KNEE INJURIES

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KNEE INJURIES

• Team Physicians Course
• March, 2007

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Objectives

• Initial assessment of Acute Knee injuries
• Some of the Occult Knee Injuries
• When to Refer patients to specialists
• Return to Sport
• Understand the Red Flags

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Questions I did ask

• Did you hurt your knee?
• Does your knee swell
• Does your knee lock
• Does your knee give way
• Do you have pain in the knee

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Other Questions I should Have asked!!

• Previous Injuries
• Other Injuries
• Specific Functional Disability
• International level athlete or couch potato
• What has been the Response to treatment

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Red Flags History

• Sick /- temp
• Examine the patient
• Atraumatic Pain
• always a worry
• tumour
• synovitis (PVNS, RA, other stuff)
• ?? Non path pain
• Marked Pain
• most knee injuries are not very painful at rest
• Neuro / vascular symptoms

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What I forgot to examine

• Functional Assessment
• Specific point of tenderness
• Feeling at End range of Motion
• Patellar Stability
• Neurovascular status
• Other Joints especially Hips

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Red Flags Physical

• Unable to weight bear
• Marked ROM restriction
• Gross Ligament defects
• Cellulitis appearance
• Neurovascular signs

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Next Investigation

• Do You need One?
• If you do
• Plain Film
• MRI
• Ultrasound

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My indications for X-ray in the Acute Knee Injury
are HOT

• H emarthrosis
• O r unable to weight bear or
• T ender bones

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Is it going to change your management!!!

• Other Reasons

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Aspiration

• Acute Knee
• For suspicion of sepsis
• Chronic Knee
• Crystal diagnosis

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Referral

• Emergent
• sick , febrile patient
• neurovascular problem
• Urgent
• Fracture
• Elective
• All the other diagnosis

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Surgical Indications

• Most are for Pain or Function reasons
• But must be
• Patient Orientated reasons
• Not on the MRI
• or the parent / coach

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Knee Injury Return to Sport TIPS

• T -- timing
• I -- Injections and aspirations
• P Physio and rehabilitation
• S Supports and Braces

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Summary

• Listen to the patient tell you the diagnosis
• Examine carefully
• Investigate to change management
• Treat dynamically