The Knee

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The Knee
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The Knee

• Anatomy
• Injuries (Mechanism/SignsSymptoms)
• Evaluation
• Surgical procedures
• Immediate Care
• Rehabilitation

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Anatomy

• Bones
• Ligaments
• Meniscus
• Bursa
• Muscles
• Tendons

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Bones

• Femur
• Tibia
• Fibula
• Patella

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Ligaments

• Medial Collateral
• Lateral Collateral

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Ligaments

• Anterior Cruciate
• Posterior Cruciate

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Meniscus

• Medial meniscus
• Lateral meniscus

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Bursa

• A bursa is a fluid-filled sac that functions as a
  gliding surface to reduce friction between
  tissues of the body.

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Muscles

• Quadriceps-function
• is knee extension.

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Muscles

• Hamstring-function is knee flexion.

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Tendons

• Quadriceps tendon
• Patellar tendon
• Hamstring tendon

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Knee Injuries

• Quadricep strain
• Hamstring strain
• Contusion
• Patellar/Quadriceps tendonitis
• Patellar/Quadriceps tendon rupture
• Patellar dislocation
• Condromalacia
• Osgood-Slatter disease
• Bursitis
• Meniscal tear
• MCL sprain
• LCL sprain
• ACL sprain
• PCL sprain

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Quadriceps strain

• Grade 1
• What are the symptoms?
• Tightness in the thigh.
• Unable to walk properly.
• Probably not much swelling.
• Trying to straighten the knee against resistance
  probably won't produce much pain.

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Quadriceps strain

• Grade 2
• What are the symptoms?
• Probably cannot walk properly.
• Occasional sudden twinges of pain during
  activity.
• The athlete may notice swelling.
• Pressing on the muscle causes pain.
• Straightening the knee against resistance causes
  pain.
• Unable to fully bend the knee.

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Quadriceps strain

• Grade 3
• What are the symptoms?
• Unable to walk properly without the aid of
  crutches.
• In severe pain.
• Bad swelling appearing immediately.
• A static contraction will be painful and might
  produce a bulge in the muscle.
• Expect to be out of competition for 3 to twelve
  weeks.

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Hamstring Strain

• Grade 1 What does it feel like?
• Might have tightness in the back of thigh.
• May be able to walk properly.
• Probably won't have much swelling.
• Lying on front and trying to bend the knee
  against resistance probably won't produce much
  pain.

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Hamstring strain

• Grade 2 What does it feel like?
• Probably cannot walk properly.
• May get occasional sudden twinges of pain during
  activity.
• May notice swelling.
• Pressing in causes pain.
• Bending the knee against resistance causes pain.
• Might be unable to fully bend the knee.

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Hamstring strain

• Grade 3 What does it feel like?
• Unable to walk properly without the aid of
  crutches.
• In severe pain.
• Bad swelling appear immediately.
• A static contraction will be painful and might
  produce a bulge in the muscle.
• Expect to be out of competition for 3 to twelve
  weeks or more.

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Contusion

• Caused by a direct blow to the muscle. Most
  likely to occur in the quadriceps.

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Hyperextended knee

• In this injury, your knee extends beyond its
  normally straightened position so that it bends
  back on itself.

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Quadriceps Tendonitis

• A person experiencing quadriceps tendonitis will
  have particular pain straightening the lower leg,
  or decelerating when walking. The major point of
  pain coming from above the kneecap.

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Patellar Tendonitis

• What is patellar tendonitis?
• Patellar tendonitis, also called jumper's knee,
  is inflammation in the band of tissue (the
  patellar tendon) that connects the kneecap
  (patella) to the shinbone (tibia).
• How does it occur?
• The most common activity causing patellar
  tendonitis is too much jumping. Other repeated
  activities such as running, walking, or bicycling
  may lead to patellar tendonitis. All of these
  activities put repeated stress on the patellar
  tendon, causing it to be inflamed.

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Patellar dislocation

• What is a dislocated patella? A dislocated
  patella occurs when the kneecap (patella) pops
  out from its normal position. This can occur as
  the result of force or, is more often related to
  a developmental condition that leads to an
  improper alignment of the kneecap with the
  thighbone (femur). This is sometimes called
  "unstable kneecap."

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Patellar tendon rupture
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Patellar fracture
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Dislocated Knee
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Chondromalacia

• Chondromalacia of the patella is the grating or
  grinding sensation during extension of the knee.
  The cause is thought to be related to overuse,
  trauma and/or abnormal forces on the knee, such
  as a mildly abnormal alignment of the patella
  (knee cap) and femur. Symptoms include knee
  tenderness, pain in the knee after sitting for a
  prolonged period of time, knee pain that is worse
  with stairs or getting out of a chair, and a
  grating sensation in the knee.

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Chondromalacia
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Chondromalacia
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Osgood-Slatter disease

• Osgood-Schlatter (OS) disease is one of the most
  common causes of knee pain in the adolescent.
• During periods of rapid growth, stress from
  contraction of the quadriceps is transmitted
  through the patellar tendon onto a small portion
  of the partially developed tibial tuberosity.
• This may result in a partial avulsion fracture
  through the a small portion of the partially
  developed tibial tuberosity. This may result in a
  partial avulsion fracture.

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Osgood-Slatter disease
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Bursitis

• Housemaid or Carpet layers knee. This is
  caused by direct trauma.

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Meniscal tear

• One may tear the meniscus by twisting the knee,
  pivoting, cutting or decelerating. In athletes,
  meniscal tears often happen in combination with
  other injuries such as a torn ACL (anterior
  cruciate ligament).

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Meniscal tear

• Signs and Symptoms
• Pain and clicking while walking or bending
  knee.
• Pain and clicking while going upstairs.
• Remedies RICE with medication, or surgery.

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Meniscal tears
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Meniscal injury tests
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Medial Collateral injury

• What causes Medial Collateral Ligament Sprain?By
  far the most common cause of medial collateral
  ligament sprain is a blow or sudden impact to the
  outside (lateral) of the knee joint. This causes
  the outside of the knee to collapse inward toward
  the midline of the body and the inside of the
  knee (where the medial collateral ligament is
  located) to widen and open up. This opening up
  stretches the ligament, which results in the
  injury.

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Medial Collateral injury

• What are the Signs Symptoms of Medial
  Collateral Ligament Sprain?
• The most common symptom of a MCL injury is pain
  around the inside of the knee joint. Also common
  is bruising and swelling.

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Medial Collateral tests
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Lateral Collateral sprain

• Apply everything from an MCL injury, except the
  mechanism of injury is a direct blow from the
  medial side of the knee.

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Anterior Cruciate sprain

• How is the anterior cruciate ligament
  injured?The ACL or anterior cruciate ligament
  is injured either through twisting the knee or
  through an impact to the side of the knee - often
  the outside.

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Anterior Cruciate sprain

• Signs and Symptoms
• Pain at time of the injury.
• Athlete and/or people in the area will hear a
  pop.
• Swelling.
• In the later stages when the swelling has
  decreased there may be instability in the joint.
• For a partial rupture pain may be felt on the
  Anterior Drawer test where the tibia is pulled.

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Female Anterior Cruciate injury

• NCAA study showed that women suffered ACL
  injuries four times more often in basketball
  three times more often in gymnastics and
  two-and-a-half times more often in soccer.

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Q angle
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Anterior Cruciate stress tests

• Anterior Drawer test

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Anterior Cruciate stress tests

• Lachman test

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Posterior Cruciate sprain

• Mechanism of injury
• PCL tears can occur when a football or soccer
  player falls on a bent knee. Motor vehicle
  accidents are another common cause of injury to
  the PCL. When the driver or passenger strikes the
  bent knee just below the kneecap (patella)
  against the dashboard, the force can tear the PCL
  and damage other ligaments, bones and muscles.

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Posterior Cruciate sprain

• Signs and symptoms
• Marked, immediate swelling (within three hours of
  the injury)
• Difficulty walking after the injury
• Painful to move the knee
• Occasionally, a feeling of instability, or the
  knee "giving way"

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Posterior Cruciate Sprain
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Unhappy Triad

• Medial Meniscus tear
• Medial Collateral ligament tear
• Anterior Cruciate ligament tear

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Unhappy Triad
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Knee Stress Tests

• Chondromalacia Test
• Apprehension Test- Patellar Subluxation
• Valgus Test- MCL
• Varus Test- LCL
• Anterior Drawer- ACL
• Lachmans Test- ACL

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Knee Stress Tests

• Posterior Drawer- PCL
• Sag Test- PCL
• McMurray Test- Meniscus
• Apley Compression Test- Meniscus