Injuries to the

Thigh, Leg, &

Knee
Ch. 15

Stress Fractures of Femur

Very rare, but possible
Usually seen in running sports (XC)
When stress is put on femur it bends similar
to a pencil with stretching forces on one
side and compression forces on the other

Femur Fractures
Great deal of stress required to break femur
Athlete will have severe pain, inability to
move leg
Complications can include internal
bleeding, tearing of muscles, tendons,
nerves and arteries
Usually causes leg to externally rotate
Immobilize and call EMS

Perthes Disease
Disruption of blood flow to head of femur
Causes avascular necrosis
Signs and symptoms include groin and/or
knee pain with limp
Mostly seen in children or teens who are
still growing
Refer to doc immediately, can be disabling
later in life

Patellar Fractures

Not very common

Very debilitating
Typically caused by direct trauma
Surgery is usually necessary to put pieces back
together, unless its a stable fracture
Recovery is fairly long depending on severity of
fracture, and whether or not surgery was necessary
Cast/splint, PT

Fractured patella

Knee Dislocation
VERY serious
Obvious deformity, athlete will be in intense pain
Can cause neurovascular problems
Check for pedal pulse and sensation

Must be splinted
Surgery is a definite
EMS in a hurry

Dislocated knee
http://www.youtube.com/watch?v=3e1ZKtD25Ho&feature=player_embe
dded

Dislocated knee, about a week later

Lower Leg Fractures

Another VERY serious problem
Usually a compound fracture
Sometimes an open one
Also called a tib-fib fracture

Splint and check for pulse and sensation

EMS
More surgery

Tib-fib fracture
http://www.youtube.com/watch?v=BGmT2jeVzFs&feature=related

Thigh Contusions
Unlike normal contusions, deep thigh
contusions can cause disability
Causes tissue tearing and bleeding
Can result in myositis ossificans if not
treated properly
Formation of bony tissue within muscle

Treatment of Thigh Contusions

PRICE
Knee must be flexed when icing or athlete will
lose ability to flex knee
If contusion is severe enough they should be put
on crutches
Ice and stretching will help to restore ROM
Can use ultrasound or Hivamat to break up any
hematoma that may form, and can break up any
bony deposits that may have started to form

Acute Treatment for

Thigh Bruise

Muscle Strains
Very common in rectus femoris, hamstrings,
and groin
Typically HS are weaker than quads and get
over-powered

Can tear the rectus femoris, and still

compete
Visible defect
Pg. 229, picture

Osteochondritis Dissecans
Also called joint mice
Loose bodies in knee joint that can damage
joint surfaces
Cause proposed to be ischemia, trauma, and
degenerative changes
Cause pain and joint locking at times
Doc will decide on treatment, possible surgery

Bursitis
Typically occurs over prepatellar bursa
Many other possible locations

Causes swelling and pain, sometimes

disability
Ice and compression are the best treatments
A day or two off may be necessary to
reduce swelling and restore proper function

Pre-patellar bursitis

Patellar
Dislocation/Subluxation

Occurs fairly often

Typically dislocates laterally
Usually becomes chronic problem
Causes a lot of pain and some swelling
Can be fixed surgically but quad/hip
strengthening help tremendously

Dislocated Patella

Osgood-Schlatter Disease
Irritation of patellar tendon at insertion
point, causing irritation at tibial tuberosity
Characterized by pain, swelling, and
tenderness
Restrict activity, let pain be the guide
May need pad because of tenderness
Usually resolves by itself in mid-late teens

Osgood-Schlatter Disease

Patellofemoral Pain
VERY common problem(s)
Almost always caused by weak muscles
Typically VMO and/or hips
Q angle plays a part also

Chondromalacia

Roughening of backside of patella

Due to patella not tracking properly in its groove
Lots of crepitus
Usually starts with mild, intermittent discomfort and worsens
Can lead to other problems

Patellofemoral Pain
Jumpers Knee
Tendonitis (tendinosis) of patellar tendon
Can be caused by overuse, can also be caused by
patella not tracking properly, causing the tendon to be
pulled at awkward angle
Both chondromalacia and Jumpers Knee cause pain
and swelling (sometimes random) in the knee
Treat both w/ ice, rest, strengthening, and sometimes
NSAIDs

Meniscus Injuries
Half circle pieces of cartilage that attach to the
tibia on medial & lateral sides
Provide stability, absorb shock, allow smooth
movement of the joint, protect joint surface
Usually torn when athlete rotates leg with foot
planted
Can also accompany a torn ACL & MCL
Unhappy triad

Meniscii

Meniscus Injuries
Signs & symptoms

Popping or clicking when walking/running

Pain sometimes, but not always
Swelling sometimes, but not always
If a flap of the meniscus is torn it could cause the knee to lock
due to the flap getting caught in the joint

Treatment
Ice, see the doc, surgery probable
Depending on location of tear the doc can clean it up or repair it
Repairs take much longer to come back from, typically on crutches for 4-6
weeks

Knee Ligaments
4 major ones
ACL, PCL, MCL, LCL
All work together to stabilize knee
If one is torn, stability is greatly compromised, as are the remaining
ligaments

ACL injured with sudden stopping or changing direction

PCL injured by falling on knee (posterior force)
MCL injured by valgus force
LCL injured by varus force

Major knee ligaments

Knee Ligaments
http://www.youtube.com/watch?v=1JQKko6C42s
ACL

http://www.youtube.com/watch?v=lr57dyxpeZQ
MCL

Knee Ligaments
MCL & LCL typically heal on their own (if
not completely ruptured) as long as they are
protected
ACL & PCL require surgery
You can still perform ADLs and play sports
when one of these is torn, but you put your
knee at risk for further injury

Knee Injury Prevention

Strong quads, HS, hips, and proper landing techniques are
VERY important
Prophylactic bracing was thought to be beneficial to
preventing injuries but has since been proven ineffective
Post surgical bracing is typically up to the athlete. Some
docs require it to a certain point and then athlete can
decide if they want to wear it or not. Some docs make
them optional all together