KNEE INJURIES

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KNEE INJURIES

• Review Gross and Functional Anatomy.
• Discuss traumatic injuries to the knee.
• Discuss overuse injuries in and about the knee.

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KNEE INJURIES

• Discuss the signs and symptoms of the specific
  injuries.
• Discuss causes and treatments.

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KNEE
(Anterior view)
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NORMAL KNEE MOTION
KNEE FLEXION-EXTENSION takes place between the
bottom of the femur and the top of the
menisci. TWISTING MOTION takes place between the
bottom of the menisci and the tibia.
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MENISCUS OF THE KNEE
Purpose Equalize weight distribution across the
knee joint. Shock absorption.
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Coronary Ligament
Medial is tighter than the lateral. Thus, there
is less mobility medially.
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MENISCAL INJURY
Medial Meniscus excessive external rotation of
the tibia.
Lateral Meniscus excessive flexion of the
knee.
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MECHANISMS OF INJURY

• VALGUS
• VARUS
• HYPEREXTENSION
• HYPERFLEXION
• INTERNAL ROTATION
• EXTERNAL ROTATION

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X
VALGUS
Distal bone of the joint moves away from midline
of the body.
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Medial Support Complex
Not Shown Quads
Medial Head of Gastrocnemius
Medial Hamstrings
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VARUS
Distal bone of the joint moves towards the
midline of the body
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Lateral Support Complex
Not Shown Iliotibial Band Biceps Femoris M.
Poplitius Tendon
Head of the Gastrocnemius
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ANTERIOR CRUCIATE
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HYPEREXTENSION
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ANTERIOR CRUCIATE
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Posterior Cruciate Ligament
Impact on anterior tibia.
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Rotation Affecting Tension
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Valgus with External Rotation of the Knee.
M.C.L Deep, Superficial and A.C.L.
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Mechanisms of Injury
MCL Valgus of Knee ACL Valgus after MCL
Extension with tibia in internal
rotation. Hyperextension.
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PCL Valgus after MCL and ACL. Varus
after LCL,ACL Hyperflexion with tibial
internal rotation. Blunt trauma to
tibial tuberosity.
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FCL Varus of knee. M.M. External rotation
of the tibia. Valgus to knee. L.M.
Hyperflexion of the knee.
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SIGNS AND SYMPTOMS OF LIGAMENT INJURY
(Not all symptoms have to be present to indicate
injury)

• Immediate pain
• Feeling of tearing.
• Hearing unusual noises.

. 2.
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.. 2 Signs and Symptoms

• Feeling of giving way.
• Loss of function of the joint
• Be cautious of the painful and then not
  very painful knee.

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REMOVAL FROM FIELD (Non-weight Bearing)
Feeling of a tearing or popping in the knee. If
pain, no pain.
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REMOVAL FROM FIELD (Non-weight bearing)
If complaining of not feeling right or feeling
funny
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REMOVAL FROM FIELD Weight bearing
Minor pain with full R.O.M. Stand. Pain? Slowly
walk off field with support.
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Return to play only after the athlete has been
evaluated by a physician.
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Patello-femoral Pain Syndrome. Iliotibial Band
Friction Syndrome. Osgoode Schlatters Disease.
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PATELLO-FEMORAL PAIN SYNDROME

• Causes
• . Excessive Q angle.
• . Excessive pronation.
• . Weak plantar flexors/inv.
• . Weak V. Medialis/Tight Ham

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Q ANGLE
(Quadriceps)
Q
Two lines ASIS to MPP the other from TT to
MPP. Angle of intersection called Q angle.
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The greater the Q angle, the greater the tendency
to move the patella laterally against the lateral
femoral condyle. A large Q angle plus strong
quad contraction can dislocate pat.
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Equal pressure distribution across the back of
the patellae ensures proper nutrition by
inbibition.
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Medial aspect of Patellofemoral Joint has
hypopressure. Lateral aspect has hyperpressure.
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Signs and Symptoms of Patello-femoral Pain Syn.
Painful crepitus of the knee. Locking, catching
of knee. Swelling. Loss of strength. Activity
worsens symptoms.
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SUGGESTED TREATMENTS

• Strengthen Vastus Medialis.
• Reduce Pronation.
• Stretch Hamstrings, ITB, and Quads.
• Modify activities.

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The greater the Q angle, the greater the tendency
to move the patella laterally against the lateral
femoral condyle. A large Q angle plus strong
quad contraction can dislocate pat.
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My knee came apart and went back together
again.
For example, I was running forward, planted on
my right foot, cut to my left and attempted to
push off with my right.
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SUBLUXED OR DISLOCATED PATELLA
Lateral
Medial
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DISLOCATED PATELLA
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If the patella is dislocated, slightly flex the
hip and slowly extend the knee. Usually the
patella relocates. If it does not, do not force
the patella medial. There may be some associated
fractures (back of the patella, lateral femoral
condyle). MEDICAL
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Iliotibial Band Friction Syndrome
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I.T.B.F.S. Predisposing Factors
Tight Tensor Fascia Lata and weak Gluteus
Medius. Genu Varum Downhill Running Training
Errors
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I.T.B.F.S. Treatment

• Modification of Activity and shoes.
• Stretching.
• Icing after activity.
• Strengthening.

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Iliotibial Band And Hip Abductor Stretch
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OSGOODE SCHLATTERS DISEASE
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Osgoode Schlatters
Separation of the traction epiphysis of the
quadriceps muscle. Active pre-pubescent kids. No
gender bias.
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Signs and Symptoms Pain increase with
activity. Tibial tubercle is warm to touch. Pain
on squeezing the tibial tubercle from sides.
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• Inform parents.
• Stop irritating activity.
• Icing the tibial tubercle.
• Stove-pipe casts are some- times applied to
  ensure rest.
• Return if asymptomatic.