1. The Knee and Related Structures
Chapter 20

3. KNEE ANATOMY Bones Articulations femur fibula tibia patella
tibiofemoral
patellofemoral

4. ANATOMY cont. Menisci Ligaments Medial meniscus Lateral meniscus
Blood supply (3 vascular zones)
Versus hyaline cartilage
Ligaments
Medial collateral - MCL (deep & superficial)
Lateral collateral - LCL
Cruciates - ACL & PCL

5. ANATOMY cont. Joint Capsule Synovial Capsule Knee musculature
quadriceps group
hamstrings group
iliotibial band
gastroc, gracilis, sartorius, popliteus, plantaris
Patellar tendon

6. ANATOMY cont. Additional Knee Structures Bursa Popliteal fossa
Fat pads / plica
Nerves
Blood vessels

7. KNEE ALIGNMENT DEVIATIONS
Patellar malalignments
Genu valgum
Genu varum
Genu recurvatum
Q angle

8. KNEE INJURIES and CONDITIONS
FRACTURES
DISLOCATION
CONTUSIONS
SPRAINS
MENISCUS TEARS
The Unhappy Triad
SYNOVIAL PLICA SYNDROME

9. INJURIES cont. OSTEOCHONDRITIS DISSECANS PATELLAR DISLOCATION/SUBLUX
CHONDROMALACIA
OSGOOD-SCHLATTER’S DISEASE
LARSEN-JOHANSSON
JUMPER’S KNEE
ILIOTIBIAL BAND SYNDROME
ARTHRITIS - DJD

10. KNEE INJURY EVALUATION
HISTORY AND MECHANISM (MOI)
How did it happen / what happened?
previous injury or problems
acute or chronic problem
Sounds heard?
Returned to play?
PHYSICAL EXAM - SYMPTOMS
Pain, swelling, ROM, etc.
Areas of pain localized if possible

11. EVALUATION cont. SPECIAL TESTS ADDITIONAL SPECIAL TESTS
Valgus / Varus test
Drawer test
Lachman’s test (alternate Lachman’s?)
McMurray’s test
ADDITIONAL SPECIAL TESTS
X-ray and/or MRI
KT-1000
Apley’s, Slocum’s, Rotary instability tests?

12. Evaluation of Swelling
Sweep Test:
Determine swelling by manually moving the fluid in the knee from one side of the knee to the other.
Ballotable Patella Test:
Downward pressure on the patella is applied. A positive test is indicated by the patella bouncing back to its original position.

13. Tests for ACL Instability
Drawer Test
Lachman’s Test
Alternate Lachman’s Test
Modified Lachman’s Test
KT 1000 Arthrometer

14. Tests for PCL Instability
Posterior Drawer Test
Godfrey’s Test
Uses gravity to extenuate the posterior sag as noted by observation. Flex knees bilaterally to 90 degrees.

15. Tests for Rotary Instabilities
Clinically, athletes suffering from rotary instabilities will complain of the knee “going out”.
Slocum Drawer for Rotary Instability
Drawer test with int. & ext. rotation
Pivot Shift Test
Crossover Drill

16. Tests for Meniscal Tears
Meniscal injuries may often be in combination with other injuries to the knee, or they can be isolated. Immediate diagnosis is often difficult, but fortunately not an emergency.
McMurray’s Test
Apley’s Compression/Distraction Test

17. Additional Conditions
Infrapatellar Fat Pad
Bursitis
Other Patello-femoral conditions
Extensor Mechanism problems
Osgood-Schlatter’s Iliotibial band syn.
Larsen-Johansson disease - Pes Anserine syn.
Jumper’s knee Collapsing knee
Patellar tendon rupture

18. Knee Rehabilitation General Conditioning Weight Bearing
Knee Joint Mobilization
Flexibility
Muscular Strength
Neuromuscular Control
Bracing

19. Summary Knee Injuries are of Increasing Concern
Most common injuries are sprains of MCL, ACL, and LCL; meniscal tears, and patello-femoral problems.
Prevention Seems to be Difficult
Braces have limited effect
Evaluation and Management of Knee Injuries Experience
Rehabilitation Following Injury will Vary