Athletic Injuries (knee)

Popliteal Cyst

MOI: A Baker's cyst is a pocket of fluid that forms a lump behind the knee. A Baker's cyst is caused when excess joint fluid is pushed into one of the small sacs of tissue behind the knee. When this sac fills with fluid and bulges out, it is called a cyst. The excess fluid is usually caused by conditions such as rheumatoid arthritis or osteoarthritis that irritate the knee. It may also be caused by an injury. Signs and Symptoms: Often a Baker's cyst causes no pain. When symptoms occur, they may include: Tightness or stiffness behind the knee, swelling behind the knee that may get worse when you stand, slight pain behind the knee and into the upper calf. You are most likely to feel this when you bend your knee or straighten it all the way, sometimes the pocket of fluid behind the knee can tear open and drain into the tissues of the lower leg. This can cause swelling and redness in that part of the leg.

Osteochondral knee fracture

MOI: This injury has breaking of the articular cartilage and underlying bone on the weight bearing surface of the femur, tibia, or under the patella creates fragments of bone and/or cartilage that vary in size and in depth. This injury typically results from either rotation or direct trauma that compress the articular cartilage between the medial or lateral femoral condyles and the tibial plateau. Usually, this injury is localized to a single area, but occasionally more than one occurs at the time of injury. This injury can lead to osteoarthritis. Signs and Symptoms: The patient commonly complains of diffuse pain along the joint line. Symptoms included immediate joint effusion and crepitus and pain with weight bearing when standing or walking.

MCL sprain

MOI: This ligament is injured in valgus force on the knee or lateral tibial rotation. This ligament is damaged more often due to the blows on the outside of the knee forcing valgus. Signs and Symptoms: The patient will have pain, swelling, knee instability, weakness, loss of motion, and tightness over the medial border of the knee.

PCL sprain

MOI: This ligament is most at risk when the knee is flexed to 90 degrees. A fall with full weight on the anterior aspect of the bent knee with the foot in plantar flexion or receipt of a hard blow to the front of the bent knee can tear the ligament. In addition, it can be injured by a rotational force, which also affects the medial or lateral aspect of the knee. Signs and Symptoms: The patient will report feeling a pop in the back of the knee. Tenderness and relatively little swelling will be evident in the popliteal fossa. Laxity will be demonstarted in a posterior sag test. The posterior drawer test is fairly reliable; however; an abduction stress test that is positive at both 30 degrees and in full extension is considered to be a definitive test for a torn this ligament.

Infrapatella Bursitis

MOI: A bursa is a small sac of fluid who's function is to lubricate the movement between tendons and bone. This ligament bursitis or clergyman's knee as it may sometimes be known as is inflammation of the infrapatellar bursa. The deep bursa lies between the patellar ligament and the upper front surface of the tibia or shin bone. The superficial bursa is situated between the patellar ligament or patellar tendon and the skin. This condition can be caused by friction between the skin and the bursa and may sometimes happen in conjunction with Jumper's knee. Signs and Symptoms: This condition consists of pain at the front of the knee with swelling over the area of the bursa. Pain may be similar to that of jumper's knee or patellar tendonitis with pain just below the kneecap.

Meniscal Tear

MOI: A compression force with a twisting motion is what often leads to tears of this area. With this area being avascular (no blood supply) the area will not heal. Surgery is required to fix the tear. Shaving and reshaping is the goal. Signs and Symptoms: joint line pain, loss of motion, intermittent locking and giving away of the knee; and pain when the patient squats.

Patella Tendon Rupture

MOI: A sudden powerful contraction of the quads muscle with the weight of the body applied to the affected leg can cause a rupture. The rupture may occur to the quad tendon or to the patellar tendon. Usually rupture does not occur unless there has been inflammatory condition over a period of time in the region of the knee extensor mechanism, causing tissue degeneration. A rupture seldom occurs in the middle of the tendon; usually it is torn from its attachment point. The quads rupture from the superior part of the patella, whereas the patellar tendon ruptures from the inferior pole of the patella. Signs and Symptoms: The patella moves upward toward the thigh and the defect can be palpated. The patient can't extend the knee. There is considerable swelling with significant pain initially, followed by a feeling that the injury may not be all that serious.

Peroneal Nerve Contusion

MOI: Compression of this nerve as it crosses directly behind the underlying neck of the fibula most commonly occurs from a kick or direct blow. Signs and Symptoms: Immediately following the impact the patient experiences local pain from the contusion and pain (linked to an electric shock) radiating down the anterior leg into the dorsum of the foot. Numbness and paresthesia in the cutaneous distribution of the nerve may also be present. Locally, there may be skin abrasions or ecchymosis with tenderness of the underlying nerve. Local pressure may exacerbate the tingling. Usually numbness, paresthesia, and tingling last only a few seconds or minutes, but if the injury is severe, the hypesthesia and weakness of the peroneals and dorsiflexors persist, and it is possible that the patient could develop a drop foot. However, most of the time the contusion of the nerve is minor, and usually the athlete recovers within one or two days following injury.

Knee fracture

MOI: Fractures of the knee cap can be caused by direct or indirect trauma. Most are caused by indirect trauma with a severe pull of the patellar tendon. Direct trauma creates displacement of the knee cap and fragmentation. In a tibial break just below the joint line and may be seen with ligament damage also. The fibula breaks often result in puncture of the skin. Sings and Symptoms: Knee cap breaks can cause hemorrhage and joint effusion, resulting in generalized swelling. Indirect fracture causes capsular tearing, separation of bone fragments, and possible tearing of the quads. Direct break involves little bone separation. Lower leg breaks can result in numbness, inability to weight bear, sometimes deformity, bleeding, bruising, and tenderness in the leg.

I.T. band friction syndrome

MOI: It is a common cause of lateral knee pain, particularly among runners, military personnel, and cyclists. It is considered an overuse syndrome that usually is treated successfully with a conservative approach. Biomechanical and training factors play a large role in the development of ITBFS, but its exact etiology is somewhat elusive. Leg length discrepancy can cause it along with overponation. Signs and Symptoms: While pain is localized along the lateral knee, it also can include the hip, as in the image below. Pain is worse with downhill running and becomes worse with activity after a pain-free start. Pain may radiate from knee proximally or distally. Most individuals experience pain only during activities; however, individuals may experience pain with walking as the syndrome progresses.

Patella Tendinitis

MOI: Jumping, as well as kicking or running, may place extreme tension on the knee extensor muscle complex. As a result of one or more commonly repetitive injuries, it occurs in the patellar or quads tendon. On rare occasions, a patellar tendon may completely fail and rupture. Sudden or repetitive forceful extension of the knee may begin and inflammatory process that will eventually lead to tendon degeneration. Signs and Symptoms: The patient will report pain and tenderness at the inferior pole of the patella on the posterior aspect. The patient can go through pain after activity, pain during and after activity, and pain during and after activity prolonged. Which may progress to on going pain with complete rupture.

LCL sprain

MOI: The force required to tear this ligament is varus, often with the tibia internally rotated. If the force is severe enough, both cruciate ligaments, the attachment of the I. T. band, and the biceps muscle may be torn. This same mechanism could also disrupt the lateral and even the medial meniscus. If the force is great enough, bony fragments can be avulsed from the femur or tibia. An avulsion can also occur through the combined pull of this ligament and biceps muscle on the head of the fibula. Sings and Symptoms: Pain and tenderness over the lateral border of the knee, with the knee flexed and internally rotated, the defect may be palpated. Swelling and effusion over the ligament, and pain greatly increased or lowered depending on the severity of the sprain.

Fat pad contusion

MOI: There are two of these areas in the body, one is a infrapatellar and the other is a suprapatellar. The infrapatellar lies between the synovial membrane on the anterior aspect of the joint and the patellar tendon, and the suprapatellar one lies between the anterior surface of the femur and the suprapataller bursa. Of the two areas, the infrapatellar is the more often injured, principally as a result of its large size and particular vulnerability during activity. May become wedged between the tibia and the patella, irritated by chronic kneeling pressures, or traumatized by direct blows. Signs and Symptoms: Repeated injury to this area produces capillary hemorrhaging and swelling of the fatty tissue; if the irritation continues, scarring and calcification may develop. The patient may complain of pain below the patellar ligament, especially during knee extension, and the knee may display weakness, mild swelling, and stiffness during movement.

Popliteus tendinitis

MOI: This condition is a gap in the tendon of the popliteus. Popliteus is quite an uncommon pathology which often occurs in athletes and people with a history of other knee ligament injuries after trauma. It is a relatively unusual condition in non-athletes without a history of knee traumas. Common causes of posterolateral knee joint injury, are either a direct varus force, while the tibia is externally rotated, or a sudden forced knee hyperextension with the tibia internally rotated. Signs and Symptoms: inflammation, pain, swelling, or even tenderness outside of the knee. If the patient continues to load its knee, symptoms will worsen and scar tissue can form, which makes physical activity to be extra painful.

Suprapatella Bursitis

MOI: This condition, which extends superiorly from beneath the patella (kneecap), occurs when the suprapatellar bursa becomes swollen and inflamed. Signs and Symptoms: Pain will often be felt above the kneecap and can even radiate into the thigh.

ACL sprain

MOI: This ligament sprain is generally considered to be the most serious ligament injury to the knee. This ligament is vulnerable to injury when the tibia is externally rotated and the knee is in a valgus position. This ligament can sustain injury from a direct blow to the knee or from a noncontact single-plane force. The single-plane injury occurs when the lower leg is rotated while the foot is fixed. Most common way of injury is a deceleration with a plant and cut motion. Signs and Symptoms: If this ligament is torn, the patient will experience a pop followed by immediate disability and will complain that the knee feels like it is shifting. This ligaments tears produce rapid swelling at the joint line. The patient with an isolated tear, will exhibit a positive anterior drawer test and a positive Lachman's sign.