1. The Knee Anatomy Assessment Injuries

2. Anatomy Hinge joint: flexion and extension Bones: tibia, fibula, femur, patella Menisci: medial and lateral Ligaments: cruciate and collateral Muscles

3. Menisci Cartilage btwn femur and tibia Cushions and shock absorption Help stabilize knee

4. Ligaments, Cruciate Anterior Cruciate Lig. (ACL): prevents knee from moving front to back Posterior Cruciate Lig. (PCL): stronger, prevents hyperextension

5. Collateral Ligaments Medial Collateral Lig. (MCL): prevents knee from valgus or outside forces Lateral Collateral Lig. (LCL): prevents knee from varus or inside forces

6. Muscles Extension: Quadriceps Flexion: Hamstrings Iliotibial Band: lateral stabilizer

7. Assessment History: where, how, pops, swelling, previous injury, sudden or gradual onset? Observation: walking, stairs Palpation: intra- or extracapsular Special Tests

8. Valgus: MCL Varus: LCL Anterior Drawer: ACL Lachman: ACL Pivot-shift: ACL Posterior Drawer: PCL Sag test: PCL

9. Meniscal Tests McMurray’s Apley Compression and Distraction

10. Patella Examinations Q Angle: Angle of thigh to knee Male: 10 degrees Female: 15 degrees Over 20 considered excessive

11. MCL Sprain Result from blow to lateral side or outward twist Test immediately after injury As laxity inc. so does grade

12. LCL Sprain Common in skiers (skis cross forcing body weight forward) Treatment similar to MCL Quad strength, ROM

13. ACL Sprain Most serious knee injury Caused by twisting motions (hit or making a cut) Feeling of “pop” and instability Unhappy Triad injury to MCL, ACL and medial meniscus (soccer, football)

14. ACL Surgery Generally required Grafts: patella tendon, hamstring, or cadaver Lots of rehab to restore atrophy

15. PCL Sprain Most important ligament in knee 95% of support against hyperextension Injury occurs when excessively hyperextended or fall on bent knee “pop” in back of knee

16. Meniscal Tears Medial  ”C” shaped Lateral  “O” shaped, more mobile Medial most common to tear Torn by twisting motions Feeling of catching and pain down stairs

17. Types of Tears and Treatment Bucket handle Parrot beak Arthroscopic surgery to remove torn portion or stitch together

18. Patella Dislocations Cutting mechanism Usually displaces laterally Treatment: reduce patella, RICE, and send for X-ray Avoid knee flexion

19. Osgood-Schlatter Disease Apophysitis at attachment of patella lig. to tibial tubrical Usually resolves btwn 18-20 yrs. Treatment: ICE, US, patella band

20. Larson-Johansson Disease Similar to Osgood-Schlatter except at distal patella Pain with kneeling, jumping, and running Treatment: same as O-SD

21. Jumper’s Knee Patella tendonitis Treatment: reduce inflammation, NSAIDS, friction massage, US, ICE Some like patella bands

22. A football running back is hit on the lateral surface of his knee by an opponent making a tackle. He has significant pain and some immediate swelling on the medial surface of his knee. What is the suspected injury and what tests can be done to determine the nature and extent of the injury? List and describe the tests.

23. A lacrosse player carrying the ball attempts to avoid a defender by planting his right foot firmly on the ground and cutting hard to his left. His knee immediately gives way, and he hears a loud pop. He has intense pain immediately, but after a few minutes he feels as if he can get up and walk. What ligament has most likely been injured? What stability tests should be done? List and describe the tests.