Something new (sort of...) to learn about the knee!

Hello everyone!
The semester came out swinging on these bloggers and before we knew it, two months had gone by without getting our first post up when we wanted it. Sorry about that, but going forwards into the end of 2013 and the start of 2014 we can keep you updated with what sort of fun stuff we're doing at Naturopathic Med school, tips to study and any other interesting articles in regards to anatomy, medicine and health.

    Hopefully everyone heard and got as excited about the anterolateral ligament (ALL) as me when this study was published by researchers in Belgium. However, turns out (as their abstract states) this structure had been observed as early as 1879 by Paul Segond, a surgeon from France. He described a 'pearly, resistant, fibrous band' at the anterolateral aspect of the knee, but it took until 2013 for these researchers to provide a full anatomical description.

    They found that in 40/41 (97%) of cadavers dissected, the ALL was 'a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule,' and that it ran from the lateral femoral epicondyle to the anterolateral tibia with firm insertions to the lateral meniscus along the way. 

Image of an exposed ALL. Taken from MedicalXpress.

    So what's important about this? Researchers believe that the ALL plays an important role in patients ACL tears. The Belgian doctors were finding that even after patients had reconstructive ACL surgery, they still experienced pivot shift episodes where the knee would give out and they would lose stability. Due to the common nature of these tears in athletes playing a wide variety of sports, fully understanding this ligament may allow doctors to treat patients with ACL tears more effectively in the future. 

If you're interested in reading more about this 're-discovery', make sure to check out the abstract at the top and take a read through this New York Times article. 

For more information on the knee and performing a proper knee exam, check out Pro Health System's website! 

Osgood-Schlatter Disease

Having sore knees is both painful and frustrating whether you're a 75 year old out for a walk or a 12 year old sidelined at football practice. I was the latter- for a few summers, I was the husky youngster that over-exerted myself and wound up with Osgood-Schlatter disease. Luckily, mine was a very minor case and after football practice I recovered with adequate rest and ice. Others, however, may take weeks to months for recovery and could possibly deal with this issue well into adulthood.

What is it?

Osgood-Schlatter disease is characterized by:

• An enlargement of the tibial tuberosity, just below the patella, that is painful and tender
• Knee pain that worsens with activity- running, jumping, climbing etc- and improves with rest
• Tightness of the surrounding muscles, especially the thigh muscles

A typical image of someone suffering from Osgood-Schlatter disease
Source: http://louisvilleorthopedics.com/

How does it happen?

A nice side angle showing where the patellar
ligament pulls away from the tibial tubercle.
Source: http://www.laserhealthsolutions.com

Osgood-Schlatter disease happens by repeated stress on the tibia by the patellar ligament (also known as the patellar tendon), which is pulled by the quadriceps every time they are engaged. As the quads are used and pull on that tendon, it may pull away from the tibial tuberosity (or tubercle), resulting in the pain and swelling that is common with the disease. If the issue is not treated, it may progress far enough to be a full avulsion fracture. Overtime, the adolescent's bone may try to heal itself and close that gap with new bone growth- this is going to result in a bony lump at that spot. 

Contraction of the powerful quadricep muscles
will cause irritation of the patellar tendon and
tibial tuberosity.
Source: http://activerelease.ca/wordpress/

How to treat it

For most kids, R.I.C.E. (see our previous post to refresh your memory on dealing with inflammation) will do the trick. The period of rest will differ for each young athlete- in my case, I would usually need a few days between practices or games to feel ready to run again, others may take as long as 4 weeks. In mature patients, surgery does become an option if the skeleton is fully grown but the knees are still bothered by Osgood-Schlatters.

For more information on Osgood-Schlatter disease and many others, check out the Professional Health Conditions Manual.

Also, if you're looking to take your studying with you on the go,  download the new ProHealth App from the iTunes store FOR FREE until the end of the month! It's an easy to use and informative app that lets you take much of the Professional Health Muscle Manual with you on your iPhone or iPad. All you have to do is search "ProHealth" on iTunes to find it and you will be on your way with an excellent new tool to excel in your studies.