The Knee Denise Carita

Anatomy Bones Joints Ligaments Menisci Muscles 4 total 3 total 5 total 12 total (that will be covered in class)

Joints and Ligaments Joints Ligaments Tibiofemoral Joint Patellofemoral Joint Proximal Tibiofibular Joint Ligaments Medical Collateral Ligament (MCL) Lateral Collateral Ligament (LCL) Anterior Cruciate Ligament (ACL) Posterior Cruciate Ligament (PCL)

Menisci Medial Meniscus Lateral Meniscus Vascular Supply “C” shaped Larger than Lateral Meniscus Lateral Meniscus “O” shaped Smaller than the Medial Meniscus Vascular Supply Poorer blood supply the more anterior you go Outer Portion (red zone) High blood supply Inner Portion (white zone) No blood supply

Muscular Restraints Anterior Muscles Rectus Femoris Vastus Lateralis Vastus Intermedius Vastus Medialis Sartorius Gracilis

Muscular Restraints Posterior Muscles Biceps Femoris Semitendinosus (Semi T) Semimembranosis (Semi M) Gastrocnemius Plantaris Popliteus

Muscular Restraints Lateral Muscles Tensor Fascia Late Illiotibial Band

Pathologies Alignment Issues Sprains Strains Meniscal Tears Contusions Patellar Pathologies “Growing” Related Pathologies Fractures Over-use Pathologies

Sprains Affect ligaments Can affect more than one ligament at a time Alex Morgan

Strains Affect Muscles and can affect more than one at a time Michael Owen

Meniscus Tears

Contusion

Fractures Numerous Types Open vs. Closed Kevin Ware

Special Tests Varus Stress Test Tests How to test Positive Test LCL ACL PCL Arcuate ligament Biceps femoris tendon IT Band Lateral head of the gastroc Posterior lateral capsule How to test Have the patient in a supine position Sit with the affected leg across your lap (between their legs) Grasp the leg with one hand at the ankle and the other on the medial knee Apply a varus force to the knee at 0 degrees flexion and then again at 30 degrees flexion Positive Test Pain Gapping Laxity Difference in end-fell Should be a hard end-feel

Special Tests Valgus Stress Test Tests How to test Positive test MCL Collision injury ACL PCL Medial retinaculum Posterior medial capsule How to test Have the patient supine and grasp their leg with one hand on the lateral knee and the other on their ankle Use your hand that is placed on the lateral knee to apply a valgus force to the knee Apply this force at 0 degrees flexion and 30 degrees flexion Positive test Pain over the MCL Gapping Laxity Difference in end-feel Should be a hard end-feel

Special Tests Lachman’s Tests How to test Positive test Specifics ACL Popliteus Posterior oblique ligament Posterior capsule Arcuate ligament How to test Have the patient in a supine position Put your bent knee, a taping block, or some sort of a prop under their upper leg placing the knee into 20-30 degrees of flexion Place one have on the distal quads and the other wrapped around the lower leg with your thumb on the tibial tuberosity Create an anterior displacement force to the tibial while keeping the upper leg stabilized Positive test Pain Gapping Laxity Difference in end-feel Specifics This test should be the first special test preformed in an on-field evaluation of the knee It should also be done quickly so that the muscles surrounding the knee to not tense up which could cause a negative test

Special Test McMurray’s Test How to test Testing Positive Have the person lay supine Bend their knee to 90 degrees of flexion while applying a valgus force and the tibia ER and bring them down into extension Then bring them back to 90 degrees of flexion and extend the knee with everything in the neutral position The last position is to bring their knee into 90 degrees of flexion and place a varus force on their knee with the tibia IR and bring their knee back into extension Testing Valgus position with ER Medial meniscus Neutral position Varus position with IR Lateral meniscus Positive Popping, locking, clicking This test can also come up negative depending on the location of the tear

Special Tests Apley’s Compression/ Distraction Test How to test Have the person lay prone on the table Bend their knee to 90 degrees Compress the tibia down into the knee joint and IR and ER it Then release that force and grasp around the ankle and pull the tibia into distraction Testing Compression With IR is lateral meniscus injury With ER is medal meniscus injury Distraction Ligaments Positive Pain produced by compression and reduced by distraction is indicative of meniscus tear

Thank You Thank you for participating Please take the post-test online users.rowan.edu/~carita06/PathandEvalOne.html