Download kNEE 2

KNEE INJURIES
• Review Gross and
Functional Anatomy.
• Discuss traumatic
injuries to the knee.
• Discuss overuse
injuries in and about
the knee.
KNEE INJURIES
• Discuss the signs
and symptoms of
the specific
injuries.
• Discuss causes and
treatments.
KNEE
(Anterior view)
BEHAVIORAL
CHARACTERISTICS
OF
STRUCTURES
AROUND THE KNEE
ANTERIOR CRUCIATE
LIGAMENT LOCATION
POSTERIOR CRUCIATE
LIGAMENT LOCATION
STABILIZING ROLE
OF THE
ANTERIOR CRUCIATE
LIGAMENT
HEAT SENSITIVE VIEWS
OF THE
ANTERIOR CRUCIATE
IN FLEXION
STABILIZING ROLE
OF THE
POSTERIOR
CRUCIATE LIGAMENT
HEAT SENSITIVE VIEW
OF THE POSTERIOR
CRUCIATE IN FLEXION
AND EXTENSION
A.C.L. and P.C.L.
LINKAGE
MEDIAL COLLATERAL
LIGAMENT DURING
FLEXION AND
EXTENSION
LATERAL VIEW OF KNEE
FLEXION and EXTENSION
PATELLO-FEMORAL
JOINT DURING FLEXION
AND EXTENSION
NORMAL KNEE MOTION
KNEE FLEXION-EXTENSION
takes place between the
bottom of the femur and the
top of the menisci.
TWISTING MOTION takes
place between the bottom of
the menisci and the tibia.
MENISCUS OF THE KNEE
Purpose:
Equalize weight
distribution across the
knee joint.
Shock absorption.
Coronary
Ligament
Medial is tighter
than the lateral.
Thus, there is
less mobility
medially.
MENISCAL INJURY
Medial Meniscus:
excessive external
rotation of the tibia.
Lateral Meniscus:
excessive flexion of
the knee.
MECHANISMS OF INJURY
 VALGUS
 VARUS
 HYPEREXTENSION
 HYPERFLEXION
 INTERNAL ROTATION
 EXTERNAL ROTATION
VALGUS
Distal bone
of the joint
moves away
from
midline of
the body.
X
Medial Support Complex
Not Shown:
Quads
Medial Head of
Gastrocnemius
Medial
Hamstrings
X
VARUS
Distal bone of
the joint
moves
towards the
midline of the
body
Lateral Support Complex
Not Shown:
Poplitius
Tendon
Head of the
Gastrocnemius
Iliotibial
Band
Biceps
Femoris M.
ANTERIOR CRUCIATE
ANTERIOR CRUCIATE
Posterior Cruciate
Ligament
Impact on
anterior tibia.
Rotation Affecting
Tension
Valgus with
External
Rotation of
the Knee.
M.C.L Deep,
Superficial
and A.C.L.
Mechanisms of Injury
MCL
Valgus of Knee
ACL
Valgus after MCL
Extension with tibia
in internal rotation.
Hyperextension.
PCL Valgus after MCL
and ACL.
Varus after LCL,ACL
Hyperflexion with
tibial internal
rotation.
Blunt trauma to
tibial tuberosity.
FCL
Varus of knee.
M.M.
External rotation
of the tibia.
Valgus to knee.
L.M.
Hyperflexion of the
knee.
SIGNS AND SYMPTOMS
OF LIGAMENT INJURY
(Not all symptoms have to be
present to indicate injury)
• Immediate pain ++++
• Feeling of tearing.
• Hearing unusual noises.
…. 2.
.. 2 Signs and Symptoms
• Feeling of ‘giving way’.
• Loss of function of the
joint
• Be cautious of the
‘painful’ and then ‘not
very painful’ knee.
REMOVAL FROM FIELD
(Non-weight Bearing)
Feeling of a
tearing or
popping in the
knee.
If pain, no pain.
REMOVAL FROM FIELD
(Non-weight bearing)
If complaining
of ‘not feeling
right’ or
feeling ‘funny’
REMOVAL FROM FIELD
Weight bearing
Minor pain with
full R.O.M.
Stand. Pain?
Slowly walk off
field with support.
Return to play only after the
athlete has been evaluated
by a physician.
Patello-femoral Pain
Syndrome.
Iliotibial Band Friction
Syndrome.
Osgoode Schlatter’s
Disease.
PATELLO-FEMORAL PAIN
SYNDROME
Causes:
. Excessive Q angle.
. Excessive pronation.
. Weak plantar flexors/inv.
. Weak V. Medialis/Tight Ham
Q ANGLE
(Quadriceps)
Two lines; ASIS
to MPP; the
other from TT
to MPP. Angle
of intersection
called ‘Q angle’.
Q
The greater the Q
angle, the greater
the tendency to
move the patella
laterally against the
lateral femoral
condyle. A large Q
angle plus strong
quad contraction
can dislocate pat.
Equal pressure distribution
across the back of the
patellae ensures proper
nutrition by inbibition.
Medial aspect of
Patellofemoral Joint has
hypopressure. Lateral
aspect has hyperpressure.
+
-
-
+
Signs and Symptoms of
Patello-femoral Pain Syn.
Painful crepitus of the knee.
Locking, catching of knee.
Swelling.
Loss of strength.
Activity worsens symptoms.
SUGGESTED TREATMENTS
• Strengthen Vastus
Medialis.
• Reduce Pronation.
• Stretch Hamstrings, ITB,
and Quads.
• Modify activities.
The greater the Q
angle, the greater
the tendency to
move the patella
laterally against the
lateral femoral
condyle. A large Q
angle plus strong
quad contraction
can dislocate pat.
“ My knee came apart
and went back together
again”.
For example, “I was
running forward, planted
on my right foot, cut to
my left and attempted to
push off with my right”.
SUBLUXED OR DISLOCATED
PATELLA
Lateral
Medial
DISLOCATED
PATELLA
If the patella is dislocated,
slightly flex the hip and
slowly extend the knee.
Usually the patella
relocates. If it does not, do
not force the patella medial.
There may be some
associated fractures (back
of the patella, lateral
femoral condyle). MEDICAL
Iliotibial Band
Friction
Syndrome
I.T.B.F.S. Predisposing
Factors
Tight Tensor Fascia Lata
and weak Gluteus Medius.
Genu Varum
Downhill Running
Training Errors
I.T.B.F.S. Treatment
• Modification of
Activity and
shoes.
• Stretching.
• Icing after activity.
• Strengthening.
Iliotibial Band
And
Hip Abductor
Stretch
OSGOODE
SCHLATTER’S
DISEASE
Osgoode Schlatter’s
Separation of the traction
epiphysis of the quadriceps
muscle.
Active pre-pubescent kids.
No gender bias.
Signs and Symptoms:
Pain increase with
activity.
Tibial tubercle is warm to
touch.
Pain on squeezing the
tibial tubercle from sides.
• Inform parents.
• Stop irritating activity.
• Icing the tibial tubercle.
• Stove-pipe casts are sometimes applied to ensure
rest.
• Return if asymptomatic.