Knee Injury

Last updated 20.05.13

 

Definition

-  Injury to knee joint

 

Features

-  Common presentation

-  12% of sports injuries in Australia

-  Assessment difficult in acute setting

-  Repeat 3 days post event

-  12% of sports injuries in Australia

 

Cause

-   

 

Associated S/S

-  Hx to determine injury type

-  Weight bearing

-  At time of injury

-  Post injury

-  Varus, vulgus or rotational forces

-  Impact: where, how

-  Sound: pop: ACL

-  Feeling: shift: ACL, patella dislocation

-  Collapse or inability to weight bear: fracture or high grade ligament injury

-  Knee swelling

-  In 1st hr: haemarthrosis

-  Progressive: ligamentous injury

-  Clicking: meniscal tear, chondral pathology

-  Locking: meniscal tear (loose body)

-  Instability

-  Secondary to pain

-  With rotation: ACL

-  Descending: PCL, patellofemoral pathology

DDx

-   

 

Ix

-  Knee examination

-  Ottowa Rules for Imaging to exclude fracture

-  85-100% sensitivity

-  Knee x-ray if any of

-   Aged 55yrs+

-   Tenderness at head of fibula

-   Isolated tenderness of patella

-   Inability to flex knee to 90o

-   Inability to weight bear (four steps) immediately & at presentation

-  Knee x-ray

-  Views

-  Weight bearing AP

-  Lateral

-  Intercondylar

-  Patellofemoral

-  Fractures

-  Femoral condyle

-  Tibial plateau

-  Avulsion

 

Mx

-  1st 48hrs

-  REST

-  Rest

-  Ice: 15min every 2hrs

-  Compression: stocking from ankle to upper thigh

-  Elevation: of lower limb

-  Spliting

-  Limited to initial post injury period

-  Prolonged immobilisation not helpful

-  Analgesia

-  Physiotherapy

-  Early referral

-  Maintain ROM

-  Prevent quadriceps wasting

-  Referral

-  Urgent

-  Haemarthrosis

-  Neurovascular compromise

-  Prompt

-  Locking

-  Intra-articular loose bodies

-  Meniscal tears

-  Instability

-  Worsening antalgic gait

-  Surgery

-  Indicated for most ACLs, lateral collateral ligament & meniscal tears

-  Not usually required for PCLs, medial collateral ligament & small meniscal tears

 

 

 

References

 

Sports Knee Injuries: Assessment & Mangement, AFP Vol 39, No 1/1 2010