Title: THE KNEE
1THE KNEE
2KNEE ANATOMY
- Bony Structures
- Femur thighbone
- Tibia larger shinbone
- Fibula smaller shinbone
- Patella Provides anterior protection and
increased leverage with knee extension
3KNEE ANATOMY
- Menisci Medial and Lateral
- Absorbs shock
- Provides stability to the knee
- Disperses lubrication synovial fluid
- Poor blood supply, no nerves or lymphatic
channels almost impossible to heal itself
4KNEE ANATOMY
- Stabilizing Ligaments
- Cruciate Ligaments
- ACL (Anterior Cruciate Ligament)
- PCL (Posterior Cruciate Ligament)
- Join the femur to the tibia in the center of the
knee joint - Provides large degree of stability for the knee
joint - Function To prevent the femur and tibia from
sliding and rotating away from each other
5KNEE ANATOMY
- Stabilizing Ligaments
- Collateral Ligaments
- Medial Collateral Ligament
- Lateral Collateral Ligament
- Function To prevent excessive sideways bending
of the femur and tibia/fibula
6ACUTE KNEE INJURIES
- Include ligament strains (most common), cartilage
tears, kneecap dislocations, kneecap fractures - May be caused by a twist of the knee that forces
the bones of the joint to separate (i.e. changing
directions or rapidly decelerating when running) - Symptoms Immediate pain, swelling and
instability
7ACL SPRAIN
- ACL sprain is a stretch, tear, or complete
rupture of the ligament - Cause
- A violent knee twist, usually when the foot is
fixed in place (as when cleats are stuck in the
ground) and the upper leg and/or body is rotated
8ACL SPRAIN
- Symptoms
- Immediate pain and a pop at the time of the
injury - A sensation as if the knee is coming apart
- Immediate dysfunction and instability followed by
swelling - Athlete will not be able to walk without
assistance
9ACL SPRAIN
- Athletes at Risk
- Primarily those involved in contact sports or any
sport where there are rapid changes of direction
when running (i.e. football, basketball, soccer,
field hockey)
10ACL SPRAIN
- Concerns
- The Terrible Triad - The medial collateral
ligament and medial meniscus are often injured
along with the ACL
11ACL SPRAIN
- Recovery Time
- If surgery is required, nine to twelve months of
rehabilitation is necessary before the athlete
can resume vigorous activities, though it may be
possible to start light running or cycling in
three months.
12MENISCUS INJURIES
- Involves damage to one or both of the two flat,
crescent-shaped pieces of cartilage that lie in
the knee joint between the femur and the tibia - Medial meniscus (inner knee) is five times more
likely to be injured than the lateral meniscus
(outer knee) - Meniscus injuries almost never heal by
themselves, therefore, surgery is often required
13MENISCUS INJURIES
- Cause
- Excessive twisting, turning, and compression of
the knee joint, possibly preceded by a single
small tear that worsens over time.
14MENISCUS INJURIES
- Symptoms
- Onset of symptoms is usually gradual
- Pain on the inner side of the knee joint during
sports - Pain when pressing on the joint line on the
inner side of the knee - Clicking or locking in the joint (caused by the
torn portion of the meniscus catching on the end
of the femur)
15MENISCUS INJURIES
- Concerns
- Left untreated, a torn meniscus may worsen to the
point where the entire meniscus has to be removed
instead of just repaired.
16MENISCUS INJURIES
- Recovery Time
- After arthroscopic surgery, the athlete can
expect to return to activities that put
rotational stress on the knee joint within four
to eight weeks afterwards - Strengthening exercises for the muscles of the
thigh should continue even after the athlete
returns to sports
17OVERUSE INJURIES
- Include meniscus wear tear, kneecap wear
tear, tendonitis conditions, and bursitis - Onset of symptoms is gradual
- Caused by excessive sports activity, but often
have an underlying risk factor - Risk factors are either internal or external
18RISK FACTORS
- Internal
- Usually involve deficits in strength and
flexibility of the surrounding muscles, tendons,
and ligaments - Also include anatomical abnormalities, such as
leg length discrepancies, abnormalities in hip
rotation or the position of the kneecap, bowlegs,
knock-knee, or flat feet
19RISK FACTORS
- External
- Include training errors, improper footwear, and
improper technique - Key Management of Overuse Injuries EARLY
INTERVENTION
20PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Causes
- It is believed that most kneecap pain is caused
by problems with kneecap alignment brought on by
various types of anatomical abnormalities or
deficits in strength and/or flexibility - This misalignment can lead to damage to the back
surface of the kneecap chondromalachia patella
21PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Anatomical abnormalities contributing to PFPS
- Flat feet
- Thighs that turn inward from the hip
- Q-angle greater than 15-20 degrees
- High-riding kneecaps
- Shallow femoral groove
- Looseness of the quadriceps tendon
22PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Strength and flexibility deficits that may
contribute to PFPS - Weakness and/or tightness in the quadriceps,
hamstrings, and calves - Weak inner quad muscle (vastus medialis) and a
comparatively strong outer quad muscle (vastus
lateralis) causing the kneecap to be pulled to
the outside
23PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Symptoms
- Onset of symptoms is gradual
- Usually, there is pain in front of the kneecap,
and frequently, in both kneecaps - Pain may be spread out, or localized along the
inner or outer edge of the kneecap - Pain intensifies during sports activity and
ceases when participation stops - Usually there is no swelling, although there may
be occasional puffiness in the knee
24PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Symptoms (Contd)
- Typically, pain develops when the person sits for
extended periods with the knee bent (i.e. long
car ride), as well as when walking up stairs - There may be an audible crunching, crackling in
the knee - Athlete may complain of the knee giving way
25PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Symptoms (Contd)
- Symptoms usually intensify with increased sports
activity levels and decrease when activity levels
decline
26PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Athletes at risk
- Primarily those engaged in sports involving
excessive amounts of running/squatting - Females gt Males
- Concerns
- Unlikely to clear up unless true causes are
identified and addressed
27PATELLOFEMORAL PAIN SYNDROME (PFPS)
- Recovery Time
- Both nonoperatively and after surgery, this
condition takes between six to twelve weeks to
resolve
28PATELLAR TENDONITIS JUMPERS KNEE
- Prevalent among athletes in jumping sports
- An inflammation of the tendon that connects the
tibia to the kneecap - One of the most common and troublesome overuse
injuries in sports - Develops in three phases
29PATELLAR TENDONITIS JUMPERS KNEE
- Phase one (mild) Pain is felt after activity
only and there is no effect on performance - Phase two (moderate) Pain is felt during and
after activity. The athlete can perform at a
satisfactory level. - Phase three (severe) Pain during and after
activity, and it is more prolonged. Pain may be
felt during daily activities. Sports performance
is affected.
30PATELLAR TENDONITIS JUMPERS KNEE
- Causes
- Repetitive jumping both the muscle contraction
necessary for the push-off and the impact forces
of the landing stress the tendon - Weak or inflexible thigh muscles predispose the
athlete to this condition
31PATELLAR TENDONITIS JUMPERS KNEE
- Athletes at risk
- Those engaged in sports that require dynamic
jumping, such as basketball and volleyball, as
well as weightlifters who perform squats - Concerns
- Healing is very slow because of poor blood supply
to tendons
32PATELLAR TENDONITIS JUMPERS KNEE
- Recovery Time
- Depending on the severity, this condition can
take anywhere from two weeks to several months to
resolve
33WHAT YOU CAN DO
- Depending on the severity of the injury, it may
be necessary to seek medical treatment as soon as
possible
34Questions