Sports Injuries

Knee
 One of the most commonly injur e d
joints

 Lack of bony and muscular su p p ort

 Positioned between the 2 longest

bones

Weight bearing and locomotion functions

Types of injuries

1. Acute knee injuries

 Acute knee injuries
1 . A n t e r i o r c r u c i a t e l i g a m e n t ( AC L)
injury 2 . P o s t e r i o r c r u c i a t e l i g a m e n t
( PC L) in j ur y 3 . Medial C o l l a t e r a l l
igament ( MCL) Injury 4 . L a te ral
c o l l a t e r a l l i g a m e n t ( LC L) injury 5 .
Meniscal injuries
6. Osteochondral problems
7. . Pa te l l a r dislocation/ instability
 Overuse knee injuries
1. I l i o t i b i a l ba nd
te ndonit is 2. Popliteus
tendinitis
3. P a t e l l o f e m o r a l pain
syndro me 4. Pa t e l l o f e m o r a l
synovial plica
5. I n f r a p a te l l a r fat pad
syndrome
6.P a t e l l a r
te ndoni t i s 7.
Bursitis
Important Structures
 Cruciate
ligaments
 Collateral
ligaments
 Menisci
 Articular
cartilage
 Patellar tendon
Cruciate
ligaments
 Control anterior
and posterior
movements
 Fit inside the
intercondylar
fossa
Collateral
ligaments
 Control lateral movement
 Exposed to valgus (MCL) and varus
(LCL) forces
Menisc
i Weight distribution

 Without menisci the
weight of the femur
would be concentrated
to one point on the tibia
 Converts the tibial
surface into
a shallow socket
Other Important Structures
 Articular cartilage
 1/4 inch thick
 tough and slick

 Patella and patellar

tendon
 Tibial tuberoscity
 Patellofemoral groove
 Patella acts like a
fulcrum to increase
the force of the
quadriceps muscles
Ligament
s
 Knee is like a round ball
on a flat surface
 Ligaments provide
most of the support to
the knees
 Little structure or
support from the
bones
Muscle
s
 Quadriceps - extension
 Hamstrings - flexion
 IT band from the
gluteus maximus and
tensor fascia latae
Acute Knee
Injuries
Anterior Cruciate Ligament Tears

 Can withstand
approximately
400 pounds of force
 Common injury
particularly in sports
(3% of all athletic
injuries)
 May hear a ‘pop’ sound
and
feel the knee give away
Types of ACL Tears
Causes of ACL
Injuries
 Cutting (rotation)
 Hyperextension
 Straight knee
landing
 When the knee is
extended, the ACL is
at it’s maximal
length putting it at
an increased risk of
tearing
External factors
 Amount of lower body
strength
 Footwear and surface
interaction
Unhappy Triad

1. ACL
2. Medial
collateral
ligament
3. Medial
meniscus
 Lachman Test and Anterior Drawer Test

 Normal knees
have 2-4 mm of
anterior
translation and a
solid end point
 ACL injury will
have increased
translation and a
soft end point
NCA
AFour times more ACL tears in women

than men basketball players.
 Three times more in gymnasts
 2.4 times more in soccer
 Higher rates are also found among
women in team handball, volleyball
and alpine skiing
Factors
 Smaller size of ACL
 Smaller intercondylar
notch
 Larger Q-angle (doubtful)
 normal = 17 degrees in
women
 Normal = 14 degress in
men
Factors
 Weaker hamstrings
 Ratio of 10 (quadriceps) to 7
(hamstrings)
 Hormones
 Estrogen – reduces collagen
strength
 Relaxin
ACL
Reconstruction

Shockwave
Graft Harvest
Drill
Attac
h
Rehab
Meniscal Tears
Meniscal Tears
 One of the most commonly injured parts of the knee.
 Symptoms include pain, catching and buckling
 Signs include tenderness and possible clicking
 Meniscal tears occur during twisting motions with the knee
flexed
 Also, they can occur in combination with other injuries such
as a torn ACL (anterior cruciate ligament).
 Older people can injure the meniscus without any trauma
as the cartilage weakens and wears thin over time, setting
the stage for a degenerative tear.
PCL
Injuries
PCL
Injuries
 The posterior cruciate ligament, or PCL, is not
injured as frequently as the ACL.
 PCL sprains usually occur because the
ligament was pulled or stretched too far,
anterior force to the knee, or a simple
misstep.
 PCL injuries disrupt knee joint stability
because the tibia can sag posteriorly.
 The ends of the femur and tibia rub directly
against each other, causing wear and tear to
the thin, smooth articular cartilage.
 This abrasion may lead to arthritis in the
knee.
Treating PCL Injuries
 Patients with PCL tears often do not have
symptoms of instability in their knees, so surgery
is not always needed.
 Many athletes return to activity without
significant impairment after completing a
prescribed rehabilitation program.
 However, if the PCL injury results in an avulsion
fracture, surgery is needed to reattach the
ligament.
 Knee function after this surgery is often quite
good
Collateral Ligament
Injuries
Collateral Ligament
Injuries
 Injuries to the medial collateral ligament are
usually caused by contact on the lateral side
of the knee
 Accompanied by sharp pain on the inside of
the knee.
 If the medial collateral ligament has a small
partial tear, conservative treatment usually
works.
 If the medial collateral ligament is completely
torn or torn in such a way that ligament fibers
cannot heal, surgery may needed.
 The lateral collateral ligament is rarely
injured.
Chronic
Injuries
1. Patellar Tendonitis
2. Patellofemoral Pain Syndrome
3. Subluxation of Patella
4. Chondromalacia
5. Osgood-Schlatters Disease
6. IT Band Syndrome
 Patellar Tendonitis
Jumpers knee
A condition that results from an inflammation
of the patellar tendon that connects the patella
(knee cap) to the tibia (shin bone).
The knee cap is a small floating bone
(sesamoid) which attaches the quadriceps to
the tibia through the patellar tendon.
It helps the quadriceps muscle extend the
lower leg so that you can kick a ball, jump in
air or push the pedals on your bike .
 Symptom
 Pain s
 Occasionall a swelling over the
y tendon. patellar
 Pain is usually sharp during the sporting
activities such as jumping or running and
persists as a dullache after the activity.
Initially the pain might be present only
during the start or after completing the sport
or work out which then worsens to becoming
more constant in nature .
 Everyday activities such as climbing up and
down stairs might be painful too . Pain on
pressing directly over the patellar tendon is a
characteristic feature in examination.
 X-ray
 MRI.
Patellar Tendonitis
 Due to high deceleration or eccentric forces of the quadriceps at
the knee during landing
 As you land the hamstrings cause your knee to flex to absorb
the
shock of impact
 In order to control or decelerate the flexion produced by the
hamstrings, the quadriceps muscles contract eccentricly
 Eccentric contractions occur as the muscle is being lengthened or
stretch
 Eccentric contractions produces high amounts of force, and
therefore stress to the patellar tendon
Patellar Tendonitis
 Prevention: strong quadriceps muscles

Squats Lunges
More Quadriceps
Exercises

Leg Extension

Leg Press
More Quadriceps
Exercises

Plyometric or Jump Training Uphill Running

2. Subluxation of the Patella
 Partial dislocation of the
patella
 Complete dislocation is rare
and is due to sudden (acute)
trauma
 Weak vastus medialis muscle
may contribute
3. Chondromalacia
 A softening & fissuring of the articular
cartilage of the patella
 Causes
 1. Aging
 2. Mechanical defects
Risk Factors: Subluxation and
Chondromalacia
1. Training errors
 Increasing intensity too soon
2. Weak vastus medialis muscle
3. Large Q angle
 Greater than 25 for women and
20 for men
4. Pronation of the foot causing
the tibia to medial rotate
5. Gender - more common in
women
6. Poor footwear and/or surface
 Osgood-Schlatter Disease
 Most commonly characterized by the big tibial
tubercle and pain on activities like kneeling or
repeated jumping.
 OSD arises from a strong pull of the quadriceps
muscle on the tibial tubercle during a child’s growth
spurt .
 Occurs at ages of 9 – 16 years old .
 Occurs in sports that require a quick, strong
contraction of the quadriceps, like in soccer, martial
arts, and basketball .
 Osgood- Schlatter Disease
 It has an avulsion-fracture like effect (when a small
bone fragment breaks away from the main bone
mass) that would cause an inflammation of the
periostium.
 The frequency and repetitive nature of the sport
doesn’t allow the periostium to recover and thus
causes a chronic inflammation on the prominence of
the tubercle.
 This leads to a constant, persistent pain, especially
on impact.
 Limits the performance in the sports.
Osgood- Schlatter Disease
 Management
 RICER regime (Rest, Ice, Compression, Elevation,
and Referral).
 Oral NSAIDs or injection of NSAIDs directly over
the
painful area.
 Ultrasound guided Extracorporeal Shock Wave
Therapy (ESWT) by a sports physician to break down
scarred tissues and allow for the tubercle to heal.
 Stretches and improving muscle control through
physiotherapy.
 Management
 Assessing for biomechanical factors
to prevent recurrence of pain

Prevention
The best way to prevent the onset of OSD is
to ensure adequate stretching and good
control of the quadriceps.
5. IT Band Syndrome -
Anatomy
 The ITB moves anteriorly
over the lateral condyle of
the femur as the knee
extends
 The ITB slides posteriorly
over the lateral condyle of
the femur as the knee
flexes
 Recurrent rubbing can
produce irritation and
subsequent inflammation,
especially beneath the
posterior fibers of the ITB,
which are thought to be
tighter against the lateral
femoral condyle than the
anterior fibers.
Causes of ITB Syndrome
 Duration (or mileage)
of exercise
 Hip
abductor
weakness
 Tight hip abductors
and/or IT band