Video Observation assignment

Riley Collins

Advanced Injury Management

2021-03-19

 

*Video being assessed- Joe Burrows Quarterback for the Cincinnati Bengals, Left knee, (for best look at MOI start at 1:59). https://www.youtube.com/watch?v=RsQPs5kSLs4

From 2:04 to 2:09 the injury can be seen perfectly.

 

Mechanism of Injury -

Joe Burrows is a quarterback for the Cincinnati Bengals and the lead up to the injury goes as follows…

Burrows calls for the center to snap the ball back to him. As he’s looking downfield for a player to pass to a large defensive end is coming in on the right of Burrows to make the sack.  As this player is coming in for the sack one of Burrows teammates’ (#60) attempts to block the player (#93).  Burrows has just released the football and is in a very vulnerable position. He has just thrown the ball shifting his body weight anteriorly on to his front foot which is his left foot. His center of gravity has shifted over to his left where he lands down on his left leg. His left foot has also just plantar flexed to allow him to get up and over defenders to make the pass however this puts his ankle in an open packed position which gives him the least amount of stability. As he is coming back down on his left leg, a tremendous anterior force hits his knee (#93’s shoulder) causing a large hyperextension at the knee joint. This force is then meet with a huge valgus force as #93’s shoulder continues through the knee as Burrows is falling. His left cleat gets stuck under the body weight of both #93 and #60. The force moves from the anterior of the knee to the lateral aspect of the knee and you can see the tension and valgus force being applied on the medial aspect of Burrows knee.  Since his left foot gets caught underneath him his tibia is externally rotated, a huge twisting mechanism is happening at the joint as well. To add to this, the onrushing defender, (#90) is coming in for a tackle on the opposite side of the valgus force (to Burrow’s left knee). He follows through with this tackle and creates even more tension on the left knee by forcing his upper body in the opposite direction of where #93’s shoulder is forcing Burrow’s knee. To put it simpler #93’s shoulder is pushing Burrow’s knee medial as #90 comes in and forces his upper body lateral. The amount of tension and torsion these big, bodied football players are putting on Burrow’s knee joint is tremendous and is what ultimately causes the 3 injuries listed below.

3 possible Injuries-  2 intracapsular injuries (ACL & meniscus) 1 special (MCL)

Torn ACL- The ACL’s job within the knee joint (intracapsular) is to prevent the femur from sliding backwards on a fixed tibia. Ways to put stress on the ACL are hyperextension and awkward or sudden landings. These are both MOIs that occur at Burrows’ knee joint during the injury at 2:06 in the video. The hyperextension occurs as Burrows is impacted by #93’s shoulder. Within the knee joint this is forcing the femur backwards while the foot lands and the tibia stays fixed. The tension on the ACL here is huge. The left leg is just landing as the 300 plus pound #93 is coming in with his shoulder. The shoulder actually makes contact superior of the patella, which puts the initial force on the distal aspect of the femur forcing it backwards against the fixed tibia. The ACL has too much tension force on it and is torn. The external rotation plus the valgus force also creates a shearing force on the ACL which would also contribute to the complete tear.

To confirm this injury, I would perform an anterior draw test on Burrows left knee and I would find excessive anterior glide of the tibia on the femur with an empty end feel because it was a complete tear.

Torn MCL- The MCL’s job is to stabilize the knee joint on the medial aspect (Special ligament has attachments at intracapsular medial meniscus and extracapsular semitendinosus) The MOI of a MCL is a valgus force or a force that impacts the lateral part of the knee joint, “knocking the knee inward toward the midline”. This can be seen in Burrow’s injury after the hyperextension occurs. The impact of #93’s shoulder moves from an anterior impact on the knee to a lateral impact on the knee or a large valgus force. This puts extreme tension on the MCL. The tibia is fixed because Burrow’s left foot gets stuck under #93. The tibia is fixed in that position and the force of #93’s shoulder is applied on that lateral aspect of the knee (putting tremendous tension on the MCL) and he then lands down on the posterior of the tibia (gastrocnemius muscles). Burrows is still in an upright position with his upper body and #90 comes in on the opposite side finishing his tackle and putting more tension on the tibia by forcing the upper body in the opposite direction. With the 2 players applying force in the opposite directions, you can see the tension force on the MCL perfectly at 2:07.

To confirm this injury, I would perform a MCL test, and I would find gapping at the medial joint line because it was a complete tear.

Medial meniscus tear- The meniscus provides joint stability by deepening the articulation between the tibia and femur. They are shock absorbers and improve weight distribution. The MOIs for a medial meniscus tear are compression and torsion which can both be seen in Burrow’s injury at 2:07.  The left foot gets caught underneath #93 as he is falling, and it becomes fixed in an eversion position. When the foot is everted, the tibia is being externally rotated for this movement to occur. As #93 is falling on Burrows left leg with the foot everted it produces even more tibia external rotation putting an overwhelming torsion force on the tibia in relation to the femur (This is also related to why the MCL was torn because the MCL has fibers that attach to the media meniscus and the torsion force helped with the tearing of the MCL). This extreme external rotation paired with the knee being flexed as Burrow’s falls to the ground on that left leg causes a large compression force on the lateral meniscus because the lateral condyle of the femur has extreme compression on the lateral meniscus. The twisting motion plus the compression with a flexed knee caused the meniscus tear. (From the MOIs I would suspect a longitudinal tear).

To confirm this injury, I would perform an Apley’s compression test, and I would find that Burrow’s would have pain at knee joint line with clicking or catching during the rotation.

I would most likely not perform these tests right away because of the immense pain Burrow’s would be in. His leg would be extremely unstable due to him just experiencing an unhappy triad or a completely blown knee.