1. Knee

2. Terminology
Tibial Tuberosity: Boney protrusion where the patellar tendon inserts.
Femoral Condyles: Distal end of the femur.
Intercondyler Notch: An indentation in the distal femur where the anterior cruciate descends.
Quadriceps Femoris Muscle group: attach to the patella through the quadriceps tendon.

3. Terminology
Pes Anserine:“foot of a bird”, the insertion of the semitendinosis, sartorius, and gracilis to the anteromedial tibia
Unhappy Triad (Terrible Triad): Tearing of the anterior cruciate ligament, medial collateral ligament and the medial meniscus.
Varus Stress: Stress applied to the medial aspect of the knee.
Valgus Stress: Stress applied to the lateral aspect of the knee.

4. Terminology Direct trauma: A blow or fall on the knee.
Indirect trauma: violent contracture of the quadriceps
Distal pulses: pulses in the foot. The dorsalis pedis and the posterior tibial pulse.
Chondromalacia: A degenerative condition in which there is a wearing away of the cartilage on posterior patella.
Subchondral: Below the cartilage.

5. Bones Of The Knee Femur Tibia Fibula Patella Femur Patella Fibula

6. Condyles of the Knee
Lateral Condyle
Medial Condyle

7. Patellar Tendon
Tuberosity

8. Cartilage known as Menisci

9. Cruciate ligaments form an “X”

10. Primary and Secondary Motions of The Knee
1. Primary Motions
Flexion
Extension
2. Secondary Motions
Internal Rotation
External Rotation
Gliding Motion (a little)

11. Quadriceps Strongest muscle group in the body Vastus Medialis
Vastus Intermedius
Vastus Lateralis
Rectus Femoris
Responsible for knee extension

12. Hamstrings Biceps Femoris (long and short head) Semimembranosus
Semitendinosus
Responsible for knee flexion

13. Bursa Fluid sac acting as a cushion and lubricant in areas of friction
Suprapatellar - under patella (running)
Perpatellar - on top of patella (direct blow)
Anserine - below knee (running)

14. Medial Collateral Ligament Sprain
MOI: occurs most often in violently adducted and internally rotated knees.
Path: a tear or sprain in the MCL
S/S: swelling, pain, loss of stability, popping noise, (+) valgus stress test on MCL (may vary depending on degree of injury)
Tx: RICE, rehab-light weights, straight leg raises, whirl pool (if available), crutches for discomfort and degree of injury, MCL taping

15. Lateral Collateral Ligament Sprain
MOI: blow to inside of the knee (varus force)
Path: partial to complete tear of ligament
S/S: pain on lateral side of knee, swelling, positive varus stress test
Tx: RICE, crutches and referral to physician

16. Anterior Cruciate Ligament Sprain (ACL)
MOI: twisting of the knee, hyperextension of the knee, forward movement of the tibia on the femur
Path: Stretching or tearing of the ACL; secondary injuries: medial meniscus tear and medial collateral ligament sprain
Terrible Triad: ACL pathology WITH secondary injuries
S/S: A pop followed by immediate disability, pain, rapid swelling at the joint, feels like knee is coming apart
Tx: RICE, crutches, refer to doctor.

17. Meniscus Tear MOI: sudden twisting and compression
Path: tear of the meniscus
S/S: locking, swelling, pain, giving way
Tx: RICE, crutches, refer to doctor.

18. Patellar Subluxation or Dislocation
MOI: athlete plants their foot and changes direction.
Path: the quadriceps muscles attempt to pull in a straight line and in a result pulls the patella laterally.

19. Patellar Subluxation or Dislocation Cont.
S&S: Complete loss of knee function; pain and swelling
Tx: immobilize in the position it is in, place ice around the joint, see physician, use crutches.

20. Patellar Fractures
MOI: caused by direct or indirect trauma. Forcible muscle contraction, falling, jumping, and running can also cause a fracture.
Path: a severe pull of the patellar tendon against the femur when knee is semi flexed resulting in a fracture
S/S: causes hemorrhage and joint effusion, resulting in generalized swelling.
An indirect fracture causes capsular tearing, separation of bone. Tearing of the quadriceps tendon is also a sign.
Direct fracture involves bone separation.

21. Patellar Fracture Cont.
Tx: a cold wrap should be applied, followed by elastic compression wrap, splinting, crutches and Doctor referral.

22. Knee Dislocation
The most Serious knee injury is the dislocation of the tibiofemoral joint. THIS IS AN EMERGENCY!

23. Knee Dislocation Cont.
MOI: Direct blow to the anterior proximal tibia, forceful twisting, lateral blow to the knee.
S/S: Grossly displaced tibia, sever pain, swelling, and may have absence of distal pulses.
Tx: Calm athlete down, splint, and immediate transport to the hospital. Check distal pulses.