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knee injury, traumatic

Etiology: 1) common causes - medial collateral ligament (MCL) sprain/tear 2) less common causes a) anterior cruciate ligament (ACL) sprain/tear b) medial meniscus tear (may be more common in elderly) c) subluxed or dislocated patella d) contusions e) traumatic bursitis 3) uncommon causes a) lateral collateral ligament sprain or fracture b) traumatic patellofemoral pain syndrome (PFPS) c) posterior cruciate ligament (PCL) sprain d) muscle strain 1] quadriceps 2] hamstrings 3] gastrocnemius 4] soleus 4) rare cause - muscle rupture 1] plantaris 2] quadriceps 3] hamstrings Clinical manifestations: 1) varus or valgus contact a) ligament sprains b) patellar subluxation c) meniscal tear d) fracture 2) direct blow a) patellofemoral joint injuries b) posterior cruciate ligament (PCL) sprain c) fracture d) direct blow to the lateral knee - medial collateral ligament tear [4] 3) hyperextension injury a) anterior cruciate ligament (ACL) sprain b) posterior cruciate ligament (PCL) sprain c) posterior capsule injury 4) deceleration injury - anterior cruciate ligament (ACL) sprain 5) rotational injury a) meniscal injury b) ligament injuries c) osteochondral fracture d) patellar dislocation or subluxation 6) dashboard injury a) fracture b) ligament or capsular injuries 7) pop or snap a) rupture of ligament, tendon or muscle b) fracture 8) swelling a) how quickly swelling occurred after injury indicative of severity b) bloody effusion immediately after injury most likely anterior cruciate ligament (ACL) rupture * also see physical examination of the knee Radiology: 1) radiograph -> see Ottawa knee rule 2) magnetic resonance imaging (MRI) a) excellent for meniscal & articular cartilage b) poorly demonstrates ligamentous injury Management: 1) orthopedic surgery consult in nearly all cases of trauma 2) physical therapy a) minimize loss of muscle strength & range of motion b) gradual remobilization c) dynamic stabiliation d) avoid long periods of inactivity 3) arthroscopic surgery or physical therapy with the option of surgery have similar outcomes in patients with a meniscal tear & osteoarthritis [3] 4) prevention - warm up exercise may be of benefit [2]

Related

knee pain Ottawa knee rule physical examination of the knee

Specific

anterior cruciate ligament [ACL] tear lateral (fibrillar) collateral ligament sprain/tear medial collateral ligament (MCL) sprain/tear meniscal injury patella alta posterior cruciate ligament sprain/tear

General

traumatic leg injury joint injury; traumatic arthropathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Walden M et al. Prevention of acute knee injuries in adolescent female football players: Cluster randomised controlled trial. BMJ 2012 May 3; 344:e3042 PMID: 22556050
  3. Katz JN et al Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. March 19, 2013 PMID: 23506518 http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 - Buchbinder R Meniscectomy in Patients with Knee Osteoarthritis and a Meniscal Tear? N Engl J Med. March 19, 2013 PMID: 23506467 http://www.nejm.org/doi/full/10.1056/NEJMe1302696
  4. Carek SM. Hip and Knee Injuries. Prim Care. 2020 Mar;47(1):115-131. PMID: 32014129 Review.