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Anatomy Bones Femur Tibia- total weight bearer of the femur Fibula- has nothing to do with knee movement Patella- largest sesamoid bone, has no ligament attachment, increases leverage of quads Anatomy cont. Cartilage- hard and smooth called menisci Between tibia and femur, fibrous tissue, attaches to tibia be collateral ligament, membrane like, blood supply from popliteal artery (very poor) Synovial fluid feeds menisci why it doesn’t heel well Cushioner Gives minor side to side stability There is a lateral and medial meniscus. Anatomy cont. Medial meniscus- c-shaped attaches medial collateral ligament Lateral meniscus- o shaped, no ligament attach Ligaments Cruciate Ligament - cross inside knee joint Prevent anterior and posterior movement in knee from occurring Anterior cruciate (ACL)- connects medial lateral femur condyle to the anterior tibia. Most commonly injured of the cruciate Posterior cruciate (PCL)- connects medial femur condyle to posterior of tibia. Major stabilizer of the 2 ligaments Collateral Ligaments Gives side to side stabilization Medial collateral ligament (MCL)- board, flat, connects upper condyle to upper tibia sheft, strongest of the two and most commonly injured Lateral Collateral Ligament (LCL)- 2-3 inches, cord like in shape, connects lateral condyle of femur to tip of tibia Knee Capsule Surrounds the knee, thickest in back, synovial membrane, includes bursea and connects supplies 2 quarts of synovial fluid/day, lubricates knee Bursea 18 bursea in the knee Deep infrapatellar- located below patella behind patella ligament of tibia Suprapatellar- below patella, in front of tibia Prepatella- between patella and skin Pes Anserine- between medial tibia and pes anserine muscle group Muscles 80% of stability Flexion Hamstrings- do 80% of work biceps Femoris (two joint muscle), semimembranous, semitendinsous. Gracilis, sartorius, gasroc, poplitis, planteris Muscles Extension Quads Vastus medialis- weakest Vastus lateralis- biggest and strongest Vastus intermedias- cant palpate Rectus femoris- 2 joint muscle Muscles External rotation- rectus femoris Internal rotation Pes sersine Semitnedinsous Sartorius Gracilis Popliteal semimembranosus Knee Exam History Acute- where is pain, type of pain, hear or feel anything, snap (cruciate), Grind or slip (Menisci), Tear (Collateral) How and where was blow taken What were yoou doing Was foot planted, swelling, discoloration, deformity Knee Exam Non Acute- Is the injury old or new Pain or discomfort sudden, gradual, when does it hurt How long does pain last Does it feel the same as last time you hurt it What causes pain What relieves pain did you hear or fell anything What type of shoes are used Surface What type of movement Was foot planted Posture test Test walking gate Measure quads and gasroc Knee Exam On the field Collateral test Lachman cruciate Menisci Joint line Point tenderness If no deformity or severe movement 2 man assist If yes- immoblize stretcher Knee Exam Palpation Both knees naked Start with something that does not hurt Pulse medial mallious Nerve- skin sensory Knee landmarks Knee Landmark Hamstring tendons Posterior Joint line IT band LCL Tibial plateau Joint line MCL Patella Tendon Patella VMO ROM Passive- Flexion and Extension Pain with passive motion joint injury Active – flexion, extension, abduction, and adduction Pain with active only muscle injury Stress Test Collateral- athlete on back test in valgus and varus stress. Place one hand on femur and other on Tibia. Test at full extension and 1o degree of flexion Lachmans cruciate test- one hand on femur and one on tibia. Little flexion 10-20 degree Posterior( PCL)- push tibia and pull femur Anterior(ACL)- push femur and pull tibia Stress Test Drawer Stress test (ACL and PCL)- knee at 45 degree Sit on athletes foot, thumbs on joint line, fingers around knee, relax tendons Pull up on tibia for anterior Push down on tibia for posterior Stress test Mensical test Palpation joint line McMurray Click Positioning- athlete laying on back, flex leg to chest passively, hand on joint line, rotate foot as doing internal rotation repeat lateral Positive test- pain, click with old tear Apley grind Positioning- athlete on stomach, knee at 90. Push down on foot. Internally and externally rotate foot. Stress Test Apley distraction- Tests for collateral ligament. Positioning- Athlete on stomach. Leg at 90 degree. Pull foot internally and externally rotate foot. Stress Test Patella apprehension- Tests for subluxation of the patella. Push patella to the outside Chondromalcia test- degeneration of posterior patella. Make c over knee with hand, push down and have athlete contact knee. I don’t recommend doing if you want your athletes to trust you again.
