1. Basic Athletic Training Chapter 7 Knee and Thigh Edited by Gurchiek
PE 282 Introduction to Athletic Training

2. Chapter Objectives Identify the anatomy of the knee and thigh
Identify the steps in an evaluation format
Compare the common injuries to the knee and thigh
Demonstrate the principles of rehabilitation to the knee and thigh
Describe the preventive/supportive techniques and protective devices for the lower extremity

3. Anatomy
The knee is the largest joint in the body, but structurally weak
The instability of the knee is supported by four strong ligaments and 12 muscles
The femur (thighbone) is the longest and strongest bone in the body

4. Knee, Quadriceps, and Hamstring Anatomy
Bones
Ligaments
Cartilage
Muscles and tendons and their functions
Range of motion

5. The Knee

6. Bones of the Knee

7. THE KNEE JOINT: Structure
Modified Hinge joint
Two condyles of femur articulate with tibial plateaus
Patella articulates with patellar surface of femur

8. Fibula & Tibia
All quads insert here

9. Pelvic Girdle
Hamstrings Originate Here

10. Patellar Function Protects internal components of knee
Increases turning force of quadriceps
Decreases friction

11. Patella Anatomy

12. Gross Structure of Knee Anterior View

14. THE KNEE JOINT Structure The Meniscus (Semilunar Cartilage)
Menisci are circular rims of fibrocartilage
Lateral – “O” shaped
Medial – “C” shaped
Thick peripheral borders & taper to a thin inner edge

15. Function of the Menisci
Absorb Shock
Decrease Friction
Deepen the Articular Facet

16. Ligaments of the Knee Anterior View

17. Anterior View

19. Knee Ligament Function
Anterior Cruciate Ligament (ACL):
Prevents anterior displacement of tibia from femur
Posterior Cruciate Ligament (PCL):
Prevents posterior displacement of tibia from femur
Medial Collateral Ligament (MCL):
Prevents excessive medial (valgus) opening of knee
Lateral Collateral Ligament (LCL):
Prevents excessive lateral (varus) opening of knee

20. ACL Injury PCL Injury

21. Blow from Lat Side
MCL prevents Med Opening
Blow from Medial Side
LCL prevents Lat opening

22. Knee Movements

23. Varus
Valgus

24. Muscles of the Knee

25. Knee Extensors - Quadriceps

26. Knee Flexors - Hamstrings

27. Other Soft Tissues of the Knee

28. Evaluation Format History
Mechanism of injury (How did it happen?)
Location of pain (Where does it hurt?)
Sensations experienced (What did you feel?)
Previous injury (Have you injured your knee before?)
Have you ever injured your other knee?
Did you see a Dr. or Have X-ray or Rehab

29. Observation Compare the uninjured knee to the injured knee Look for
Bleeding
Deformity
Swelling
Discoloration
Scars, and other signs
of trauma

30. Palpation
Palpate the anatomical structures/joints above and below the injured site, then palpate affected area. Using bilateral comparison, these items should be palpated:
Neurological (motor and sensory)
Circulation (pulse and capillary refill)
Anatomical structures (palpate)
Fracture test (palpation, compression, and distraction)

31. Palpation of Anatomical Structures
Bones
Patella
Femur
Tibia - Tibial Tuberosity
Fibula – Fibular head and shaft
Soft Tissues
Medial Collateral Lig (med epicondyle of femur to tibia)
Lateral Collateral Lig ( lat epicondyle of femur to fib head)
Medial & Lateral Meniscus in joint line
Patellar ligament & tendon
Popliteal space behind knee

32. Special Tests
Look for joint instability, disability, and pain. Assess disability in the following areas:
Joint stability
Valgus/Varus, Anterior /Posterior Drawer, Patellar Apprehension
Muscle/tendon
Quads, Hams, Calf, Patellar Tendon and Ligament
Accessory anatomical structures
Meniscus, Bursa
Inflammatory conditions
Range of motion (active, assistive, passive, and resistive)
Pain or weakness in the affected area

33. Valgus Stress Varus Stress Test MCL Test LCL

34. Anterior Drawer Test Reduces hamstring involvement
At 90 degrees of flexion an attempt is made to translate the tibia anteriorly on the femur
A forward slide or mushy end-feel indicates a positive test
A positive test indicates damage to the ACL

35. Conditions that Indicate an Athlete Should be Referred for Physician Evaluation
Gross deformity
Significant pain
Increased swelling
Circulation or neurological impairment
Joint instability
Suspected fracture or dislocation
Abnormal sensations such as clicking, popping, grating, or weakness
Locked knee or excessive limited motion
Any doubt regarding the severity or nature of the injury

36. Common Injuries Contusions Ligament sprains Meniscus tears
Patellar tendinitis
Chondromalacia patellae
The female athlete’s knee
Osgood-Schlatter condition
Muscular strains

37. Knee Contusions MOI: Direct blow or falling on knee
Tx: PRICES, ROM Ex with ice, Pad when return to play
May involve bursa
Compression pad helps minimize swelling

38. Thigh Contusions MOI: Direct blow to Quads or Hams
Painful and disabling injury
S & S: Pain, swelling, spasm, & discoloration
Tx: PRICES, Conservative cryokinetics
Pad when return to play
Football thigh pad works well

39. Medial Collateral Ligament Sprains
MCL damaged by blow to lateral side (Valgus Force)
First Degree = MCL Stretched
Second Degree – partial tear of MCL
Third Degree – Complete tear of MCL
Prevent injuries with
Proper shoes
Quad and Ham strengthening
Treat with PRICES
Immobilize & Crutches if unstable

40. Lateral Collateral Ligament Sprains
LCL damaged by blow to medial side(Varus Force)
Treat as MCL sprain
Varus Force

41. Anterior and Posterior Cruciate Inj
When tibia slides forward out from under femur causes ACL injury
When tibia slides backward (posterior) out from under femur causes PCL injury
Rotation of femur on top of fixed tibia also causes injury to cruciate ligaments.
Treat initially with PRICES
Refer to physician for further evaluation

42. ACL Injury PCL Injury

43. Injuries to the Menisci

44. Injuries to the Menisci
Usually injured by twisting knee while weight bearing
Also injured by squatting and landing on stiff knee due to compression of the cartilage
MCL has attachment to medial meniscus
Do not have good blood supply – usually do not heal
Signs & Symptoms = knee may be locked, athlete complains of catching or grinding inside knee with pain, pain in joint line
Treatment: PRICES, place on crutches, refer to physician

45. Patellar Tendinitis
Patellar tendon attaches patella to tibia tuberosity
Injury caused by excessive stretch and strain to tendon due to running and jumping sports
PRICES is treatment, Dr. may prescribe something to reduce inflammation
Stretch hamstrings & strengthen quads – emphasize eccentric exercise in later stages of rehab – let pain and swelling be guide for intensity
May do well with patellar tendon strap

47. Chondromalacia Patellae
Degeneration and softening of cartilage on underside of patella
MOI: Overuse in running, jumping and squatting activities
May be predisposed to injury due to improper patellar tracking or size/shape of patella, or excessive lateral pull of quad muscles
Strengthen quads with straight leg raises, stretch hams
Ice before and after exercise to decrease inflammation
Use patellar grind test to check for chondromalacia

49. The Female Knee May have greater Q angle
Tendon dominant as opposed to muscle dominant male
Flat feet can lead to greater valgus stress at knee
Associated with weak hip abductors

50. Osgood-Schlatter Syndrome
Usually seen in adolescent athletes (growth plate open)
Patellar tendon pulls on tibial tuberosity increasing bone growth at tendon insertion causing inflammation
Condition can cause chronic knee pain
Aggravated by activity – relieved by rest
Treatment varies from rest to casting
Ice before and after exercise

52. Muscular Strains – Quads and Hams
Stretch or tear of muscles in the quadriceps or hamstrings
Common causes include poor strength, repetitive overuse, improper technique
During palpation note:
Soreness and point tenderness, check for step-off
Check AROM, PROM and RROM compare to uninjured side
Treat with ROM exercise, progressive resistive strengthening
Progressive walking – jogging- running – sprinting program

54. Rehabilitation Included in any rehabilitation protocol is:
Range of motion exercises
Resistive exercises
Cardiovascular/fitness activities
Sport specific activities
Return to competition guidelines
Full range of motion
Strength, power, and endurance are proportional to the athlete’s size and sport
No pain during running, jumping, or agility movements
No loss of function

55. Preventive/Supportive Techniques
Wrapping techniques for compression
Knee compression wrap
Wrapping techniques for support
Knee joint, hamstrings, quadriceps, hip flexor, and hip adductor wraps
Taping techniques for the knee, thigh and hip
Collateral knee
Hyperextended knee
Anterior cruciate
Patella tendon
Hip pointer

56. Preventing ACL Injuries in Females
Women 4-6 times more likely to tear ACL
Common mechanism of injury: non-contact torsion
Women—tend to land more straight-legged (ligament dominant)
Men—tend to land more with bent knee (muscular dominant)
Prevention program—shown to give significant reduction in ACL injuries. Includes:
Hamstring strengthening
Plyometric/agility drills
Proper biomechanics during landing
Knee over toes; avoid valgus position

57. Protective Devices Closed/open patella neoprene sleeve
Hinged knee brace
Knee brace
Lateral patella subluxation braces
Patella stabilizing strap
Patella tendon tendinitis braces
Patella tendon strap
Pre-patella bursitis protectors
Prophylactics knee brace: rehabilitative and functional
Sport-specific pads

59. Musculoskeletal Disorders
Bursitis
Dislocation
Fracture
Iliotibial band friction syndrome
Meniscal tear
Myositis ossificans
Osteochondritis dissecans
Popliteal cyst

60. Questions ?