Download the knee joint - Doral Academy Preparatory

THE KNEE JOINT
CARE & PREVENTION OF ATHLETIC INJURIES
MS. HERRERA
FACTS
A.K.A
“TIBIOFEMORAL
JOINT”
A hinge joint
ROM: flexion and
extension
Unstable laterally
and medially
Anatomy
Bones:
Femur, tibia, fibula, and patella
Muscles:
Biceps femoris,
semitendonosis, and
semimembranosus
Rectus femoris, vastus
medialis, vastus lateralis,
vastus intermedius
Sartorius (longest muscle in
body) and gastrocnemius
Anatomy Cont’d
Mensicus (you have 2)
Medial mensicus (C-Shaped)
Lateral mensicus (O-shaped)
Made of????
Ligaments (purpose of each?)
Anterior cruciate ligament
Posterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament
Anatomy
Cont’d
Bursae
As many as
2 dozen in
the knee
Medial Collateral Ligament
Sprain (MCL)
•
MOI: direct blow from lateral side creating
excessive valgus stress
•
Excessive knee twist
MCL Sprain Cont’d
•
Categorized into 3 grades
•
Signs & Symptoms
(depends on grade)
•
Ligament fibers
torn/stretched
•
Pain, swelling (mildsevere)
•
TTP over MCL and
attachment sites
•
Loss of ROM, joint
stiffness, weak
•
+ valgus stress test
•
Management
•
Conservative tx
usually
•
Ice, e-stim,
ultrasound,
rehabilitation
•
Surgery is indicated
if MCL is sprained
along with the ACL or
PCL
Lateral Collateral Ligament Sprain
•
MOI: Blow to the medial side
of the knee causing a varus
force
•
Signs & Symptoms:
•
•
Pain, TTP over LCL,
swelling
•
Laxity with varus testing
Management:
•
Same as MCL
Anterior Cruciate Ligament
Sprain (ACL)
•
Prevents ant. movement of tibia
•
MOI: valgus force with tibia in
external rotation
•
Noncontact tears more common in
females
•
•
Why? Several reasons
Signs & Symptoms
•
Loud pop
•
Pain, laxity, immediate swelling,
and hemoarthrosis (?)
ACL Cont’d
•
Management:
•
Not repairing the ACL can lead to joint
degeneration. (examples?)
•
Should be repaired with surgery cause if not
it leads to knee instability
•
Before surgery rehab is usually given to
strengthen quadriceps. Why?
•
Surgery can be allo- or autoGRAFT
•
difference?
Posterior Cruciate Ligament Sprain
•
Purpose: To prevent
posterior translation of
the tibia.
•
MOI: Falling directly on a
bent knee
•
Signs & Symptoms:
•
Loud “pop” in back of
knee
•
pain, swelling,
tenderness over
posterior knee, laxity
PCL Cont’d
•
Management:
•
Conservative: Rehabilitation-some positive
outcomes have been reported.
•
Surgery to repair torn ligament.
•
Time frame for SX?
Mensicus Tears
•
Medial mensicus is MORE
commonly injured than
lateral mensicus.
•
•
Why? Lat. mensicus is
more mobile
MOI: Twisting force while
foot is planted, cutting
motion when running,
tears that occur overtime
due to high stress (i.e.
running)
Mensicus Tears Cont’d
•
•
Signs & Symptoms:
•
Swelling
•
Locking, clicking
•
Pain when squatting
•
Giving way
Management:
•
Conservative if person is not an athlete or tear is in a
vascular zone
•
Surgery: Indicated for high activity individuals
•
Can be repaired or resected depending on case
Joint/Muscle Contusions
•
A.K.A. “Charley Horse”
•
MOI: Direct blow to the thigh
•
Signs & Symptoms:
•
•
swelling and severe pain
•
Loss of ROM and strength
Management:
•
Rest, ice, light stretch
•
Complete ROM exercises
•
Apply pad for protection upon RTP
•
Complications: Myositis ossificans
Patellar Dislocations/Subluxations
•
MOI: planting leg, slowing down, and cutting
suddenly (most common MOI)
•
Signs & Symptoms:
•
Obvious deformity, severe pain, swelling,
complete loss of knee function
Patellar Dislocations/Subluxations
Cont’d
•
Management:
•
Keep athlete still and activate EMS
•
Splint and transfer to ER
•
Reduce dislocation
•
Crutches NWB for 4 weeks +
•
Rehabilitation with focus on quad
strengthening
Chondromalacia Patella
•
Wearing away of articular
cartilage on the posterior
patella
•
MOI: Most common
abnormal patellar tracking
•
•
Causes?
Signs & Symptoms:
•
Pain, swelling,
crepitus
•
Pain with running,
walking, stairs,
squatting
Osgood-Schlatter Disease
•
Pain in patellar tendon where it
attaches on the tibial tubercle.
•
Occurs in adolescents
•
Athlete may experience multiple
avulsions and in severe cases
COMPLETE avulsion.
•
Signs & Symptoms:
•
•
Severe pain when kneeling,
running, jumping
•
Inflammation
•
Enlarged tibial tubercle
Management: Rest, ice before and
after activity, strengthening of quads
and hamstrings
Patellar Tendinitis
A.K.A. Jumper’s Knee
•
Extreme tension/overuse of the
quads.
•
•
Signs & Symptoms:
•
•
Places stress on patellar tendon
Pain and TTP inferior to the
patella
Management:
•
Nsaids
•
Rest, Ice, Modalities
•
Rehab
•
Cross friction massage
Patellar Fx
•
MOI:
•
•
•
•
Direct impact
Management:
•
Activate EMS
•
Brace in extension
•
XRAY to confirm
•
Ice
•
Surgery
•
Rehab
Fall on the knee
Signs/Symptoms:
•
•
•
•
Obvious deformity
Intense Pain
Swelling, loss of
ROM
Unable to contract
quads
•
Prentice, William E. Arnheim’s principles of
athletic training 12th ed. McGraw-Hill, New
York Ny, 2006.