This presentation tackles the topic of knee injuries for Traumatology. Presentation provides critical information but should be combined with knowledge of the presenter since it's meant for proper presentating and not read-only. Use freely to study or present.

1. Knee ligament and
meniscus injuries
Jan Stanislav Dorosz M1770

2. Anatomy
There are four major ligaments and two
meniscuses within or around a knee.
Anterior Cruciate Ligament (ACL)
Posterior Cruciate Ligament (PCL)
Medial Collateral Ligament (MCL)
Lateral Collateral Ligament (LCL)
Medial Meniscus
Lateral Meniscus

3. Mechanism of injury
There are few mechanisms of ligament and meniscus injury:
➔ Sport
Sudden changes in direction of movement
Sudden stop in movement
Jumping
Kicking
➔ Accident
Poor landing on feet under wrong angle (redirection of force into the knee join)
Overextension of the knee
➔ Trauma
Twist of the knee
Direct impact

4. Symptoms
Symptoms of injury may occur as:
Sudden sensetion or sound of “popping” within the knee joint
Severe pain
Inability to continue activity
Rapid swelling
Loss of range of motion
Inability to sustain weight

5. Risk factors
There are risk factors that contribute to injuries:
Being female - due to different muscle strenght (weaker muscle cuff) and
hormonal impact
Participating in certain sports - Football, Basketball, Rugby, American Football,
Gymnastics, Skiing
Wrong footwear (lack of stability or protection)
Hiking

6. Diagnosis
➔ Anamnesis
We can put a suspected diagnosis based on anamnesis (circumstances of the
damage/accident)
What patient did or felt during the accident
➔ Symptoms
Based on symptoms: pain, swelling, loss of range of movements
➔ Mechanical test
Bend the patient’s knee under 30-45 degrees, lock the thigh with one hand and pull the calf
with another. Pain is sign of ligament damage
➔ Radiological imagining
X-Ray of the affected area to confirm absence of fractures
To confirm diagnosis of ligament or meniscus tear we should schedule MRI

7. Treatment
There are several ways of treatment depending on severity of injury.
RICE Principle
(R)est - affected area for minimum of 48 hours, don’t put any weight on affected
side.
(I)ce - reduces swelling and inflammation therefore pain (Do not use for
extended period of time nor directly on skin)
(C)ompression - reduces swelling (wear elastic bandage)
(E)levation - reduces swelling
Additionaly pain relief is advised (NSAIDs or stronger if prescribed by doctor)
Protective knee brace may be needed to stabilise the joint

8. Surgical treatment
➔ Arthroscopic surgery
1. Insertion of instruments through
incisions
2. Cutting the remaining portion of
torn ligament
3. Removal of part of patellar tendon
which will serve as a graft/obtaining
donor tissue
4. Drilling holes through tibia and
femur which will serve as attachment
points for new ligament
5. Insertion of patellar tendon
fragment into the canal
6. Installation of screws which will
hold new ACL in place
7. Over the next 2 months bone
growth will fill in artificial tunnel
further stabilising the graft
➔ Surgery lasts 2-3 hours

9. Surgical treatment
Another approach towards MCL damage:
Apart from arthroscopic approach in ACL/PCL we can perform an
open surgery in order to repair MCL/LCL.
1. Performing lateral/medial longitudinal incision along damaged
ligament
2. Cleaning area of damaged tissue
3. Exposing epicondyle of femur
4. Creating a tunel within femur epociondyle
5. Insertion of fiber tape which will serve as an augmentation to
MCL/PCL.
6. Locking the fiber with special degradable screws

10. Meniscus tear
Meniscus tear may appear in similar
conditions as ligament tear.
Symptoms are:
Sharp pain during the tear
Swelling
Joint locking (in case when part of the
meniscus interlocks within epicondyle)
Popping sound during movement

11. Diagnosis
When we suspect meniscus tear we
can perform a McMurray test.
1. Bent a knee
2. Externally (medial) or laterally
(lateral) rotated and then extended
3. Sharp pain is a rather big sign of
meniscus damage
4. Confirmation is achieved with MRI
scan

12. Treatment
1. Ice to reduce inflammation
2. Rest to let the meniscus heal
3. Pain relief (NSAIDs or stronger)
4. Physiotherapy to increase the
muscle strength (to reduce load on
menisci)
5. In severe cases open or arthroscopic
surgery.

13. Complications
➔ Loss of full capability of the joint
In some cases, especially severe damage or widespread damage to ligaments/menisci,
patient may lose full capability of the joint. As a consequence he or she may not perform
professionally anymore
➔ Surgical
Infection, bleeding, formation of blood clots in legs or lungs
➔ Mechanical
Some people experience increased or decreased range of motion in joint after the ligament
repair, occasional swelling, pain etc.

14. Thank you for
your attention