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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.