Knee Disorders

BY
MITTUL PATEL
 ARTHRITIS
• gradual wearing and degeneration of articular cartilage
• PRIMARY OR SECONDARY:-
e.g., age related or
rheumatic jt dz.
intra articular fractures
• Region:-patello femoral
:-tibio femoral
 Continued…..
• patello femoral-ant compartment pain
-abnormal q-angle,tilt,rotation
-flat feet
-knock knees
-abnormal tracking of patella
Ix:-
- X-ray – skyline view
- CT or MRI
• tibio femoral – med. Compartment
-genu varum
– lat. Compartment
-genu valgum
Ix:-
- X-ray- standing WB
- 30 degree knee flexion
 Chondromalacia patella
• softening of the articular cartilage of patella most
often in young adults
• Suprolateral aspect of dorsal surface of patella
• Injury, overuse, misalignment of the patella.
Symptoms
• dull pain around or under the kneecap
• worsens when walking down stairs or hills.
• also feel pain when climbing stairs or when the knee
bears weight as it straightens.
• common in runners and is also seen in skiers, cyclists,
and soccer players.
 Osteochondritis dessecance
• loss of the blood supply may be due to a slight blockage of a small artery
or to an unrecognized injury or tiny fracture that damages the overlying
cartilage to an area of bone underneath a joint surface.
• affected bone and its covering of cartilage gradually loosen and cause
pain.
• arises spontaneously in an active adolescent or young adult.
• may eventually develop osteoarthritis.
• several family members the disorder is inherited.
Symptoms
• If normal healing doesn’t occur, cartilage separates from the diseased
bone and a fragment breaks loose into the knee joint, causing weakness,
sharp pain, and locking of the joint.
Ix
• MRI
 Osgood-Schlatter Disease
• Repetitive stress or tension on part of the growth area of the
upper tibia (the apophysis).tendon is stretched so much that
it tears away from the tibia and takes a fragment of bone
• Active young people, boys , ages of 10 and 15
Symptoms
• Pain at tibial tuberosity worsens with activity and is relieved
by rest. few months and may recur until the child’s growth is
completed.
• A painful bony bump
• The motion of the knee is not affected.
Ix
• X-ray
Osgood-Schlatter Disease
 Tendon Injuries
• range from tendinitis to a ruptured tendon.
• Overuse in dancing, cycling, or running.
• “jumper’s knee” ( basketball). After repeated
stress, the tendon may become inflamed or tear.
Symptoms
• tenderness at patellar tendon ,pain during
running, hurried walking, or jumping.
• In complete inj. difficult for a person to bend,
extend, or lift the leg against gravity.
 Muscle strain
• When one muscle group is much stronger than its opposing
muscle group, the imbalance can lead to a strain. This
frequently happens with the hamstring muscles. The
quadriceps muscles are usually much more powerful, so the
hamstring may become fatigued faster than the quadriceps.
A fatigued muscle cannot relax as easily when its opposing
muscle contracts  to strains
Dx:-
--------------
Ix:-
MRI
 .
Adductor Hamstring
 Ligament injuries
• ACL :ant translation of tibia
• PCL :post translation tibia
• MCL :medial instability
• LCL :lateral instability
 Cruciate ligaments
• ACL -by a sudden twisting motion
when the foot is steady on ground
• PCL is most often injured by a direct impact,
-in an automobile accident or football tackle.
Symptoms
• You may hear a popping sound, and the leg may buckle when
you try to stand on it.
Dx
• Ant. drawer test – post drawer test
• -------
Ix
• MRI
 Collateral ligaments

• MCL is more easily injured than the LCL.

• Direct blow from the sides (football or hockey).
Symptoms
• When injury to the medial collateral ligament occurs, you
may feel a pop and the knee may buckle sideways. Pain
and swelling are common.
Dx:-
• Valgus-Varus stress test.
Ix:-
• MRI
 Meniscal injuries
Rotating the knee while bearing weight.
(dribbling basketball around an opponent
Or turning to hit a tennis ball).
- Inner , middle and outer third tears.
• Symptoms
- minimal swelling, tender joint line ,palpable meniscal
cyst, weakness of quads, locking and clicking
• Dx:-
- Apley’s grinding test
- Mac murrey’s test
- Bounce home test
 Iliotibial Band
Syndrome

• An inflammation of IT band due to its rubing

over the lateral condyle of the femure.
- direct injury or long-term overuse(sports training ,running, cycling).
Symptoms
• Ache or burning sensation lat side of the knee during activity.
may radiate up lat. Side, SNAP may be heard during extension. No
Swelling , normal knee motion.
Dx

Ix
• MRI
 Bursitis
Definition
Bursitis is inflammation of the fluid-filled sac (bursa) that lies
between a tendon and skin, or between a tendon and bone.
They assist movement and reduce friction between moving
parts.
Causes
Bursitis can be caused by chronic overuse, trauma,
rheumatoid arthritis, gout, infection, idiopathic.
Chronic inflammation can occur with
repeated injuries or attacks of bursitis.
Symptoms
Joint pain and tenderness
Swelling
Warmth over the joint
Ix
• Congenital pseudoarthrosis of the Tibia
• Congenital absence of the Tibia & Fibula
• Congenital dislocation of the Knee
• Multipartite Patella
• Congenital angulation of Tibia
• Congenital hyperlaxity of Joints
• Quadriceps paralysis
• Ruptures of Quadriceps apparatus
• Genu varum
• Genu valgum
• Genu recurvatum
• Tibia vara
Congenital pseudoarthrosis of the Tibia
Congenital absence of the Tibia & Fibula
Congenital dislocation of the Knee
Multipartite Patella
Congenital angulation of Tibia
Congenital hyperlaxity of Joints
 Quadriceps paralysis

• Polio myelitis
• Femoral neuropathy
• TB spine
• PIVD
 Ruptures of Quadriceps apparatus

• The muscle
• Tendon
• Tendo-ossious junction
- upper and lower pole
- tibial tubercle
 Dislocation of Patella

• Outward displacement of the Patella is resisted by certain

anatomical structures(VMO, med.capsule, retinacula )
(1)Direct trauma
(2) Genu valgum
(3) Shallow Lat. Femoral condyle
(4) Elongated patellar tendon
(5) Deficient vastus medialis
(6) External tibial torsion or Lat insertion of patellar tendon
(7)Medial capsular laxity
(8) Abnormal attachment of IT band on patella.
 Larsen Johanson Dz
• Osteochondritis of poles of patella
adolescents, usually boys(10-14).
• Unknown cause, repeated strains at the
attachment of the patellar tendon or
quadriceps tendon interfere with normal
ossification perhaps by limiting blood supply
• Often associated with Osgood-Schlatter Dz
 Genu varum

• Bowlegs is condition of outward angulation of

knee deviating longitudinal axis of tibia and
femur medially.
- Rickets rarely
- Epiphyseal injury to medial portion of tibia
 Genu valgum

• Knock- knee consists of medial angulation of

the knee and outward deviation of
longitudinal axis of tibia and femure.
- Pronated feet
- # dislocation of outer part of epiphyseal plate
- Rickets when B/L .
 Genu recurvatum

• Backward bowing of knee is most commonly due to

injury to ant. part of lower femoral or upper tibial
epiphyseal plate.
consequently the posterior condyles grow larger in
contrast with the anterior portions.
• Regardless oe the site of deformity Sx correction is
confined to the upper end of the tibia.
• It is also caused by muscle imbalance , as in
poliomyelitis and by equinus deformity of foot which
throws the in hyperextension.
 Tibia vara

• Developmental condition characterized by disturbance of the orderly sequence of

endochondral ossification at the upper end of tibia affecting the medial portion of
the growth plate mainly in its posteromedial aspect.
• An abrupt angulation develops at metaphysis while the diaphysis remains
straight.
• Commonly In infants and children. In adolescents it is in milder form and results
in longitudinal growth retardation.
• More evident in Wt bearing, pes planovalgus develops secondarily.
Etiology:-
- Idiopathic
-Both sexes equally affected
-West Indies and West Africa
-Appears early and progresses rapidly in blacks.
- No hereditary factor .
THANK YOU
 Plica Syndrome

• Plica (pronounced PLI-kah) syndrome occurs when plicae (bands of synovial tissue) are irritated by
overuse or injury. Synovial plicae are the remains of tissue pouches found in the early stages of fetal
development. As the fetus develops, these pouches normally combine to form one large synovial cavity.
If this process is incomplete, plicae remain as four folds or bands of synovial tissue within the knee.
Injury, chronic overuse, or inflammatory conditions are associated with this syndrome.
• Symptoms
• Symptoms of plica syndrome include pain and swelling, a clicking sensation, and locking and weakness
of the knee.
• Diagnosis
• Because the symptoms are similar to those of some other knee problems, plica syndrome is often
misdiagnosed. Diagnosis usually depends on excluding other conditions that cause similar symptoms.
• Treatment
• The goal of treatment for plica syndrome is to reduce inflammation of the synovium and thickening of
the plicae. The doctor usually prescribes medicine such as ibuprofen to reduce inflammation. People
are also advised to reduce activity, apply ice and an elastic bandage to the knee, and do strengthening
exercises. A cortisone injection into the plica folds helps about half of those treated. If treatment fails to
relieve symptoms within 3 months, the doctor may recommend arthroscopic or open surgery to
remove the plicae.
• The prepatellar bursa is located beneath the skin and in front of the
kneecap. It becomes inflamed as a result of infection, injury, gout, or
repeated irritation from kneeling. Symptoms include swelling in the front
of the knee that may be painful. Redness and/or warmth may occur with
infection or gout. Infrapatellar bursitis (clergyman's knee), a similar
condition, affects the infrapatellar bursa, located just below the kneecap.
•  Pes anserinus bursitis 
• This bursa is located just beneath the knee on the inner part of the leg. It
can irritated in people who jog, have "knock-knees" or osteoarthritis of
the knees, or in those who are overweight. Symptoms include pain on the
inner part of the knee; pain when sleeping on the side if the knees touch
each other; pain while climbing stairs; and pain that travels to the back
and inside of the thigh."
Definition
• Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a
tendon and skin, or between a tendon and bone.
• They assist movement and reduce friction between moving parts.
Causes
• Bursitis can be caused by chronic overuse, trauma,
rheumatoid arthritis, gout, infection, idiopathic.
• Chronic inflammation can occur with
repeated injuries or attacks of bursitis.
Symptoms
• Joint pain and tenderness
• Swelling
• Warmth over the joint