Sports Medicine Lecture

Overview

• Focus: Knee as starting point for lower extremity
• Today's Content: Lower extremity
• Tomorrow's Content: Upper extremity, head, spine, and sports-related topics

Sports Medicine Basics

• Perception: Not rocket science

Key Topics

1. Knee Injuries: Anatomy and Biomechanics

   • ACL and PCL cross with a four-bar linkage system (Amos)
   • Collateral ligaments: medial and lateral
   • Posterior medial and posterior lateral corner
   • Knee as a diarthrodial joint, allows rotation and translation
   • Susceptibility to arthritis if mechanics are off
   • Articular cartilage: Type 2 cartilage, water content changes with arthritis

2. Ligament Anatomy and Function

   • ACL: tibia to lateral femoral condyle, 2 bundles
   • PCL: medial femoral condyle to tibial sulcus, 2 bundles
   • Blood supply: middle genicular artery
   • Collateral ligaments: MCL (both superficial and deep) and LCL
   • Ligament Strength: MCL strongest, LCL weakest
   • Layer Concept: Superficial (Sartorius, superficial MCL), Deep (semimembranosus, deep MCL)

3. Posterior Lateral Corner

   • Components: Biceps tendon, Iliotibial band (superficial); LCL, popliteus muscle, capsule (deep)

4. Patellofemoral Joint

   • Increases moment arm for quadriceps
   • Patella divided into medial and lateral sides
   • Importance of medial patellofemoral ligament

5. Meniscus Anatomy and Injury

   • Crescent-shaped, composed of longitudinal and radial fibers
   • Medial meniscus: more C-shaped
   • Lateral meniscus: semicircular, closer horn attachments
   • Meniscal repair: Vertical mattress suture technique

6. Clinical Examination

   • ACL: Lachman test as gold standard
   • PCL: Posterior drawer (70-90 degrees flexion)
   • MCL/LCL: Varus/valgus instability tests
   • Posterior Lateral Corner: Dial test

7. Imaging and Arthroscopy

   • Lateral capsular sign, Pellegrini-Stieda lesion, Fairbanks changes, OCD
   • Arthroscopy: Anterior lateral portal for knee viewing

8. Meniscal Surgery and Repair Considerations

   • Preserve as much meniscus as possible
   • Avoid thermal devices due to risk of cell death
   • Be cautious with MRI interpretations
   • Meniscal transplantation

9. Other Injury Management

   • Meniscal Cysts: Partial meniscectomy, decompression
   • Discoid Meniscus: Types and their management
   • Osteochondral Injuries: Management via drilling or graft
   • Osteonecrosis: Spontaneous osteonecrosis (SONK)
   • Synovectomy: For RA, PVNS, hemophilia
   • Ligament Injuries: ACL (reconstruction), PCL (controversial, grade-based treatment), MCL (hinge brace)
   • Combined Injuries: Emphasis on recognizing and treating multilayer issues

10. Specific Knee Conditions

    • Quadriceps Tendon Rupture: In over 40s
    • Patellar Tendon Ruptures: Under 40s
    • Patellar Dislocation: MPFL as key ligament
    • Lateral Patellar Compression Syndrome: Rarely need lateral releases
    • Patellar Chondrosis: Rehab-focused treatment

11. Pediatric Knee Disorders

    • Osgood-Schlatter Disease: Tibial tubercle
    • Sinding-Larsen-Johansson Syndrome: Inferior patella
    • Physeal Injuries: Stress radiographs
    • ACL Mid-substance Tears: Avoid tunnels in young children

12. Nerve and Muscle Conditions

    • Surfers' Neuritis: Saphenous nerve entrapment
    • IT Band Syndrome: Hill runners, Ober test
    • Nerve Entrapments: Medial/lateral plantar nerves, treat by avoiding exacerbating factors
    • Popliteal Artery Entrapment Syndrome: Intermittent claudication, treated by gastroc release
    • Muscle Injuries: Various strains and contusions, specific treatments

13. Key Tests and Syndromes

    • Complex Regional Pain Syndrome: Sympathetic block (diagnostic and therapeutic)
    • Popliteal Cysts: Observe in children
    • Patella Alta/Baja: Important in injury diagnostics

14. Diagnostic Practices

    • Use stress radiographs prudently
    • Be aware of conservative vs. aggressive treatment indications
    • Emphasize the need for accurate radiographic and clinical diagnostics