Knee Pain in the Work Comp Patient William F Bennett MD Sarasota, Fl.

Knee Pain in the Work Comp Patient

William F Bennett MD

Sarasota, Fl.

Anatomy

Bones-FemurTibiaFibulaPatella

Tendons

Rectus femoris

Vastus Medialis obliquus

Vastus lateralisObliquusPatellar Ligament-Sesamoid

Bursae

Prepatellar Bursae

Pes Anserinus Bursae

Ligaments

Anterior Cruciate Ligament

Posterior Cruciate Ligament

Medial Collateral Ligament

Lateral Collateral ligament

Cartilage

Articular Cartilage-type 1 collagen

Meniscus-type 2 collagen

Healing articular cartilage-type 2 collagen

Synovium/Capsule

Synvoium-synovial fluidHyaluronic acid complex

Baker’s Cyst-

capsule

Knee

Biomechanics

Knee is basically a hinge joint

More complex as its rotates as well

During extension-tibia rotates externally to lock knee in what is known as a screw home mechanism

Patellofemoral Biomechanics

Patella glides in a groove in the distal femur

Full extension-patella lays on the suprapatellar fat pad

During flexion-first20-30 degrees patella jogs laterally then seats itself centrally in the groove

Deep flexion places more pressure on the cartilage

Patellofemoral Biomechanics

With deeper flexion-patellar tendon comes into contact

Contact area with flexion moves from distal to proximal and from medial to lateral

Patella has a medial facet, lateral facet and median ridge

Pain-”itis”

“itis” means inflammationTendonitis-inflammation of tendonBursitis-inflammation of bursaeSynovitis-inflammation of bursaeArthritis-inflammation of a jointOops-chondromalcia- inflammation, deteriorization of the cartilage, means ‘sick cartilage”

Other sources of pain

Trauma-

Torn Ligaments

Fractures-bones

Effussion-fullness achiness in the knee

Common Problems

Falls- ladder,stairs ect.

-Fractures-

-femur

-tibia

-tibial plateau

-tibial eminence

-patellar

Fractures

Patella

Fractures

Plateau

Ligament Disruptions

Medial Collateral Ligament Injuries

Lateral collateral Ligament Injuries

Anterior Cruciate Ligament Injuries

Posterior Cruciate liagment Injuries

Posterolateral Complex Injuries

ACL Disruptions

Arthroscopic ACL Reconstruction

ACL FINAL

Patellofemoral Problems

Kneeling/Squatting/ladders/Stairs

Prepatellar Bursitis-kneelingPatellofemoral Pain-kneeling, stairs, ectPatellofemoral ChondromalaciaPatellar Subluxation/Dislocation

Patellofemoral Chondromalcia

Patello-femoralSubluxation/Dislocation

PF Joint Sex Differences

Female Male

Cartilage Problems

Meniscal tears- shock absorber, twistingAssociated with ACL tears

Articular Cartilage- Flaps, divots, wearchondromalcia

Meniscal Tears

Articular Cartilage Tearsgeneralized/localized

Cortisone InjectionsAnti-inflammatory medicineLubricating medicineBraceArthroscopic DebridementA.C.I.O.A.T.S.

Ancillary testing

Xrays

MRI-Gadolinium- absorbed into articualr

cartilage defect after 3-5 hours

Treatment

Fractures-Casts IM rods- tibia/femurORIF- patella fractures/tibial plateau

fractures/eminence fractures

Treatment

Ligament DisruptionsMCL- brace PWB 6-8 weeksLCL- Brace or repairACL-ReconstructionPCL-+/- reconstructionPosterolateral complex-+/- reconstruction

Treatment

Patellofemoral injuries Prepatellar Bursitis- Neoprene

sleeve/rest/advil/injection Patellofemoral Pain- neoprene

sleeve/rest/advil/phyiscal therapy/posisble arthroscopic release

Patellofemoral Chondromalacia-same as above +/- tibial tubercle transfer/VMO advancment

Patellofemoral Sublux/Disloc-arthroscopic repair medial patellofemoral retinaculum/lateral release, cartilage debridment

Cartilage Problems

Meniscal tears-Repair young and not complex in red-red

zoneFastest to work- partial menisectomy,

older/compelx tearsMeniscal Allograph

Articular Cartilage

Generalized-Advil rest InjectionsBrace/medial or lateral

LocalizedA.C.I.O.A.T.S.

Time To WorkFractures- 3-4 monthsLigament Disruptions- 6-12 weeksPatellofemoral Prepatellar- continuous PF Pain/Chondro- variable- 6-8 weeks

Cartilage Meniscal Repair- 3 months Meniscal Resection- 6 weeksGeneralized articular var 1-8 wksLocalized 3-4 months

ImpairmentLowerExtremity

ImpairmentWholeBody