SPORT INJURY

dr. S.Rhatomy,Sp.OT (K)

Divisi Sport and Adult Reconstruction

Dept.Orthopaedi dan Traumatologi
RSUP Soeradji Tirtonegoro
Klaten
SPRAINS & STRAINS
COMMON ACUTE SOFT-TISSUE
INJURIES
 SPRAINS
➤ A sprain is a stretch or tear of a ligament.

➤ A ligament is a band of connective tissue that connects one bone to

another.

➤ That connective is called “fibrous connective tissue,” which mainly relates

to holding structures together and stable.
➤ The areas most vulnerable to sprains are ankles, knees, and wrists.
➤ Sprained ankles are most common, which occurs when the foot turns inwards
and causes extreme tension in the ligaments of the ankle.
 STRAINS
➤ A direct injury to muscles or tendons.
➤ Tendons are fibrous tissue that connects muscles to bones.
➤ Most common strain injuries occur in the back of the foot or
leg. (Achilles tendon---Achilles Tendonosis)
 GRADES
➤ Sprain Classification
Grade 1: some stretching and
some damage to the fibers
(fibrils) that compose the
ligament.

Grade 2: A partial tearing

causes extra looseness when the
joint is moved in specific ways.

Grade 3: The ligament is

completely torn and causes the
joint to be nonfunctional.
SIGNS AND
SYMPTOM TREATMENT
S
➤ Grade 1
➤ RICE ?
➤ Pain
➤ Physical Therapy
➤ Swelling
➤ Grade 2
➤ Bruising
➤ Bracing
➤ Inflammation
➤ Grade 3
➤ Surgery to repair the torn
ligaments.
SPORT SPECIAL
CASE
 ANTERIOR
CRUCIATE LIGAMENT
RUPTUR
 Frequency

 It is currently one of the most common

orthopedic procedures in the world
 6th frequent orthopedic surgery in US
 100.000 ACL tears each year
 75 000 annually primary ACL
reconstruction, 1000 – 3000 revision
 Annual incidence of ACL injuries?

3 /10 000 Nielsen & Yde -91

– In the population
6 / 10 000 Daniel & Fritchy -94
– In the active age group
18 /10 000
– Soccer players
Roos et al. -95
27 /10 000
– Female soccer players
 Clinical Examination
 Subjective = Giving way

 Objective = Lachman test **

 Lelli Test (Lever sign test)
 Gold Standar Dx
 Arthroscopic
Posterior Cruciate Ligament
 Femoral Insertion:
 Broad insertion:
▪ 88° ± 5.5° angle to the roof
 Midpoint of femoral
insertion:
▪ 1 cm proximal to articular
cartilage of MFC
Function
Primary restraint
▪ Posterior translation of tibia (90-95%)
▪ Greatest translation occurs at 75 degrees flexion
Secondary restraint
▪ Varus/valgus
▪ External rotation
 Incidence varies:
 1%-44% of all acute knee injuries depending on severity and
energy (Harner AJSM 1999)

 NFL Combines:
 2% incidence in asymptomatic knees
 (Parolie and Bergfeld, AJSM 1986)

 Lower incidence in sports with less contact

 Typical- fall on flexed knee
 Hyperextension
 Inspection:
Sag compared to other knee

 Quadriceps active (posterior ) drawer test

Knee 90° flexed
Stabilize foot
Fire quads
 Most accurate:
 Posterior drawer test
POSTERIOR CRUCIATE LIGAMENT
INJURY

Normal

Posterior drawer sign. Push the tibia posterior to the femur .

 ACHILLES
TENDON RUPTUR
Anatomy

 Largest tendon in
the body
 Origin from
gastrocnemius and
soleus muscles
 Insertion on
calcaneal tuberosity
Achilles Tendon Rupture

 Pathophysiology
 Repetitive microtrauma
in a relatively
hypovascular area.
RUPTUR TENDON ACHILLES
Achilles Tendon Rupture:
Textbook Facts

 Antecedent tendinitis/tendinosis in 15%

 75% of sports-related ruptures happen in

patients between 30-40 years of age.

 Most ruptures occur in watershed area

4cm proximal to the calcaneal insertion.
Achilles Tendon Rupture

 History
 Case reports of fluoroquinolone use, steroid
injections

 Mechanism
 Eccentric loading (running backwards in tennis,badminton)
 Sudden unexpected dorsiflexion of ankle
 (Direct blow or laceration)
Achilles Tendon Rupture

 Physical
 Partial
 Localized tenderness +/- nodularity
 Complete
 Defect
 Cannot heel raise
Positive Thompson test
RUPTUR TENDON ACHILLES
 THOMPSON TEST
Imaging

 Ultrasound
 Inexpensive,fast,
reproducable, dynamic
examination possible
 Operator dependent
 Best to measure thickness
and gap
 Good screening test for
complete rupture
Imaging

 MRI
 Expensive, not
dynamic
 Better at detecting
partial ruptures and
staging degenerative
changes, (monitor
healing)
Management Goals

 Restore musculotendinous length and

tension.

 Optimize gastro-soleous strength and

function

 Avoid ankle stiffness

Surgical Management

 Bunnell Suture

 Modified Kessler

 Many techniques
available
W. Edwards Deming
MATUR NUWUN