The knee and related structures f09
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The knee and related structures f09

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The knee and related structures f09 The knee and related structures f09 Presentation Transcript

  • The Knee and Related Structures
  • The Knee
    Bones
    Femur
    Patella
    Largest Sesamoid bone in human body
    Tibia
    Fibula
    Non-weight bearing bone
    Articulations
    Four Articulations
    Femur and Tibia
    Femur and Patella
    Femur and Fibula
    Tibia and Fibula
  • Meniscus
    Two oval fibrocartilages that sit in the tibia
    Semi-lunar (half moon shape)
    Stabilize the knee
    Especially the medial, when the knee is flexed at 90 degrees
    Medial
    C-shaped
    Attach to the tibia, joint capsule by the coronary ligament, and the semimenbranous muscle (hamstring)
    Lateral
    O-shaped
    Attached to the tibia, loosely to capsule, and popliteal tendon, and ligament of Wristberg
    Blood Supply
    Divided into 3 circumferential zones
    Red –Red
    Red-White
    White-White
    Avascular
  • 3 Zones of Meniscus
  • Stabilizing Ligaments
    Account for a considerable amount of knee stability
    Two ligamentous bands that cross one another within the joint capsule of the knee
    Anterior Cruciate Ligament (ACL)
    3 twisted bands
    Prevents the femur from moving posteriorly weight bearing and anteriorly non-weight bearing.
    Stabilizes the tibia from excessive internal rotation (IR)
    Posterior Cruciate Ligament (PCL)
    Resists IR of the tibia
    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
    Superficial ligament(MCL) is separate from the deeper capsular ligament.
    Attaches above the join line on the medial epicondyle of the femur and below on the tibia – Just beneath the attachment of the pesanserinus (hamstring tendons)
    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
    Size of a pencil
    Attached to lateral epicondyle of the femur and to the head of the fibula.
    Taut during knee extension but relaxed during flexion
  • More Structures of the Knee
    Joint Capsule
    Knee joint is surrounded by the LARGEST joint capsule in the body.
    Contains: infrapatellar pouch, fat,pad, and bursae, MCL, and other ligaments.
    Divided into Four regions – are reinforced by other anatomical structures
    Posterolateral & medial
    Anterolater al & medial
  • Knee Musculature
    13+ Muscles
    Movements of the Knee
    Knee Flexion & Extension
    External & Internal Rotation
    Bursae
    Reduce friction
    2 dozen have been identified in the knee
    Fat Pads
    Several pads located around the knee
    Infrapatellar fat pad is the largest
    Nerve & Blood Supply
  • Specific Injuries
    Medial & Lateral Collateral Sprain
    Hit from opposite side of leg
    ACL & PCL Sprain
    ACL= lower leg is rotated while the foot is fixed (jumping)
    PCL=fall with full weight on the anterior aspect of the bent knee with the foot in plantar flexion (sliding)
    Meniscal Lesions
    Most common= weight bearing combined with a rotary force while running
    Patellar Conditions
    Patellar orientation predisposes you to have certain types of injuries
    Acute patellar subluxation or dislocation
    Chondromalacia
    Softening and deterioration of the articular cartilage on the back of the patella
    Three stages
    Patellofemoral Stress Syndrome
    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
    Quadriceps angle
    Normal is 10’ Males / 15’ Females
    20’ (+) predisposed to
    patellar subluxation/dislocation
  • Extensor Injuries
    Osgood-Schlatter Disease
    Pain at the attachment of the patellar tendon to the tibial tubercle
    Can lead to avulsion fracture
    Larsen-Johansson Disease
    Occurs at the inferior pole of the patella
    Excessive repeated strain on the patellar tendon
    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)
    General expression for many repetitive and overuse conditions
    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