Knee Injuries. PSK 4U Mr. S. Kelly North Grenville DHS. Medial Collateral Ligament Sprain

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1 Knee Injuries PSK 4U Mr. S. Kelly North Grenville DHS Medial Collateral Ligament Sprain Result from either a direct blow from the lateral side in a medial direction or a severe outward twist Greater injury from medial sprains because MCL is more directly related to joint capsule and medial meniscus Most meniscus injuries result not from original injury, but after collateral ligaments have been stretched by injury 1

2 Grade 1 MCL Sprain Few ligament fibers torn/stretched Joint is stable during stress tests Some joint stiffness and point tenderness below medial joint line Close to full active and passive ROM Management RICE/PIER 24hrs Crutches if athlete cannot walk without limp Ice pack before exercise, ultrasound Knee joint rehab MCL Sprains 2

3 Grade 2 MCL Sprain Microscopic and gross ligament disruption Slight laxity during full extension Slight or absent swelling unless other structures involved (ACL, etc) Moderate to severe tightness Athlete cannot put heel on ground Loss of passive ROM Pain, weakness, instability Management RICE 48-72hrs Crutches (3-pt gait) Full leg cast or immobilizing brace 2-5d Isometric exercise Closed chain exercise (stationary bike) Tape or therapy when returning to play Grade 3 MCL Sprain Complete tear of supporting ligaments Complete loss of medial stability Immediate severe pain followed by dull ache Loss of motion Test for ACL and PCL tears (when trauma occurs without load) Management RICE 20 min every 2 hrs during walking day Controversy of conservative nonoperative care vs. surgery (recovery and future stability is the issue) 3

4 Valgus Stress Test Knee at 0 degrees or 30 degrees flexion Abducting force is applied, if knee opens up (medial side), there is likely damage to MCL At 30 degrees, MCL is primary stabilizer, test mainly for MCL injury At 0 degrees, the entire joint capsule, ACL and MCL are all tested for stability / laxity) Varus Stress Test Similar procedure to Valgus test, used to assess gap in lateral joint space. More gap = more severe injury Similar degree of abduction, hands at opposite positions proximally and distally For both tests: it is important to compare injured joint to non-injured joint. Testing for LCL, FCL, PCL stability / laxity 4

5 Support: what can be done? Brace Wrap KT Athletic Tape **Assessment should ALWAYS precede attempts to support the joint. Return to play protocols: does the athlete risk injuring other structures? Anterior Cruciate Ligament Sprain / Tear Most serious ligament injury in the knee Can result from a single-plane force (lower leg rotated with foot fixed) Ex: athlete running at speed, cutting or changing direction, skier catching ski in the snow, body twists medially or laterally 5

6 Knee Tissue Anatomy ACL Sprains Pop followed by immediate disability Knee feels like it is coming apart Test for stability 6

7 ACL Sprain ACL Injury Grades 7

8 Anterior (and Posterior) Drawer Test Athlete lies on back, injured leg flexed Trainer s hands on upper portion of lower leg, below knee Fingers in popliteal space, index fingers on hamstrings (relaxed), thumbs on medial and lateral joint lines Positive if tibia slides forward on femur Lachman Drawer Test 30 degrees flexion One hand grasps distal end of thigh (femur) Other hand attempts to move lower leg in anterior direction (firm pressure, but DO NOT jerk or pull without communicating with athlete ) Positive test indicates ACL damage 8

9 ACL Management Swelling in 1-2hrs (RICE) Clinical evaluation and/or arthroscopic examination Controversy over when to operate Unsatisfactory treatment usually leads to major joint degeneration ACL Injury Summarized 9

10 ACL Reconstruction Ligament replaced with tendon from semitendinosus, TFL, patellar tendon 3-5 weeks in brace 4-6 months rehab Controversy over use of braces during return to activity Brace vs. No Brace post-op Mayr, Stueken et al (2014) found the following: 64 patients examined 4 years post-op (ACL reconstruction); split evenly into brace and no brace groups No significant laxity difference between groups AND pain test results were significantly better under sports activity or heavy physical work in braceless group 10

11 Knee Pain Chart 11