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Knee Anatomy (1) Modified hinge joint Two distinct joints
flexion/ extension, internal/ external rotation Two distinct joints tibiofemoral joint Patellofemoral joint
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Knee Anatomy (2) Tibiofemoral joint condyles of the femur
very rounded medial condyle is larger than the lateral condyle Tibial plateaus flattened, very slightly concave “Screw home mechanism” required to reach full extension tibia rotates laterally on the femur to produce a locking of the knee
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Knee Anatomy (3) Patellofemoral joint Q angle patella femur
triangular shaped seasamoid bone: protect the knee joint femur Patellofemoral groove or trochlear surface Q angle The angle of pull of quadriceps on the patella normal is 13 degrees male/ 18 female
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Knee Anatomy (4) Menisci firbrocartilage discs
Functions: 1) deepen the tibial plateaus or joint 2) absorption and dissipation of force 3) congruency of the surface to improve wt distribution 4) nourishment and lubrication of joint surfaces Thicker along the lateral portion
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Menisci Cont Poor blood supply (only outer 1/3 receives direct blood supply) Fig 11-5-C Medial is C shaped; Lateral is O shaped The medial is more commonly injured because of its attachment to the MCL ligament & more securely attached to the tibia (which makes it less mobile)
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Knee Anatomy (5) 4 main ligaments- help stabilize knee jt
Medial Collateral (Tibial Collateral) prevents valgus & rotational forces/stresses Attaches to medial femoral epicondyle and anterior medial tibia Lateral Collateral (Fibular Collateral) prevents varus struss Attaches to lateral femoral epicondyle and head of fibula
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Knee Anatomy (6) Fig 11-9 Anterior Cruciate (ACL)
Prevents tibia from moving forward/ femur from going back attaches to lateral femoral condyle/ medial tibia at intercondylar eminence Posterior Cruciate (PCL) Prevents tibia from moving backward/ femur from going forward attaches to medial femoral condyle/ lateral tibia at intercondylar eminence
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Knee Anatomy (7) Bursa – Fig 11-2 C formed by joint capsule
function to reduce friction several: Suprapatellar: largest in body Prepatellar: between skin and patellar tendon (housemaids knee) Infrapatellar: below petella (superficial and deep) Pes anserine bursa- medial proximal aspect of tibia
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Knee Anatomy (8) Muscles-contribute to jt stability
Quadriceps (EXT): Vastus lateralis, vastus medialis, rectus femoris, vastus intermedius; quads also aid in patella alignment Hamstrings (Flex): Semitendinosus (IR), Semimembranosus(IR), Biceps Femoris (ER) Gastroc (Flex), Sartorius(Flex/IR), Gracilis (Flex/IR), & popliteus (Flex)
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Knee Anatomy (9) Blood supply – Fig 11-5 Nerve Supply
femoral artery to popliteal artery, then medial superior/inferior genicular, lateral superior/inferior genicular Nerve Supply Femoral nerve(Ant); Sciatic nerve (post) to tibial nerve and common peroneal nerve
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Prevention of Knee Injuries
Stretching and strengthening of knee (FS 11.1) Protective Knee Braces Three types: prophylactic, functional, and rehabilitative (Fig 11-6) Patellofemoral- Fig “Cho-Pat” strap: horseshoe knee sleeve Proper footwear- correct shoe for the correct surface
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Treatment of Knee Injuries
Normal acute protocol and NSAIDs Progression of cold to hot treatments Control swelling, fit for crutches if necessary,increase ROM and strength Return to competition the safest and quickest way possible thru rehab, functional activities, and sports specific activities
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MCL Injuries MOI: valgus stress or lateral forces, internal rotation
HOPS Pain and swelling over the medial joint, pn over medial epicondyle or medial tibia, + valgus stress test Tx hinged knee brace, treat symptoms, strengthen musculature, rule out meniscus tear with MRI; will heal by itself with conservative treatment; immobilize
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LCL Injuries MOI: Varus stress or medial forces HOPS Tx
Pain and swelling over the lateral joint, pn over lateral epicondyle or fibular head, + varus stress test Tx hinged knee brace, treat symptoms, strengthen musculature; immobilize; can heal by itself
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ACL Injuries MOI: HOPS Tx
Sudden deceleration, blow to lateral leg with the knee bent, foot fixed HOPS Immediate pain and swelling; hot knee; Pain “inside the knee”; knee “feels loose”, “something not right” + anterior drawer stress test and lachmans Tx depends on the severity, with 3rd degree = surgery; treat symptoms; immobilize
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PCL Injuries MOI: HOPS Tx
Fall on a bent knee; posterior force on tibia, hyperextension HOPS Immediate pain and swelling; hot knee; Pain in the popliteal fossa; knee “falling apart” knee “feels loose” + posterior drawer stress test, posterior sag test Tx depends on the severity, immobilized, strengthen knee musculature; surgery
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Menisci Injuries MOI: Twisting with foot fixed HOPS Tx
Pn over the joint line, catching/locking or giving out of the knee. Popping or clicking in joint line, swelling after activity with little heat, Pn with or deep squat Tx strengthen knee musculature, surgery if sx persist; recovery time depends on type of surgery and tear
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Patello Femoral Stress Synd.
Precursor: females, high Q angle, weak VMO, MOI: lateral riding of the patella HOPS dull achy pain in the center of the knee, pn with compression of the patella Tx isometric quad contractions, strengthen/stretch all surrounding musculature , closed chain exercises; knee braces; surgery last option
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Chondromalacia Degenerative condition of the articular cartilage of patella Precursor: females, high Q angle, weak VMO, MOI: lateral riding of the patella HOPS pain going down stairs, crepitation under patella Tx: knee sleeve, avoid knee bends’ strengthening of VMO; surgery last option
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Subluxing/ Dislocating patella
MOI: decelaration with cutting maneuver Other injuries that may occur with sub/dislocating patella: may tear the medial retinaculum and or quad tendon, bruise patella and lateral femoral condyle HOPS pop, violent collapse of knee, + Pattella Apprehension test, obvious deformity Tx: RICE, splint if able refer to a physician
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Patellar Tendonitis “Jumper’s knee” MOI: overuse HOPS Tx
Pn over the patellar tendon, crepitation in tendon, thickening of the tendon, pain after prolonged sitting, pn walking stairs, Tx Rest, eccentric quad strengthening, stretch hamstrings, treat symptoms, taping, bracing
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IT Band Friction Syndrome
Occurs when the IT band snaps over the lateral femoral condyle Precursor: distance runners, cyclist, large Q angle MOI: overuse HOPS Pn while running up and down hill, point tender over the lateral femoral condyle Tx Box 11-3; look at the shoes
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Osgood Schlatter Disease
Inflammation or partial avulsion of the tibial apophysis due to traction forces (Fig 11-14) Precursor: adolescent athletes (male 10-15; female 8-13) MOI: overuse; jumping and cutting type sports HOPS Pn over the tibial tuberosity, bony growth of tibial tuberosity; a knot will form Tx treat symptoms, padding, complete rest (may be needed); will usually grow out of condition
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SPECIAL TESTS Range of motion Stress Tests + Laxity; Note Pain
AROM N= 135 flex extension RROM Flexion with IR/ER- prone Extension - seated Stress Tests + Laxity; Note Pain Valgus = MCL; p.214 Fig 11-19 Varus = LCL; p.214 Fig 11-19 McMurray’s Click- Menisci
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SPECIAL TESTS (2) Stress Tests Anterior Drawer = ACL; p.214 Fig 11-18a
Posterior Drawer = PCL; p.214 Fig 11-18a Lachman’s= ACL; See class demonstration Posterior Sag = PCL; p.214 Fig 11-18b Patellar apprehension = Subluxing Patella; + sign is apprehension; p.214 Fig 11-20 Ober’s test = IT band contraction; + knee doesn’t fall into Adduction; p.215 Fig 11-21
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Links http://www.scoi.com/kneeanat.htm
- Anatomy Review
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Links http://www.arthroscopy.com/sp05018.htm- ACL Surgery
Step by Step of an ACL Surgery - Knee Scenario
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