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The Knee and Related
Structures
Chapter 16
Pages 384-409
Anatomy





Bony anatomy: femur, tibia,
fibula, patella.
Cartilage: medial and lateral
meniscus.
Ligaments:
 Anterior cruciate ligament
(ACL)
 Posterior cruciate
ligament (PCL)
 Medial collateral ligament
(MCL)
 Lateral collateral
ligament (LCL)
Muscles: grouped by
particular motions.
ROM: flexion, extension, and
rotation.
Prevention of Knee Injuries

Physical conditioning and rehabilitation
 Total body conditioning which should include strength,
flexibility, CV, muscle endurance, agility, speed, and
balance.
 Muscles around surrounding the knee must be as strong
as possible.
 Shoes
 Transition to soccer-type cleats especially with football.
 Functional and prophylactic braces
 Prophylactic knee braces are worn on the lateral surface
of the knee to prevent MCL-type injuries.
 Functional knee braces are worn to provide support to an
unstable knee following the return to activity.
 These braces are custom-fit.
 Designed to prevent excessive rotation.
Assessment Principles: History

Current injury:
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What were you doing
when the knee was hurt?
What position was your
body in?
Did the knee collapse?
Did you hear a noise or
feel any sensation at time
of injury?
Could you move knee
after injury?
Did swelling occur?
Where is pain?
Have you hurt knee
before?

Recurrent/chronic
injury:

What is your major
compliant?
When did you first notice the
condition?
Is there recurrent swelling?
Does the knee ever lock or
catch?
Is there constant or
intermittent pain?
Do you feel any
grating/grinding sensations?
Does your knee feel like it’s
going to give away?
What does it feel like when
you go up/down stairs?
What previous treatment
have you received?

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Assessment Principles:
Observation

Do knees appear to be symmetrical?
 Is one knee obviously swollen?
 Is muscle atrophy apparent?
 Does athlete walk with limp?
 Can the athlete fully bear weight?
 Can athlete perform half-squat to extension?
 Can athlete go up and down stairs with ease?
Assessment Principles: Palpation
and Special Tests


Soft tissue, bony
landmarks, joint line
should be palpated.
Special Tests:

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Valgus/varus stress test
(MCL/LCL)
Drawer test (ACL)
Lachman’s test (ACL)
McMurray’s test
(Meniscus)
Apley’s compression test
Functional tests
Knee Injuries
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MCL/LCL sprain
ACL sprain
PCL sprain
Meniscus injuries
Joint contusions
Bursitis
Runner’s knee
Fractured patella
Patella
dislocation/subluxation
Chondromalacia patella
Patellar tendinitis
Osgood-schlatter’s disease
MCL Sprain

MOI:


S&S:



Valgus force from lateral side or external rotation
of the tibia.
Joint stability should be tested immediately.
G 1, 2, 3
Treatment:

RICE for 24 hours, crutches, knee immobilizer for
2-5 days, ROM, isometrics, bike, and more
functional activities.

http://www.youtube.com/watch?v=Le8rMnL56w8
LCL Sprain

MOI:

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S&S:
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Laterally directed varus force from the medial side
or from internal rotation of the tibia.
Pain and tenderness over LCL, swelling and
effusion, laxity with varus stress test at 30
degrees.
Treatment:

Same as MCL.
ACL Sprain

MOI:
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External rotation of the foot and internal rotation of
the knee. Hyperextension.
S&S:
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Audible pop, rapid swelling, intense pain, positive
Lachman’s.
Treatment:
Immediate RICE, crutches, surgery, 3-5 weeks in
brace, 4-6 months in rehab, functional knee brace.
http://www.youtube.com/watch?v=LuClWeD9ouI&feature=related
http://www.youtube.com/watch?v=WcG0RylJ8yE&feature=related
http://www.youtube.com/watch?v=ctAP-1eOJxk&feature=related
http://www.youtube.com/watch?v=jMLFz-iIg4c
PCL Sprain

MOI:
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S&S:
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Knee is hyperflexed from falling with full weight on
the anterior aspect of the bent knee with the foot in
plantarflexion.
A pop in the back of the knee, tenderness and
swelling in the popliteal fossa, laxity with Posterior
Drawer.
Treatment:

RICE, non-operative for G 1and 2, quad strength.
G3 is controversial.
Meniscus Injuries

MOI:
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S&S:
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Weight bearing combined with rotational force while
extending or flexing the knee.
Medial meniscus has higher incidence of injury than the
lateral meniscus.
Effusion over 48-72 hours, joint-line pain, loss of ROM,
locking and giving away, pain with squatting.
Chronic lesions have recurrent swelling and muscle atrophy
around the knee.
Treatment:

RICE, arthoscopic surgery.
Joint Contusion
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MOI:
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S&S:
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Direct trauma. Especially the vastus medialis.
May appear to be a knee sprain.
Severe pain, loss of ROM, and signs of acute
inflammation.
Treatment:
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Compression and ice, and rest for at least 24
hours.
If swelling and pain are intense, refer to physician.
Protective padding.
Bursitis
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MOI:
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S&S:
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Acute, chronic, or recurrent.
Prepatellar and infrapatellar
bursae are the most often
irritated.
Continued falling and/or
overuse of patellar tendon.
Localized swelling above the
knee, redness, and increased
temperature.
Treatment:


Eliminate the cause, rest,
reduce inflammation.
Compression wraps and
NSAIDS.
Iliotibial Band Friction Syndrome

MOI:
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S&S:
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ITBS is an overuse condition commonly occurring in runners
or cyclists than can be attributed to malalignment and
structural asymmetries of the foot and lower leg.
Irritation is over the lateral femoral condyle.
Tenderness, mild swelling, increased warmth and redness
over the lateral femoral condyle.
Pain increases with running or cycling activities.
Treatment:

Stretching, correction of foot/leg alignment problems, ice,
decrease irritating activities, NSAIDS, transverse friction
massage.
Patellar Fracture &
Subluxation/Dislocation

Patellar Fracture

Caused by direct or indirect trauma.

Patellar Subluxation/Dislocation
 MOI:
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S&S:
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Plants foot, decelerates, and cuts in the opposite direction from the weight
bearing foot, thigh rotates internally and the lower leg rotates externally
causing a medially directed valgus force at the knee.
Displacement typically takes place laterally.
Complete loss of knee function, pain, swelling, and the patella rests in an
abnormal position.
Treatment:

Immobilization, ice, refer to physician, immobilized for 4 weeks, muscle
rehab, knee sleeve.

http://www.youtube.com/watch?v=XO6vtyO92tk&feature=related
Jumper’s Knee
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MOI:
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S&S:
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Jumping, kicking, or running
that places tension on the knee
extensor muscle complex.
May be a single acute injury or
a repetitive injury.
Patellar or quadriceps tendon.
Vague pain and tenderness
around the inferior portion of
the patella or posterior aspect
that worsens with jumping
and/or running.
Treatment:

Rest, ice, NSAIDS, brace or
strap, transverse friction
massage.
Osgood-Schlatter Disease
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MOI:
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S&S:
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Occurs in the rapidly growing immature adolescent’s knee.
Repeated pull of the patellar tendon at the tibial tubercle.
Bony callus forms.
Swelling, hemorrhage, gradual degeneration at the tibial
tubercle, severe pain with kneeling, jumping, and running.
Treatment:

Stressful activities are decreased from 6 months to 1 year,
padding, ice, isometric strengthening of quadriceps and
hamstring muscles.
Osgood-Schlatter Disease
Visual Aids Courtesy of the
Following Websites:
 http://images.medicinenet.com/images/il
lustrations/knee_joint.jpg
 http://www.gla.ac.uk/ibls/fab/tutorial/ana
tomy/knee6.html
 http://www.alimed.com/resources/comm
on/images/products/full/6513_d.jpg
 http://www.zadeh.co.uk/paediatricorthop
aedics/osgood-schlatter_1.jpg