MSD&D Knee

MSD&D Knee

1. Bony conditions

   • Spiral Tib/Fib Fracture
     • Foot stuck but body rotates
   • Comminuted fracture
     • Multiple forces
   • Stress Fracture
     • Overuse
     • Remodelling cannot keep up with stress
       • Wolffs Law
   • Greenstick fracture
     • Occurs in children
     • Bending that cause incomplete break
   • Patella Fracture
     • 78% of all are RTA
     • 1% of all fractures
   • Patela dislocations
     • Can be acute (trauma) or chronic (>3 times)
     • Usually dislocates laterally
       • Ruptures MCL
     • Taping, exercise to strengthen support of knee.

2. Bone diseases

   • OA
     • Degeneration of articular cartilage and underlying bone
     • Severe OA= Narrow joint space, Osteophytes, displacement, subcondral cyst
   • RA
     • Auto-immune disease attacks hyaline cartilage
   • Pagets
     • Accelerated reabsorption and placement of bone, causing fragile new growth
       • Creates poor woven bone
   • Juvenile osteochondritis Dissecans
     • Separation of cartilage from subchondral bone
     • U12's treated conservatively
     • Over 12 treated surgically
   • Osgood schlatters
     • Micro avulsion to tibia tuberosity
       • Patella lig pulling away- over used of quadriceps.
       • CONSERVATIVE- Strength support round knee, taping.

3. Total Knee Replacements

   • Bi Component
   • Tri-component
   • Problems:
     • Polyethene wear
     • Joint loosening due to shear force
     • Level of compromise between joint ROM and stability
   • Constrained
     • Necessary with joint displacement
       • Ligaments not saved (less ROM)
     • Mobile Bearing
       • Reduce shear force through knee
         • Menisci
   • Unconstrained
     • Only when no displacement is present
       • Uses PCL- Better ROM
         • Less shear force

4. Soft Tissue Conditions

   • Ewings Sarcoma
     • Tumour of the femur
     • C/P- persistent joint pain
     • Child/adolescents
   • Osteosarcoma
     • Rare malignant bone tumour
     • Rapid growth
     • Bone pain and Pain weight bearing
   • Bursitis