Knee to know
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Knee to know Knee to know Presentation Transcript

  • KNEE- ANATOMY by A.Arputha Selvaraj
  • The Knee • Bones o Femur o Patella • Largest Sesamoid bone in human body o Tibia o Fibula • Non-weight bearing bone • Articulations o Four Articulations • Femur and Tibia • Femur and Patella • Femur and Fibula • Tibia and Fibula
  • • Meniscus o Two oval fibrocartilages that sit in the tibia • Semi-lunar (half moon shape) o Stabilize the knee • Especially the medial, when the knee is flexed at 90 degrees o Medial • C-shaped • Attach to the tibia, joint capsule by the coronary ligament, and the semimenbranous muscle (hamstring) o Lateral • O-shaped • Attached to the tibia, loosely to capsule, and popliteal tendon, and ligament of Wristberg o Blood Supply • Divided into 3 circumferential zones o Red –Red o Red-White o White-White • Avascular
  • 3 Zones of Meniscus
  • • Stabilizing Ligaments o Account for a considerable amount of knee stability o Two ligamentous bands that cross one another within the joint capsule of the knee • Anterior Cruciate Ligament (ACL) o 3 twisted bands o Prevents the femur from moving posteriorly weight bearing and anteriorly non-weight bearing. o Stabilizes the tibia from excessive internal rotation (IR) • Posterior Cruciate Ligament (PCL) o Resists IR of the tibia o Prevents hyperextension of the knee
  • ACL & PCL
  • Common Cause of ACL Tear
  • Common Cause of PCL Tear Situations in which the PCL can tear include - excessive hyperflexion (forced bending), eg falling onto the shin with a bent knee and foot pointed dashboard injury in a car - where the knee is bent to a right angle and a sudden force drives the tibia backwards
  • • Medial Collateral Ligament o Superficial ligament(MCL) is separate from the deeper capsular ligament. o Attaches above the join line on the medial epicondyle of the femur and below on the tibia – Just beneath the attachment of the pes anserinus (hamstring tendons) o Deep medial capsular ligaments • Primary purpose are to attach the medial meniscus to the femur and to allow the tibia to move on the meniscus inferiorly • Lateral Collateral Ligament o Size of a pencil o Attached to lateral epicondyle of the femur and to the head of the fibula. o Taut during knee extension but relaxed during flexion
  • More Structures of the Knee • Joint Capsule o Knee joint is surrounded by the LARGEST joint capsule in the body. o Contains: infrapatellar pouch, fat,pad, and bursae, MCL, and other ligaments. o Divided into Four regions – are reinforced by other anatomical structures • Posterolateral & medial • Anterolater al & medial
  • • Knee Musculature o 13+ Muscles o Movements of the Knee • Knee Flexion & Extension • External & Internal Rotation • Bursae o Reduce friction o 2 dozen have been identified in the knee • Fat Pads o Several pads located around the knee o Infrapatellar fat pad is the largest • Nerve & Blood Supply
  • Specific Injuries • Medial & Lateral Collateral Sprain o Hit from opposite side of leg • ACL & PCL Sprain o ACL= lower leg is rotated while the foot is fixed (jumping) o PCL=fall with full weight on the anterior aspect of the bent knee with the foot in plantar flexion (sliding) • Meniscal Lesions o Most common= weight bearing combined with a rotary force while running • Patellar Conditions o Patellar orientation predisposes you to have certain types of injuries • Acute patellar subluxation or dislocation • Chondromalacia o Softening and deterioration of the articular cartilage on the back of the patella o Three stages • Patellofemoral Stress Syndrome o Some lateral deviation of the patella as it tracks in the femoral groove
  • MCL & LCL Sprain
  • Meniscal Lesions
  • Patellar Tracking
  • Patellar Examination • The Q-Angle o Quadriceps angle o Normal is 10’ Males / 15’ Females o 20’ (+) predisposed to • patellar subluxation/dislocation
  • • Extensor Injuries o Osgood-Schlatter Disease • Pain at the attachment of the patellar tendon to the tibial tubercle • Can lead to avulsion fracture o Larsen-Johansson Disease • Occurs at the inferior pole of the patella • Excessive repeated strain on the patellar tendon o Patellar Tendinitis (Jumper’s/Kicker’s Knee) • Repetitive trauma • Extreme tension on the knee extensor muscle complex • Painful at patellar or quadriceps tendon • Iliotibial Band Friction Syndrome (runner’s knee) o General expression for many repetitive and overuse conditions o Malalignment and structural assymetries of the foot and lower leg.
  • Extensor Injuries
  • Patellar tendonitis can be classified by the following techniques: Stage 0 - No Pain Stage 1 - Pain only after intense sports activity; no undue functional impairment Stage 2 - Pain at the beginning and after sports activity; still able to perform at a satisfactory level Stage 3 - Pain during sports activity; increasing difficulty in performing at a satisfactory level Stage 4 - Pain during sports activity; unable to participate in sport at a satisfactory level Stage 5 - Pain during daily activity; unable to participate in sport at any level
  • Knee Joint Rehabilitation • General Body Conditioning • Weight Bearing • Knee-Joint Mobilization • Flexibility • Muscular Strength • Neuromuscular Control • Bracing / Taping • Functional Progression • Return to Activity
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