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Orthopaedic Knee Injuries

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by

Matt Garner

on 16 March 2013

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Transcript of Orthopaedic Knee Injuries

What you knee'd to know Knee Injuries Bursitis Overuse Syndrome Ligament Tear Chondromalacia Patella Objectives Clinical Presentation of various orthopaedic knee injuries
Physical findings of various orthopaedic knee injuries
Lab and imaging studies of various orthopaedic knee injuries
Treatment and clinical course of various orthopaedic knee injuries Swollen Knee/Effusion Clinical Presentation Traumatic
Acute pain/swelling (meniscus tear, tendon rupture)
Atraumatic
Less acute over a course of hours or days (infection, gout)
Chronic
Insidious, wax and wane (osteoarthritis "OA", rheumatoid arthritis "RA") Physical Exam Effusion
Possible erythema
Pain with deep flexion due to capsular distention and pressure
Pain with joint line palpation Studies Single most important study in determining the cause of an acute or chronic knee effusion is aspiration and analysis of joint fluid
Clear - OA or torn meniscus
Bloody - trauma (ACL rupture or fracture "fx")
Cloudy/blood-tinged - infection or inflammation
Turbid - gout, chondrocalcinosis, Lyme artritis, or infection
Fluid analysis should include Gram stain, culture, cell count, and crystal analysis
X-rays (weight-bearing AP, lateral, and sunrise) for evidence of OA or fx
MRI for soft tissue injuries such as meniscus tear or ACL rupture
CRP, ESR, serum uric acid levels, and WBC count may be useful Treatment Sterile aspiration can provide relief
Treatment of underlying pathology
Intra-articular corticosteroid injections
Septic effusions require surgical irrigation, debridement, and IV or oral antibiotics
Recurrent effusions may require surgery
Physical therapy Clinical Presentation Anterior knee pain with deep knee flexion, stair and hill ascent and descent, and prolonged sitting due to the softening and degeneration of the cartilage of the patella
More common in young women
Anatomical risk factors include:
Patella alta (high riding patella)
Patellofemoral dysplasia
High Q angle Physical Exam Knee effusion
Tenderness on the undersurface of the patella
Patellar crepitation
Increased Q angle and valgus posture
Hypermotility of the patella
Pain with patelar inhibition testing
Evidence of trauma to the knee Studies Plain x-rays (standing AP, lateral, and Merchant or sunrise views)
MRI, CT, and bone scan rarely indicated in the initial evaluation Treatment Isometric exercises and activity modification
Patellar taping or bracing
Corticosteroid injections
Physical therapy
Up to 84% will have decreased pain after 8 wks of stretching and strengthening exercises Clinical Presentation Inflammation, swelling, and enlargement of the bursa
Prepatellar bursitis (Housemaid's knee)
Results from frequent kneeling or from acute trauma to the anterior knee
Usually only painful when kneeling directly on it
Can evolve into pyogenic prepatellar bursitis (synovial fluid provides an excellent medium for bacterial growth)
Pes anserins bursitis Physical Exam Prepatellar bursitis
Focal swelling on the anterior surface of the knee overlying the patella and the patellar tendon
Pain and erythema is unusual unless infected Studies Diagnosis is usually clinical
If acute trauma, x-rays may be indicated to rule out fractures
If suspected infection, aspiration and analysis of fluid is recommended Treatment Aseptic
RICE (rest, ice, compression, elevation
Avoidance of kneeling
NSAIDS
Aspiration and corticosteroid injection
If recurrent, surgical excision may be necessary
Physical therapy
Pyogenic
Surgical excision and drainage
Post-op antibiotics
Physical therapy Osteoarthritis Baker Cyst Meniscus Tear Clinical Presentation Musculoskeletal pain or dysfunction that is the result of any physical activity that exceeds the strength of musculoskeletal tissues resulting in microtrauma to these structures
Usually seen in active individuals after heavy physical activity with no history of trauma
Can cause tendinitis, capsulitis, periostitis, bursitis, or stress fractures
Pain is achy usually 1-2 days after physical activity particularly if the patient did not warm up or stretch
More common in the middle aged "weekend warrior" Physical Exam Pain is vague and poorly localized
Underlying structures will be tender and inflamed
Stress fractures can develop with focal point tenderness over the bone (most commonly the anterior medial tibia) Studies Radiographs often nondiagnostic
MRI or bone scan should be obtained if there is suspicion of stress fractures or avascular necrosis Treatment Temporarily discontinue excessive activity
RICE (rest, ice, compression, elevation) and NSAIDs to reduce swelling
Rule out any structural abnormalities
Physical therapy
Occasional use of steroid injection into inflamed soft tissue
Avoid ligaments and tendons (weaken and increase risk of rupture)
Avoid stress fractures (can inhibit healing)
Can be recurrent
Often resolves within 8 weeks
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