1. The Knee
Denise Carita

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

3. 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)

4. 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

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

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

7. Muscular Restraints Lateral Muscles Tensor Fascia Late
Illiotibial Band

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

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

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

11. Meniscus Tears

12. Contusion

13. Fractures
Numerous Types
Open vs. Closed
Kevin Ware

14. 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

15. 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

16. 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 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

17. 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

18. 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

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