1. Unit 4: Knee

2. Anatomy
Bones:
Femur
Tibia
Fibula
Patella- “knee cap”

3. Anatomy Meniscus 2 fibrocartilages: Functions: Medial (C shaped)
Lateral (O shaped)
Functions:
Deepen articular facets of tibia
Cushion any stresses
Maintain space between femoral condyles and tibial plateaus

4. Anatomy Ligaments Anterior Cruciate Ligament (ACL)
Prevents the femur from moving posteriorly during WB
Limits anterior translation of tibia in non-WB
Posterior Cruciate Ligament (PCL)
Resists internal rotation of the tibia
Prevents hyperextension of knee
Limits posterior translation of tibia in non-WB

5. Anatomy Ligaments cont’d Medial collateral ligament (MCL)
Prevents valgus force
Lateral collateral ligament (LCL)
Prevents varus force

7. Muscles Knee flexion Knee extension External Rotation
Internal Rotation
Hamstrings
Gracilis
Sartorius
Gastrocnemius
Popliteus
Soleus
Quadriceps
Biceps femoris
Semitendinosus
Semimembranosus

8. posterior

9. anterior

10. Evaluation- History Mechanism of injury is really important Mechanics
How did it happen?
Overuse vs acute
How long has it been happening
Mechanics
Distinguishing between muscular, bony, or ligamentous injury
Type of pain
Did they hear or feel a pop? Clicking? Grinding?

11. Evaluation- Observation
Position of the patella
Baja, alta, squinting, frog-eyed
Knee position
Genu valgum, genu varum, genu recurvatum
Q-angle
Swelling

12. Evaluation- Palpation
Bones
Joint line – medial and lateral
Femoral condyles – medial and lateral
Tibial plateau
Head of fibula
Patella
Tibial tuberosity
Ligaments – MCL and LCL
Muscles – quadriceps, hamstrings, adductors, IT band

13. ROM Motion/movement Normal ROM Knee flexion 135-145 degs
Knee extension
0-2 degs

14. Evaluation- Special Tests
Muscle testing
Quadriceps
Hamstrings
Adductors
Abductors

15. Evaluation- Special tests
What it tests for…
Video
Varus stress test
LCL
Valgus stress test
MCL
Anterior Drawer
ACL
Lachman
Posterior drawer
PCL
McMurray’s test
meniscus
Obers test
IT band/TFL

16. Positive tests Lachman Valgus
Valgus

17. Knee injuries MCL sprain ACL sprain Meniscal injuries
Patellofemoral pain syndrome
Patellar tendinitis
IT band syndrome

18. Knee Injuries MCL Sprain
MOI: direct blow from the lateral side in a medial direction (valgus force) or from lateral tibial rotation
Signs and symptoms:
Instability of the knee joint
Pain in medial aspect
Swelling (depending on severity)
ROM changes
Treatment:
RICE
Crutches or splint
Gradual rehab
Refer to doctor depending on severity

19. Knee injuries
ACL sprain

20. Knee injuries Menisical injuries
MOI: weight bearing combined with a rotary force while the knee is extended or flexed
Signs and symptoms:
Swelling
Joint line pain
Loss of motion
Locking, catching, or giving away of joint
Treatment:
Conservative rehab
Refer to doctor  may need surgical intervention

21. Knee injuries Patellofemoral pain syndrome
lateral deviation of the patella as it tracks in the femoral groove
Tight hamstrings or gastroc
Tight lateral retinaculum
Tight IT band
Patella alta
Vastus medialis weakness
Signs and symptoms: dull ache in center of knee, patellar pain and crepitus, swelling
Treatment: stretching and strengthening program

22. Knee injuries Patellar tendinitis AKA jumpers knee
MOI: jumping, kicking, running (repetitively)
Signs and symptoms:
Pain and tenderness at the inferior angle of patella
Pain may progress depending on severity (after activity, during activity)
Treatment: ice, modalities, ice, rehab

23. Knee injuries IT band syndrome AKA runner’s or cyclist’s knee
MOI: length leg discrepancy, genu varum, pronated feet, muscular tightness
Signs and symptoms: pain along the lateral leg and knee
Treatment:
Correction foot alignments
Ice massage
Proper warm up and stretching

24. Rehab
In small groups come up with a 3 day ankle/lower leg rehab program
Show progression through the program
Pick one of these injuries:
ACL injuries
MCL injuries
Meniscus injuries
Quad strain
Hamstring strain

25. Rehab Exercises for knee rehab… Lunges Squats (DL and SL)
Bulgarian squats
Side shuffles with band
SL hopping