The Athlete’s Knee

The Athlete’s Knee
Presentation by:
John R. (Trey) Green, III, MD
University of Washington
Sports Medicine Clinic
206-543-1552

Anterior Knee Anatomy
* Superficial fascia
* Quadriceps muscle group
* Patella
* Synovium / plicae
* Bursae

Anterior Knee Anatomy
* Quadriceps muscle group
o Rectus femoris
o Vastus medialis
o Vastus lateralis
o Vastus intermedius

Quadriceps Muscle Group
* Vastus medialis
o Larger, and more distal insertion than vastus lateralis
o Oblique distal fibers (VMO)

Patella Articular Surface

* Thickest articular cartilage in the body (5mm)
* 25% non articular (inferior pole)

Anterior Knee Anatomy

* Bursae
o Occur to assist tissue gliding
o Variable location

Patellofemoral Biomechanics

* Patella function
o Act as a fulcrum to increase the lever arm of the quadriceps muscle

Resultant Force on the Patella

* Compression
* 2-3 x body weight
* Maximum force at 70-80 degrees of flexion

Q Angle

* Angle between the quadriceps tendon and patella tendon in full extension

Anterior Knee Pain History
* Pain
* Instability
* Catching
* Crepitation
* Weakness
* Swelling

Physical Examination

* Gait

Physical Examination

* Limb length

Physical Examination
* Compartment assessment (crepitation)
* Observation
Effusion
Prepatellar Bursal Fluid
* Range of Motion (ROM)
* Anterior knee
* Patellar position
* Patellar tracking
* Muscle tone/bulk
* Thigh circumference
* Sitting
* Lying
* Hip abductor strength
* Prone quadriceps tightness

Radiologic Examination
Rosenberg View
Merchant View
Measuring Merchant’sView
Anterior Knee Pain Treatment
* Rehab with therapist
Anterior Knee Pain Treatment
* Refer to Orthopaedist

Assessment of Meniscus, Ligament and Articular Cartilage Injuries
* Most require orthopaedic consultation
History
Pain Location
Meniscus Tears
* Meniscus tears are common
* Rapid flexion with rotation is most common mechanism
* A history of mechanical symptoms and joint line pain and tenderness suggests meniscal tear
Meniscus Tear Types
Meniscus Tears
* Arthroscopy is the gold standard for diagnosis and treatment
* Basic principles of meniscus surgery are:
o Conserve meniscal tissue
o Remove abnormal tissue
o Prevent further tear propagation
o Repair when possible
Articular Cartilage Injury
* Limited intrinsic repair capability
* Likely to eventually progress to arthrosis
* History of pain with recurrent effusions may indicate cartilage lesion
Articular CartilageTreatment Options
Medial Collateral Ligament
Beware Co-existing ACL or PCL Injury
Lateral Sided Ligament Injury
ACL Tear
PCL Tears
Knee Physical Exam
Physical Examination
Collateral Ligament Testing

The Athlete’s Knee.ppt