1. Recognition of Knee Injuries
Evaluation & Treatment Standard 15
I WILL….describe common knee injuries, mechanism of injury, special test, and rehabilitation protocols.

2. The mission of the Cane Ridge Academy of Health Management is to provide a solid academic foundation in a nurturing environment that prepares students with the professional skills necessary for post-secondary academics and healthcare related careers.

3. Knee Injuries

4. Treatment
RICE
Crutches
Ace Wrap/Compression sleeve
Knee immoblizer

5. EFFUSION means SWELLING

6. Objective Measurement of Knee Swelling

7. Boney Anatomy Femur Tibia Fibula Patella Medial Condyle
Lateral Condyle
Tibia
Tibial Plateau
Tibial Tuberosity
Fibula
Fibular Head
Patella

8. Boney Anatomy Patellofemoral Joint Tibiofemoral Joint
Where the patella and femur articulate*
Tibiofemoral Joint
Where the tibia and femur articulate

9. Soft Tissue Anatomy Ligaments* Attach bone to bone Sprain Ligaments
Medial collateral ligament (MCL)
Lateral collateral ligament (LCL)
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)
Sprain Ligaments
Cruciate means “cross”

10. Soft Tissue Anatomy Muscles* Quadriceps Hamstrings Flex the knee
Rectus Femoris
Vastus Lateralis
Vastus Medialis
Vastus Intermedius
Vastus Medialis Oblique (VMO)
Extend the Knee
Hamstrings
Semitendinosus
Semimembranosus
Biceps femoris
Flex the knee
* Strain muscles

11. Anterior Anatomy
Posterior Anatomy

14. Soft Tissue Anatomy Tendons*: Attach muscle to bone Quadriceps tendon
Hamstring tendons
Patellar Tendon
Illiotibial Band (IT Band)

15. Soft Tissue Anatomy Articular Cartilage
Cartilage covering the articular surfaces of the bones forming a joint
Allows the bones of a slide smoothly against one another.
* Meniscus
A curved, fibrous cartilage that acts as a cushion between the ends of bones
Medial is torn most often
MOI - twisting motion

16. What’s wrong with these knees?

17. Knee Classifications

18. Ligament Injury Grades
Stretching of ligament
Little to no laxity
Firm end point*
Mild swelling
Some decreased ROM
Crutches if necessary
RICE and rehab
Continued bracing may be required
Grade 2
Partial tear of ligament
Slight laxity but no gross instability
Firm end point
Moderate swelling
Moderate to severe joint tightness w/ decreased ROM
Positive special test
Crutches
RICE and rehab
Return to play with brace
Grade 3
Complete tear of supporting ligaments
Complete loss of stability
No end point
Swelling and joint effusion
Loss of motion due to effusion and hamstring guarding
Positive special test
Crutches
RICE and rehab
Surgery may be necessary
Return to play in brace
Increased recovery time

19. Medial Collateral Ligament (MCL) Sprain
MOI:
Signs & Symptoms
Caused by valgus* stress from direct blow to lateral knee OR
Foot planted with toes turned out thigh internally rotates
ACL or meniscus damage can also occur
Swelling medial knee
Pain medial knee
Laxity - Grades 1, 2 or 3
Typically scar down and heal well with rehab…non-surgical approach

20. Lateral Collateral Ligament (LCL) Sprain
MOI
Signs & Symptoms
Caused by varus* stress from direct blow to knee OR
Foot planted and thigh externally rotates
Less common than MCL or ACL
Can damage the cruciate ligaments, IT band, and meniscus
Swelling lateral knee
Pain lateral knee
Can pinpoint LCL with knee in figure 4
Laxity - Grades 1, 2 or 3
Usually heals well with rehab and rest

21. Posterior Cruciate Ligament (PCL) Sprain
MOI
Signs & Symptoms
Fall on bent knee is most common mechanism
Most at risk during 90 degrees of flexion
Can also be damaged as a result of a rotational force
PCL prevents tibia from moving too far posteriorly
Swelling and pain posterior knee
Athlete may feel a pop or say their knee gave out
Knee effusion
Decreased ROM
Laxity - Grades 1, 2 or 3

22. Anterior Cruciate Ligament (ACL) Tear
MOI
Foot planted with toes turned out (external rotation) and upper leg rotates in (internal rotation)
Or contact forcing knee into hyperextension
Rotation biggest component
70% non-contact injury
Often can be accompanied with other injuries
Meniscus, MCL, or both
ACL prevents tibia from moving to far forwards

23. Higher incident in females!
Research has indicated that the following factors are contributing to ACL tears in females…
Biomechanical…Q-angle
Hormonal….menstruation
Environmental
Anatomical….notch

24. ACL Tear Signs & Symptoms Joint effusion* Joint instability*
Diffuse pain
Many times athlete feels a
pop or say their knee gave out
Loss of range of motion
Can have partial tears
Most are surgical cases

25. Meniscus Tears MOI Signs & Symptoms
Most common MOI is twisting with knee flexed/extended OR
Deep squatting
Medial meniscus is more commonly injured
Can be longitudinal, oblique or transverse
Swelling along joint line or effusion
Pain along the joint line
Decreased range of motion
Catching, popping or locking
Pain with twisting or squatting
Non-surgical or surgical
Repair or removal
Has poor blood supply

26. Iliotial Band (ITB) MOI Signs & Symptoms “Runners Knee”
Repetitive/overuse injury
Mal-alignment or structural asymmetries
Muscles imbalances
Weak core a factor
Can be the result of running on uneven roads
Increase in activities
Common in runners & bikers
Pain and tightness at the knee or hip

27. Injury???

28. Patella Dislocation MOI Signs & Symptoms
Patella moves out of patellar grove, usually laterally
Contact or non-contact.
Non-contact from twisting or quick change of direction.
Ligaments, cartilage and bone can be damaged as patella dislocates.
Occurs most often in adolescent females due to weak quad muscles and/or increased Q-angle
Usually has to be relocated by athletic trainer or doctor.
Subluxation* also possible
X-ray taken to view articular cartilage
Brace
Pain that decreases once relocated
Visual deformity
Swelling, pain and discoloration medially.
Positive apprehension test.

29. Hamstring Tear MOI Signs & Symptoms Acceleration Rapid Deceleration
Kicking
Over stretching
Hyperextension
Pain
Tenderness
Bruising
Swelling
Spasm
Difficulty Contracting

30. Patellar Tendonitis MOI Overuse: esp. jumping
Inadequate conditioning or stretching
Obesity
Patella Alta: Knee cap sits higher than normal
Signs and Symptoms
Pain
Swelling
Warmth
Stairs exacerbate

31. Special Test Anterior Drawer – ACL Posterior Drawer – PCL
Apprehension Test – Patella
Valgus stress – MCL
Varus stress – LCL
Deep Squat – meniscus
Swelling – objective & documentation

32. ROM Exercises
Heel Slides/Ankle pumps
Seated Bike
Mini-squats (if FWB)

33. Strengthening Quad sets…isometric Straight Leg Raise x 4 way…isometric
Thera band x 4…isometric (standing)
Ankle weights x 4….isotonic
Machines x 4…isotonic

34. Prophylactic Bracing

35. Knee Immobilizers

36. MRI Bone Bruising

37. Knee Injury Exit Ticket
What are the 4 stabilizing ligaments of the knee?
Define valgus and varus forces?
Which side of the knee does the patella dislocate?
What are some s/s of a meniscus tear? Which one is most often torn?
What is the MOI for an ACL tear?
What is the MOI for tearing a meniscus
What percentage of ACL tears are non contact?
4 factors that contribute to a higher incident of ACL tears in females?

38. Knee Injury Do Now….
Which set of muscles flex the knee?
What is the spongey material on the end of the bone called?
Define subluxation?
Which quad muscle controls the patella the last 30%?
Contrast sprain & strain
Which meniscus is most commonly torn?
What is the purpose of prophylactic bracing?
What 2 factors are contraindications of rehabilitation program progression?
Every rehab bout should end with what modality?

39. Osteoarthritis & total knee replacement

40. MRI ACL TEAR

41. Osteoarthritis

42. MRI Bone Bruising

43. MRI Meniscus Tear

44. MRI Bone Bruising

45. Tibia Tuberosity fracture & repair

46. Patella fracture & repair

48. ACL Tear