2. KNEE INJURIES Review Gross and Functional Anatomy.
Discuss traumatic injuries to the knee.
Discuss overuse injuries in and about the knee.

3. KNEE INJURIES Discuss the signs and symptoms of the specific injuries.
Discuss causes and treatments.

4. KNEE
(Anterior view)

8. BEHAVIORAL
CHARACTERISTICS OF
STRUCTURES
AROUND THE KNEE

9. ANTERIOR CRUCIATE LIGAMENT LOCATION

11. POSTERIOR CRUCIATE LIGAMENT LOCATION

13. STABILIZING ROLE
OF THE
ANTERIOR CRUCIATE
LIGAMENT

15. HEAT SENSITIVE VIEWS
OF THE
ANTERIOR CRUCIATE
IN FLEXION

17. POSTERIOR CRUCIATE LIGAMENT
STABILIZING ROLE
OF THE
POSTERIOR CRUCIATE LIGAMENT

19. HEAT SENSITIVE VIEW OF THE POSTERIOR CRUCIATE IN FLEXION AND EXTENSION

21. A.C.L. and P.C.L. LINKAGE

23. MEDIAL COLLATERAL LIGAMENT DURING FLEXION AND EXTENSION

25. LATERAL VIEW OF KNEE FLEXION and EXTENSION

27. PATELLO-FEMORAL JOINT DURING FLEXION AND EXTENSION

30. NORMAL KNEE MOTION
KNEE FLEXION-EXTENSION takes place between the bottom of the femur and the top of the menisci.
TWISTING MOTION takes place between the bottom of the menisci and the tibia.

31. Equalize weight distribution across the knee joint.
MENISCUS OF THE KNEE
Purpose:
Equalize weight distribution across the knee joint.
Shock absorption.

32. Coronary Ligament
Medial is tighter than the lateral. Thus, there is less mobility medially.

33. MENISCAL INJURY
Medial Meniscus: excessive external rotation of the tibia.
Lateral Meniscus: excessive flexion of the knee.

34. MECHANISMS OF INJURY VALGUS VARUS HYPEREXTENSION HYPERFLEXION
INTERNAL ROTATION
EXTERNAL ROTATION

35. Distal bone of the joint moves away from midline of the body.X
VALGUS
Distal bone of the joint moves away from midline of the body.

37. Medial Support Complex
Not Shown:
Quads
Medial Head of Gastrocnemius
Medial Hamstrings

39. Distal bone of the joint moves towards the midline of the bodyX
VARUS
Distal bone of the joint moves towards the midline of the body

42. Lateral Support Complex
Not Shown:
Iliotibial Band
Biceps Femoris M.
Poplitius Tendon
Head of the
Gastrocnemius

44. ANTERIOR CRUCIATE

45. HYPEREXTENSION

48. ANTERIOR CRUCIATE

51. Posterior Cruciate Ligament
Impact on anterior tibia.

54. Rotation Affecting Tension

55. Valgus with External Rotation of the Knee.
M.C.L Deep, Superficial and A.C.L.

57. Mechanisms of Injury MCL Valgus of Knee ACL Valgus after MCL
Extension with tibia in internal rotation.
Hyperextension.

58. PCL Valgus after MCL and ACL.
Varus after LCL,ACL
Hyperflexion with tibial internal rotation.
Blunt trauma to tibial tuberosity.

59. FCL Varus of knee.
M.M. External rotation of the tibia.
Valgus to knee.
L.M. Hyperflexion of the knee.

60. SIGNS AND SYMPTOMS OF LIGAMENT INJURY
(Not all symptoms have to be present to indicate injury)
Immediate pain ++++
Feeling of tearing.
Hearing unusual noises.
…. 2.

61. .. 2 Signs and Symptoms
Feeling of ‘giving way’.
Loss of function of the joint
Be cautious of the ‘painful’ and then ‘not very painful’ knee.

62. REMOVAL FROM FIELD (Non-weight Bearing)
Feeling of a tearing or popping in the knee.
If pain, no pain.

63. REMOVAL FROM FIELD (Non-weight bearing)
If complaining of ‘not feeling right’ or feeling ‘funny’

64. REMOVAL FROM FIELD Weight bearing
Minor pain with full R.O.M.
Stand. Pain?
Slowly walk off field with support.

65. Return to play only after the athlete has been evaluated by a physician.

67. Patello-femoral Pain Syndrome.
Iliotibial Band Friction Syndrome.
Osgoode Schlatter’s Disease.

69. PATELLO-FEMORAL PAIN SYNDROME
Causes:
. Excessive Q angle.
. Excessive pronation.
. Weak plantar flexors/inv.
. Weak V. Medialis/Tight Ham

70. Q ANGLE
(Quadriceps) Q
Two lines; ASIS to MPP; the other from TT to MPP. Angle of intersection called ‘Q angle’.

71. The greater the Q angle, the greater the tendency to move the patella laterally against the lateral femoral condyle. A large Q angle plus strong quad contraction can dislocate pat.

73. Equal pressure distribution across the back of the patellae ensures proper nutrition by inbibition.

74. Medial aspect of Patellofemoral Joint has hypopressure
Medial aspect of Patellofemoral Joint has hypopressure. Lateral aspect has hyperpressure. - + - +

76. Signs and Symptoms of Patello-femoral Pain Syn.
Painful crepitus of the knee.
Locking, catching of knee.
Swelling.
Loss of strength.
Activity worsens symptoms.

77. SUGGESTED TREATMENTS
Strengthen Vastus Medialis.
Reduce Pronation.
Stretch Hamstrings, ITB, and Quads.
Modify activities.

79. The greater the Q angle, the greater the tendency to move the patella laterally against the lateral femoral condyle. A large Q angle plus strong quad contraction can dislocate pat.

80. “ My knee came apart and went back together again”.
For example, “I was running forward, planted on my right foot, cut to my left and attempted to push off with my right”.

81. SUBLUXED OR DISLOCATED PATELLA
Lateral
Medial

82. DISLOCATED PATELLA

83. If the patella is dislocated, slightly flex the hip and slowly extend the knee. Usually the patella relocates. If it does not, do not force the patella medial. There may be some associated fractures (back of the patella, lateral femoral condyle). MEDICAL

84. Iliotibial Band Friction Syndrome

85. I.T.B.F.S. Predisposing Factors
Tight Tensor Fascia Lata and weak Gluteus Medius.
Genu Varum
Downhill Running
Training Errors

87. I.T.B.F.S. Treatment Modification of Activity and shoes. Stretching.
Icing after activity.
Strengthening.

88. Iliotibial Band
And
Hip Abductor
Stretch

89. OSGOODE
SCHLATTER’S
DISEASE

91. Osgoode Schlatter’s
Separation of the traction epiphysis of the quadriceps muscle.
Active pre-pubescent kids.
No gender bias.

92. Signs and Symptoms:
Pain increase with activity.
Tibial tubercle is warm to touch.
Pain on squeezing the tibial tubercle from sides.

94. Inform parents.
Stop irritating activity.
Icing the tibial tubercle.
Stove-pipe casts are some- times applied to ensure rest.
Return if asymptomatic.