Course

Knee

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14 Lessons

Injuries to the knee are among the most common problems seen in football. It is important to make an accurate diagnosis as the treatment of knee injuries can vary widely. For example, anterior knee pain commonly develops insidiously and is best managed non-operatively. In contrast, ligamentous injuries are almost always due to direct trauma and are often best managed with surgery.

In this module, you will learn about how to assess an injured knee and how to manage anterior knee pain, patella instability and significant ligamentous injury.

Remember to review the “ACL” and “Meniscus/chondral injuries” modules. Together, these three modules will give you a great understanding of the major knee injuries seen in football.

Dr Bert Mandelbaum

Orthopaedic Surgeon

Presented by

Bert Mandelbaum

Learning outcomes

By the end of this module you should:

  • have an awareness of the major causes of anterior knee pain and their presentation in football;
  • be able to appropriately work up and manage most anterior knee pain presenting in a football context;
  • understand the mechanisms of injury and presenting symptoms for the major ligamentous injuries seen in football;
  • be able to examine, order appropriate investigations and initiate rehabilitation for athletes presenting with a history suggestive of a knee ligament injury;
  • know when to refer an athlete (with a knee injury) for an orthopaedic assessment and have an understanding of the major procedures and return to sport.

Tasks

  • Read the relevant section in the F-MARC Football Medicine Manual and other required reading.
  • Review the suggested reading.
  • View, or listen to, any relevant multimedia content.
  • Complete the course quiz.

Required Reading

F-MARC Football Medicine Manual 2nd Edition:

Chapter 3.1 (pages 154-160).

Suggested Reading

Brukner and Khan’s

Clinical Sports Medicine 4th Edition

Chapters 32 (pages 626-683), 33 (pages 684-714) and 34 (pages 715-734)

References

  1. Narvani A, Mahmud T, Lavelle J, Williams A. Injury to the proximal deep medial collateral ligament: a problematical subgroup of injuries. J Bone Joint Surg Br. 2010;92(7):949-953.
  2. Shelbourne KD, Muthukaruppan Y. Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy. 2005;21(4):457-461.
  3. Akisue T, Kurosaka M, Yoshiya S, Kuroda R, Mizuno K. Evaluation of healing of the injured posterior cruciate ligament: analysis of instability and magnetic resonance imaging. Arthroscopy. 2001;17(3):264-269.
  4. Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med. 2012;40(1):222-231.
  5. Chen FS, Rokito AS, Pitman MI. Acute and chronic posterolateral rotatory instability of the knee. J Am Acad Orthop Surg. 2000;8(2):97-110.
  6. Petrigliano FA, Lane CG, Suero EM, Allen AA, Pearle AD. Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res. 2012;470(3):815-823.
  7. Fithian DC, Paxton EW, Stone ML, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114-1121.
  8. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med. 2002;21(3):499-519.
  9. Alba-Martin P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Nunez-Nagy S, Pecos-Martin D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci. 2015;27(7):2387-2390.
  10. Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30(6):857-865.
  11. Roush MB, Sevier TL, Wilson JK, et al. Anterior knee pain: a clinical comparison of rehabilitation methods. Clin J Sport Med. 2000;10(1):22-28.
  12. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. 2002;30(3):447-456.
  13. Cook JL, Khan KM, Kiss ZS, Purdam CR, Griffiths L. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport Tendon Study Group. Br J Sports Med. 2001;35(1):65-69.
  14. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802.
  15. Ferretti A, Conteduca F, Camerucci E, Morelli F. Patellar tendinosis: a follow-up study of surgical treatment. J Bone Joint Surg Am. 2002;84-A(12):2179-2185.
  16. Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008;337:a2469.
  17. 17. Bizzini M, Junge A, Dvorak J. Implementation of the FIFA 11+ football warm-up program: how to approach and convince the football associations to invest in prevention. Br J Sports Med. 2013;47(12):803-806.