Introduction to Athletic Training Fall 2013

The knee is a hinge joint What motions occur at the knee? Flexion Extension What do you already know about the knee?

Femur Tibia Fibula Patella

Lateral epicondyle Medial epicondyle Patellofemoral groove

Tibial tuberosity What attaches here? Patella tendon Tibial plateau What rests here? Medial & lateral menisci

Fibular head

Anterior Cruciate Ligament Posterior Cruciate Ligament Medial Collateral Ligament Lateral Collateral Ligament

ACL Prevent anterior translation (forward movement of tibia on femur) PCL Prevent posterior translation (backwards movement of tibia on femur) LCL Provide lateral stability MCL Provide medial stability

Medial femoral epicondyle Lateral femoral epicondyle Patella Tibial tuberosity Tibial plateau Tibia Fibula Fibular Head Lateral Collateral Ligament Medial Collateral Ligament

Quadriceps Rectus femoris Vastus medialis Vastus lateralis Vastus intermedius Cause what action? Extension

Hamstrings Biceps femorus Semimembranosis Semitendinosis Cause what action? Knee flexion

Calf Muscles = Gastroc-soleus Complex Gastrocnemius Soleus Cause what action? Gastroc. helps with knee flexion

Patella tendon Quadriceps tendon Quadriceps Rectus femoris Vastus medialis Vastus lateralis Hamstrings Biceps femoris & tendon Semimembranosus Semitendinosus Gastrocnemius tendons Gastrocnemius

Knee flexion ~135 degrees Knee extension 0-10 degrees Measuring ROM Fulcrum – lateral epicondyle of femur Stationary arm – midline of fibula Moving arm – midline of femur

Leandro Barbosa (basketball) Victoria Azarenka Sara Tucholsky Jamaal Charles

What stabilizes the knee? Menisci, ligaments, tendons, muscles What can we do to make the knee more stable? Strengthen surrounding musculature (hamstrings, quads)

Excess weight “For every pound of weight lost, there is a four pound reduction in knee joint stress.” Biomechanical problems Leg length discrepancy, patellar tracking, angle of hips/knees Lack (or imbalance!!) of muscular strength or flexibility Certain sports Example: female soccer and basketball players predisposed to ACL injury Previous injury

PEP Program Designed by the Santa Monica Sports Medicine Research Foundation 5 Sections Warm Up Strengthening Plyometrics Agilities Stretching

Patellofemoral Syndrome (Chondromalacia) S/S Achiness around patella Increases with prolonged sitting Grinding with flexion and extension Treatment/prevention Strengthen quadriceps (especially vastus medialis) Quad./hamstring flexibility

Patellar Dislocation of Injury Patella is forced laterally Occurs when knee is bent and forced into internal rotation. Soccer patella dislocation:

Signs/symptoms Deformity Pain Should AT’s reduce a patellar dislocation? NO!!! Refer to physician Rehabilitation Brace for support Restore ROM Improve strength

Patellar Tendinitis Chronic Predisposing factors Running Jumping Signs/symptoms? 3 Stages 1: Pain after activity 2: Pain during & after activity 3: Pain during & after for a prolonged amount of time. Rehab/Prevention? Rest/Avoid aggravating activities Chopat strap Strengthening leg muscles Stretching leg muscles If untreated, can lead to? Patella tendon rupture (tear)

Osgood – Schlatter Disorder Repeated avulsion fractures at the tibial tuberosity. More common in young athletes Peaks around 16 – 17 years old Predisposing factors? Running Jumping Treatment?

Anterior Cruciate Ligament ACL prevents what? Anterior translation of tibia against femur Mechanism of Injury Quick change of direction Twisting motion at the lower leg Hyperextension

Signs and Symptoms of ACL Tear A small pop can be heard or felt Limited ROM due to swelling, pain Swelling Instability Pain in back of knee Immediate Treatment? PRICES Long Term Treatment? Surgery (3 Graft types – patella tendon, hamstring, cadaver) Post – Op rehabilitation for ~6 months

Posterior Cruciate Ligament Prevents? Posterior translation of tibia against femur Mechanism of Injury Falls and lands on bent knee Forced hyperflexion Blow to front of tibia

PCL Signs/symptoms Pop may or may not be heard Mild swelling Initial Treatment? PRICES Long term treatment? Surgery not required depending on individual Rehabilitation Strengthening of quadriceps How does a PCL tear differ from an ACL tear?

Medial Collateral Ligament Mechanism of Injury Valgus stress S/S Grades 1 – 3 (mild  severe) Treatment/Rehab PRICES Mild – elastic wrap for compression/support Moderate/Severe – immobilizer Strengthen which muscles? Hip adductor muscles

Lateral Collateral Ligament Mechanism of Injury Varus force Blow from the medial side S/S Grades 1 – 3 (mild  severe) Treatment/Rehab Surgery required to repair Similar to MCL injury EXCEPT… Strengthen the hip abductors instead

Function of menisci Shock absorption Stability M.O.I. Twisting movement Hyperflexion/hyperextension S/S Pain the joint line Weight bearing Catching and locking Loss of motion (both flexion & extension)

Treatment/Rehabilitation Need for surgery depends on what? Severity of tear Rehabilitation depends on type of surgery… Menisectomy (removal of tear) 4 – 6 weeks until athlete may return to play Meniscus repair (stitch the tear and anchor to joint capsule) 3 – 6 months until athlete may return to play

You are covering a girls’ soccer game. During a transition in game play one of the players goes down and does not get back up. When you get over to her, she is in considerable pain. She says she felt a pop “inside” her knee when she changed directions. She has some loss of motion and swelling on either side of her patella. After you help her up to move off the field she is hesitant to put weight on it because it’s painful and feels like it’s going to give out again. ACL Tear

A middle school basketball player enters the athletic training room complaining of pain in the anterior part of his right knee along his patellar tendon. He used to just have pain after he finished practices and games, but is starting to have pain during AND after activity. It has been bothering him for about a month. There is some thickening of the patellar tendon and it is painful to palpate. Patellar tendinitis

A tennis player enters the athletic training room with knee pain. She says that during a match yesterday she planted her foot and pivoted, trying to make a play. She doesn’t remember feeling or hearing any pops, but has been having a significant amount of pain in her knee that hasn’t gotten any better. She says that her pain increases when she goes up or down the stairs. She’s also starting to notice that her knee feels like it’s catching or locking when she flexes and extends it. Upon palpation you notice that most of her pain is located along the tibial plateau (or joint line). Meniscus tear