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Peripheral Nerve Entrapment Around the Foot and Ankle

Introduction Athletes may suffer from chronic lower limb pain, which could be caused by peripheral nerve entrapment. Compared with other problems of the lower limb, this entity is quite rare, with a heterogeneous group of nerve disorders and multiple, sometimes very complex, etiologies and clinical presentations. Even for a perceptive clinician, distinction between the different medical causes may be difficult, given that many of their presenting…

Leg Pain and Exertional Compartment Syndromes

Exertional leg pain (ELP) is a common problem encountered in recreational and competitive athletes. Although its incidence in the general population is unknown, ELP is thought to affect between 12.8% and 82.4% of athletes. Specifically, at least 45% of runners will experience such pain, with running more than 40 miles per week serving as a significant risk factor. Defined as pain distal to the knee and…

Imaging of the Foot and Ankle

Radiographs Radiographs are often the initial imaging study performed for any patient presenting with a problem related to the foot and ankle. Radiographs are clearly beneficial when evaluating for suspected arthritis, osteonecrosis, tumors, nonunion, or trauma. In addition, the alignment of the ankle and foot may contribute to the presenting complaint even if the radiographs being viewed are free of pathologic abnormalities. To appropriately evaluate the…

Foot and Ankle Biomechanics

The relationship between the joints, ligaments, tendons, and fascia of the foot, ankle, and lower extremity allows weight-bearing athletes to perform extraordinary feats of power, speed, and endurance. In this chapter, motion of various foot and ankle segments (kinematics) and the forces experienced by the lower extremity (kinetics) are explored over the gait cycle. Special attention is given to the biomechanical mechanisms by which the components…

Vascular Problems of the Knee

The most common sources of pain and dysfunction in the lower limb of an athlete are musculoskeletal in origin; however, vascular pathology may also present with similar symptoms. Sports that involve frequent repetitive joint motion or high-impact collisions have the highest incidence of symptoms or injury due to vascular pathology. Vascular issues in athletic patients may be difficult to diagnose for several reasons. First, most athletes…

Loss of Knee Motion

Full range of motion (ROM) in the knee joint is critical for optimal function. A slight loss of knee motion can limit function and cause pain, and a more severe loss will lead to significant impairment and disability. For optimum function, the knee should have ROM and strength that is symmetric to the opposite, normal knee. When something causes a loss of normal knee motion, a…

Extensor Mechanism Injuries

The patellar and quadriceps tendons along with the patella make up the extensor mechanism of the knee. Disease of the extensor mechanism tendons ranges from tendinopathy to complete rupture. Tendinopathies commonly affect healthy athletes secondary to chronic overuse, but they can also occur in the presence of systemic diseases and endocrinopathies as well as in conjunction with certain medications and hormonal supplements. Ruptures commonly occur in…

Patellofemoral Pain

Patellofemoral pain is common, with an incidence as high as 50% in some populations. Often referred to as anterior knee pain, patellofemoral pain can be challenging for both patients and clinicians, as it can often be difficult to determine the underlying etiology responsible for the pain. Some patients with patellofemoral pain have no definable pathology. This process has been described by different names, including patellofemoral pain…

Patellar Instability

Patellar instability is a broad topic that encompasses a continuum of patellar abnormalities. To address this complex topic, it is important to first define several terms. During the normal knee flexion cycle, the patella tracks in the center of the femoral trochlea. Maltracking occurs when the patella deviates from the bony constraints of the trochlear groove during the range of motion (ROM) arc. The term subluxation…

Knee Arthritis

Knee osteoarthritis (OA) is an extremely common cause of disability. The etiology is multifactorial, but joint injury is a prevalent cause of OA in the knee. Studies have shown that meniscal injury requiring a meniscectomy alters knee biomechanics and leads to gonarthrosis. Anterior cruciate ligament (ACL) rupture, a frequently seen and often devastating injury, is characteristically associated with meniscal and chondral injuries. Further deterioration of the…

Multiligament Knee Injuries

Knee ligaments are responsible for providing the static stability of the knee, control of kinematics, and prevention of abnormal rotation and/or displacement that may damage the articular surfaces or the menisci. Knee dislocations are rare and are estimated to account for 0.02% to 0.2% of orthopaedic injuries ; however, it is generally accepted that multiligament injuries may occur at a higher rate because some knees spontaneously…

Lateral and Posterolateral Corner Injuries of the Knee

As understanding of the posterolateral corner (PLC) has increased, its significance to overall knee function and biomechanics has become clearer. Although it is a relatively uncommon injury, PLC injuries can have severe consequences for overall knee stability and function. Missed injuries may affect the outcome of surgeries to correct concomitant injuries. This chapter reviews the epidemiology, relevant anatomy, biomechanics, presentation, examination, imaging, and treatment of PLC…

Medial Collateral Ligament and Posterior Medial Corner Injuries

Medial ligament injuries of the knee are often assumed to be only medial collateral ligament (MCL) injuries. However, the medial ligament includes not only the MCL but also posteromedial structures that play a vital role in the stability of the knee. The work of LaPrade and colleagues has demonstrated that the posterior oblique ligament (POL) is an important valgus and rotational stabilizer of the knee. The…

Posterior Cruciate Ligament Injuries

The treatment of posterior cruciate ligament (PCL) injuries is a controversial topic in orthopaedic surgery. In contrast to anterior cruciate ligament (ACL) injuries, for which an abundance of basic science and clinical data is available, the PCL has only recently become a topic of intense investigation. PCL injuries are less common compared with ACL injuries, and thus studies on outcomes are underpowered, making it difficult to…

Revision Anterior Cruciate Ligament Injuries

As the number of primary anterior cruciate ligament (ACL) reconstructions performed annually continues to increase, the number of revision procedures is also projected to increase. A larger number of patients returning to high-demand sports and activities following primary reconstruction has resulted in an increased number of revision and repeat revision reconstructions. Failure of primary ACL reconstruction, defined by recurrent laxity or graft failure, has been reported…

Anterior Cruciate Ligament Injuries

History The anatomy and injury of the anterior cruciate ligament (ACL) has been well-documented in history for centuries, but it was not until the mid-1800s that reports of surgical treatment of ACL injuries began to appear in surgical literature. Although there are some reports of success with early repair, surgeons realized that a more robust reconstruction was necessary to provide adequate knee stability. Ernest William Hey…

Frontiers in Articular Cartilage Treatment

Articular cartilage defects in the knee ( Fig. 97.1 ) are common and often result in pain and dysfunction. Over the past several decades, research efforts have focused on better understanding how to diagnose and treat these lesions. Comprised predominately of type II collagen, articular cartilage is relatively avascular, depending on diffusion to obtain nutrients and oxygen, making spontaneous healing of articular cartilage defects exceedingly difficult.…

Articular Cartilage Lesions

Articular cartilage lesions are a key concern in orthopaedic surgery because cartilage has an extremely poor capacity to heal. Treatment of these lesions aims to restore an articular surface that matches the biomechanical properties of normal hyaline cartilage and to prevent the progression of focal cartilage injury to end-stage arthritis. A cartilage defect has a very limited ability to recover spontaneously due to its unique characteristics.…

Meniscal Transplantation

Introduction Our understanding of the role of the meniscus has evolved over many years. Dating back to 1948, Fairbank et al. described changes to the knee joint such as narrowing of the joint space, squaring of the femoral condyle, and ridge formation following meniscectomy. This led to his conclusion that a simple meniscectomy is not “wholly innocuous” and it leads to changes in joint mechanics that can…