become inflamed and irritated.
Who: Common in Adolescents
What: A noticeable bump on the knee will be present. Even complete separation of the Tibia Tubercle can occur.
Osgood-Schlatter’s Treatment● Non-steroidal anti-inflammatory drugs
● Stretching, and use of knee brace
● Last effort: Surgery to reshape Tibia Tubercle
Patellar Tendonitis● Painful inflammation of the patellar tendon
● Common in athletes who jump a lot
● Overuse injury
Patellar Tendonitis Treatments● Physical therapy
● Non-steroidal anti inflammatory medication (NSAIDs)
● Knee braces
● Icing and immobilization
Arthritis● Natural erosion of cartilage
○ Meniscus
● Many causes○ Heredity, age, weight○ Repetitive injuries, atheltics○ Osteoarthritis vs Rheumatoid
Arthritis Complications● Bone spurs
● Joint deformation
● Loss of function
Arthritis Treatments● Braces
○ Unloader, Support
● Physical Therapy
● Exercise and weight loss
● Surgery- Total Knee Replacements
Total Knee Replacement Video
http://www.ohsu.edu/xd/health/services/ortho/getting-treatment/total-knee-replacement.cfm
Question: Does this injury require surgery?- Will the injury heal on its own?
- Self-Management- How has the individual’s quality of life been impacted?- Individuals with chronic knee pain may choose non-operative care over surgery
- Non-Operative Care
Immobilization- then vs now 1967- Knee braces were developed
1968- first knee brace was born in the Super Bowl by Joe Namath
He played his entire career on a torn ACL suffered during college
Types of Surgical Procedures
● Marrow Stimulation Procedures
● Autologous Chondrocyte Implantation
● Patellar Tendon Realignment Procedure
● Meniscal Disorders
● Anterior Cruciate Ligament Reconstruction
● Osteochondral Autograft/Allograft Transplantation
● Arthroplasty
ACL Reconstructive Surgery- Connection between ACL injuries and arthritis - Reconstructive Focus- Development of arthroscopy techniques
- Increased success rate of the surgery significantly- Easier to recovery and rehabilitation
Rehabilitation and Recovery● Length of disability? ● Physical therapy is necessary for knee
function to return to normal
Upcoming Technology: Regenexx - “Your Alternative to Knee Surgery”- Two main procedures:
- Stem Cell Treatments- Blood Platelet Treatments
- Can be used to treat injuries to the meniscus, cartilage, ACL or MCL ligaments or chronic knee pain
Meniscus Tear Example