I treat the following conditions Sports injuries Shoulder Knee Elbow Arthritis Hip Knee Shoulder Knee pain and treatment options Atiba Jackson Md Knee Injuries Overuse Injuries 1 ILIOTIBIAL BAND FRICTION SYNDROME ID: 690659
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Atiba D. Jackson, M.D
Fellowship trained in sports medicine
I treat the following conditionsSports injuriesShoulderKneeElbow ArthritisHipKneeShoulderSlide2
Knee pain and treatment options
Atiba Jackson M.dSlide3
Knee Injuries
Overuse Injuries1) ILIOTIBIAL BAND FRICTION SYNDROME2) POPLITEUS TENDINITIS3) PATELLOFEMORAL JOINT PAIN SYNDROME
4) PATELLOFEMORAL SYNOVIAL PLICA5) INFRAPATELLAR FAT PAD SYNDROME6) PATELLAR TENDINITIS(JUMPER’S KNEE)7) PES ANSERINUS BURSITISAcute injuries1) ANTERIOR CRUCIATE LIGAMENT RUPTURE (ACL)2) POSTERIOR CRUCIATE LIGAMENT RUPTURE (PCL)
3) MEDIAL COLLATERAL LIGAMENT TEAR (MCL)
4) LATERAL COLLATERAL LIGAMENT TEAR (LCL)
5) INJURIES TO THE MENISCI
6) OSTEOCHONDRAL PROBLEMS
7) PATELLOFEMORAL
INSTABILITY
8) ARTHRITISSlide4
IILIOTIBIAL BAND FRICTION SYNDROME (ITB)
KNEE FLEXED 30 DEGREES: ITB BEHIND LATERAL FEMORAL CONDYLE
KNEE EXTENDED: ITB MOVES ANTERIORLY- ITB SYNDROME: INFLAMMATION DISTALLY IN THE BURSA BETWEEN ITB AND LATERAL FEMORAL CONDYLE Slide5
ILIOTIBIAL BAND FRICTION SYNDROME (ITB)
Causes RAPID INCREASE IN TRAINING DISTANCES
BANKED SURFACES RUN: BEACH OR SHOULDER OF ROAD EXCESSIVE HILL RUNNINGDISCOMFORT OVER LOWER 3cm ITB, WORSE RUNNING DOWNHILLSlide6
Physical Exam
CREPITUS, PAIN ON COMPRESSION OVER LATERAL FEMORAL CONDYLE “ STRETCHED ITB “: LEG MALALIGNMENT, LEG LENGTH DISCREPANCY, EXCESSIVE FOOT PRONATION, PELVIC CONTRALATERAL DOWNWARD TILTSlide7
Treatment
Non-operativeREDUCTION OF TRAINING and NSAIDS
DAILY STRETCHING ITB, CORRECT ORTHOSIS FOOT PRONATION, STRENGTHEN IPSILATERAL HIP ABDUCTORS LOCAL INFILTRATION OF CORTICOSTEROIDSurgical
SURGERY TO DIVIDE ITB 3cm ABOVE LATERAL FEMORAL EPICONDYLE Slide8
POPLITEUS TENDINITIS
Posterior lateral aspect of the knee Causes
RAPID INCREASE IN TRAINING DISTANCES BANKED SURFACES RUN EXCESSIVE HILL RUNNINGSlide9
POPLITEUS TENDINITIS
Symptoms Discomfort anterior of superior LCL
Pain with resisted knee flexion TREATMENT Non-operativeREDUCTION TRAINING DISTANCE, NSAIDS, STRETCHING KNEE FLEXORS, ELECTROTHERAPY.InjectionsCORTICOSTEROID INJECTIONPRP injectionSlide10
Patellofemoral pain(Anterior Knee pain)
Most common in females Common in athletes
Pain under the “KNEE CAP” with climbing or descending hills or stairs. Sitting down for long periods of time. Slide11
Anterior knee pain
Symptoms/factorsCrepitus
Inflammation of PFJ Slight swellingQuadriceps weakness and wasting of the Vastus medialisSlide12
Anterior knee pain
BIOMECHANICAL FACTORS: Tight retinacular
structuresIncrease in pressure on subchondral boneChronic pressure can lead to degenerative changes in cartilage.Vastus medialis obliquus
Lateral tracking of the patella
Increased
Q
angle >18
deg
Patella Alta,
Genu Valgus (knocked knee)
Shallow Trochlear
Pronated feet (Flat foot)Slide13
Anterior knee pain
Non-operative treatmentVastus
Medialis strengthening Taping Drop- Squats Eccentric drills 6-8 weeks TreatmentPTInjectionsPRPHyaluronic acid
SteroidSlide14
Anterior knee pain
Surgical TreatmentDebridement and lateral release Patellar Tendon Realignment (
Correct Q angle )Slide15
Plica
Remnants of the Embryonic septa from the supra-patellar pouch to the fat padUsually asymptomaticSymptoms
Snapping on the medial femoral condyle Impingement of the medial femoral condyle in flexionSlide16
Plica
Symptoms Patella Pain with
Palpable band medially Mild effusionPain on resisted knee extension TreatmentNon-operativeREST, NSAIDS, CORTICOSTEROID
INJECTION
Surgical
ARTHRO. EXCISIONSlide17
ANTERIOR Fat pad Inflammation
SymptomsRepetitive hyperextension injuries,
Post surgical scaring Patella Baja blocking knee flexionPain on hyperextension of kneeSlide18
Anterior Fat pad inflammation
TREATMENT:Non-operativeAvoid hyperextension
NSAIDS, PTSurgical SIGNIFICANT FIBROSIS: ARTHROSCOPIC EXCISIONSlide19
Jumpers knee
REPETITIVE EXTENSOR ACTION OF THE KNEE WITH A GENERATION OF LARGE ECCENTRIC FORCES- BIOMECHANICAL ANALYSIS IN BASKETBALL: JUMPING AND LOADING FORCES APPLY THE GREATEST TENSILE FORCES IN THE PATELLAR TENDON WHEN IN LANDINGSlide20
Jumpers knee
Pain in the lower pole of the patella Pain with repetitive jumping and increased training load Tenderness and swelling of the tendon TENDERNESS
, SWELLING, CREPITUSU/S OR MRI: Increased signal vs defect in tendonSlide21
Jumpers knee
Teno-periostitis of lower pole of the patella Granulation of the tendon deep in the sheath
Increased signal on MRISlide22
Jumpers Knee
TREATMENT: Acute exacerbation
Rest, ICE, NSAIDS, ChronicEccentric exercises Drop-squatTreatment Taping/strapping Patellar and quadriceps tendonPRP injectonSlide23
Jumpers knee
Surgery:
Excision of degenerative tendon and scar tissue from inferior pole of the patella6 months recoverySlide24
PES ANSERINUS BURSITIS
Inflamed bursa at the proximal medial
Pain and burning with runningTight hamstrings with hamstring InflammationTreatment RestStretching hamstrings NSAIDSInjectionsSlide25
ACL RUPTURE
Over 100,000 ACL ruptures per yearNon contact Most common
Contact multiple ligament s injuredRapid deceleration and change in directionGiving away after a change in direction, pivot or jump causing audible crack and hemarthrosisSlide26
Acl Injury
-
Approximately 75% of ruptures are sustained with minimal or no contact at the time of injury. A cut-and-plant movement is the typical mechanism that causes the ACL to tear, that being a sudden change in direction or speed with the foot firmly planted
.Slide27
ACL RUPTURE
Functions – Mechanism of injury
Resists anterior translation of the tibia on the femur. Valgus force and retraction ACL, MCL and Lateral meniscus injury Varus force LCL and ACL injury Hyperextension force ( ACL and PCL injury )Slide28
ACL RUPTURE
Exam
PainEffusionLachmanPivot Shift test- Acute hemoarthosis 60-80% ACL RUPTURE
-
X-rays:
Tibial
spine avulsion,
Segond
fractureSlide29
ACL RUPTURE
Conservative treatmentOlder patient populationHamstring strengthening
Proprioception trainingBracingSlide30
ACL RUPTURE
Surgical Treatment- Arthroscopic/Open surgeryRepair
ReconstructionAuto-graftBTB, Hamstring, Quad tendonAllograftMany graft choicesSlide31
PCL RUPTURE
PCl
Extra-synovial 2x stronger than the ACLResists posterior translation of the Tibia on the femurResist hyperextension andMechanismDirect blow over the upper tibia with the knee in flexion or,Hyperextension of the kneeSlide32
PCL RUPTURE
Symptoms
PFJ pain “Giving way” running downhill Posterior sagKnee recurvatum X-rays avulsion from the tibiaSlide33
PCl Rupture
Treatment
Non-operativeLargely conservative when isolated rupturePT Strengthen quadriceps muscle Slide34
PCL Rupture
SurgeryUsually after failure of conservative managementPCL reconstruction with allograft.Slide35
3) MCL INJURY
Direct valgus forceGrade I, II, III
Laxity with 30 Deg of flexion TreatmentGrade I 6 weeks hinged knee braceGrade II
Hinged knee brace 6wk to 3 months
Grade III
Bracing vs surgerySlide36
Mcl INJURY
TreatmentNon-surgicalBracing Surgical
MCL repair vs reconstructionSlide37
LCL INJURY
Rare direct varus force
Part of posterior lateral corner injuries- Combined with ACL, PCL tears Dial test for PLC injurySlide38
LCL injury
TreatmentConservativeBracingSurgery
Reconstruction as part of the PLCSlide39
MENISCI INJURIES
MeniscusShock absorbing structures
Increase congruency of the knee joint Increase stabilityAssist in cartilage nutritionSlide40
MENISCI INJURIES
Medial meniscal tears are more commonLateral meniscal tears are associated with ACL tears
Mechanism knee forced in flexion and rotation whileSlide41
MENISCI INJURIES
Pain on the joint line, lockingPositive McMurray’s test
Meniscal cystOrder MRI to confirm tearSlide42
MENISCUS
Treatment
ConservativePhysical therapy pain controlSurgicalArthroscopic partial meniscectomyArthroscopic meniscal repairInside out open meniscus repairSlide43
OSTEOCHONDRAL PROBLEMS
Osteochondral fracture( mimic meniscal tears) O
steochondritis dissecansSlide44
OSTEOCHONDRAL PROBLEMS
TreatmentNon-operativeStable osteochondral
fragments with open growth platesOperativeExcision of osteochondral fragmentFixation of osteochondral fragmentSlide45
PATELLOFEMORAL INSTABILITY
DislocationPatellofemoral joint pain
Recurrent dislocationsLoose bodies MechanismTwisting of the kneeSlide46
PATELLOFEMORAL INSTABILITY
X-rays and MRIs to exclude osteochondral fractures and loose bodies
Biomechanical factorsShallow trochlear groovePatella altaValgus kneesTorn medial patellofemoral ligament Slide47
PATELLOFEMORAL INSTABILITY
Treatment
First-time dislocations 6 weeks in knee immobilizerPhysical therapy to strengthen the quads vastus medialisRepeat dislocationsSurgicalFix anatomic malalignment
Reconstructive torn ligamentSlide48
arthritis
MildInjections and therapyModeratePossible arthroscopic
chondroplasty and debridementPossible PRP injectionSevereTotal joint arthroplastySlide49
Questions?