2. The Knee and Related Structures Chapter 16

3. Vocabulary n Anterior Cruciate Lig. n Bursa n chondromalacia n Hemarthrosis n Joint capsule n Joint mice n Jumper’s knee n Knee plica n Larsen-Johansson disease n Meniscus n Osgood-Schlatter disease n Osteochondritis dissecans n Posterior cruciate lig.

4. Anatomy of the Knee Page 339 n Bony n Bony structure Femur: medial/lateral femoral condyle Intercondylar notch Tibia: Tibial tuberosity, tibial plateau Fibula: proximal fibular head Ligaments Medial collateral lig MCL.=Attaches medial femoral condyle to medial proximal tibia Lateral collateral lig.LCL= attaches lateral femoral condyle to prox. Head of fibula Anterior cruciate lig. ACL= attaches posterior surface of intercondylar notch to anterior surface of tibial plateau Posterior cruciate lig. PCL= opposite of ACL

5. Anatomy of the Knee n Meniscus n Shock n Shock absorber and keeps femur in place n Lateral n Lateral = O n Medial n Medial = C

6. Injuries to the knee n n Bursitis: Bursae of the knee: pg. 354 suprapatellar, prepatellar, infrapatellar, medial gastrocnemius, pretibial S/S= swelling, pain, some loss of function Rx.= RICE, NSAID’s, ultrasound

7. Injuries to the knee n n Sprains: n n 1st degree- pain, stable lig. Joint stiffness n n 2nd degree- pain, slight joint laxity, hemarthrosis, loss of function n n 3rd degree-initial pain then subsides, extreme joint laxity, loss of ROM n n Rx.- RICE, Knee immobilizer, crutches if needed, rehab program. 3rd degree requires surgery

8. n Tendonitis n patella tendonitis, jumper’s knee n S/S= pain while going up stairs, crepitation around patella tendon n Rx.- Ice NSAID’s, ultrasound, knee strapping n Osgood Schlatter Disease n occurs during the growing years, patella tendon pulls away from the tibial tuberosity. Bones are growing too fast. n S/S= pain over tibial tuberosity, loss of function, deformity. n Rx.= Rest, Ice, NSAID’s, donut padding, stretching quads without pain, gain strength in quads and hamstrings n Patella Dislocation n dislocates laterally n Due to excessive Q angle or muscle imbalance n Rx:: reduce, knee immobilizer for 4 weeks, Isometrics

9. Injuries continued n ACL rupture: n S/S= felt a pop, instant pain, externally rotated leg, knee feels loose. Positive Lachmann and Anterior drawer test n Rx: Knee immobilizer, crutches for pain, ace wrap and ice. Surgery n Unhappy Triad: n ACL,MCL,Medial meniscus n S/S: planted foot ext. rotated, and direct hit to lateral suface of the knee n Rx: same as the ACL and surgery

10. Knee evaluation n History How did it happen, when, where’s the pain, feel pop, injured before, point to the exact location where it hurts, does it feel loose, does it crack or pop when you walk, n Observation deformity, discoloration, swelling, limping or not n Palpation n Lat/Med femoral condyles, patella, prox. Head of fibula, tibia, Lig. =MCL/LCL, patella tendon, joint line, muscles/tendons

11. Knee Evaluation Cont. Functional tests ACL= Lachmann: Anterior Drawer: Pivot shift: MCL/LCL= Valgus/Varus at 0/30 degrees Meniscus= Applies grind McMurray click Other tests: apprehension for patella dislocation Ballotment, wipe out= swelling patellar grinding= chondromalacia