The knee and related structures f09


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The knee and related structures f09

  1. 1. The Knee and Related Structures<br />
  2. 2. The Knee<br />Bones<br />Femur<br />Patella<br />Largest Sesamoid bone in human body<br />Tibia<br />Fibula<br />Non-weight bearing bone<br />Articulations<br />Four Articulations<br />Femur and Tibia<br />Femur and Patella<br />Femur and Fibula<br />Tibia and Fibula<br />
  3. 3. Meniscus<br />Two oval fibrocartilages that sit in the tibia<br />Semi-lunar (half moon shape)<br />Stabilize the knee<br />Especially the medial, when the knee is flexed at 90 degrees<br />Medial<br />C-shaped <br />Attach to the tibia, joint capsule by the coronary ligament, and the semimenbranous muscle (hamstring)<br />Lateral<br />O-shaped<br />Attached to the tibia, loosely to capsule, and popliteal tendon, and ligament of Wristberg<br />Blood Supply<br />Divided into 3 circumferential zones<br />Red –Red<br />Red-White<br />White-White <br />Avascular<br />
  4. 4. 3 Zones of Meniscus<br />
  5. 5. Stabilizing Ligaments<br />Account for a considerable amount of knee stability<br />Two ligamentous bands that cross one another within the joint capsule of the knee<br />Anterior Cruciate Ligament (ACL)<br />3 twisted bands<br />Prevents the femur from moving posteriorly weight bearing and anteriorly non-weight bearing.<br />Stabilizes the tibia from excessive internal rotation (IR)<br />Posterior Cruciate Ligament (PCL)<br />Resists IR of the tibia<br />Prevents hyperextension of the knee<br />
  6. 6. ACL & PCL<br />
  7. 7. Common Cause of ACL Tear<br />
  8. 8. Common Cause of PCL Tear<br />Situations in which the PCL can tear include -<br />excessive hyperflexion (forced bending), eg falling onto the shin with a bent knee and foot pointed <br />dashboard injury in a car - where the knee is bent to a right angle and a sudden force drives the tibia backwards<br />
  9. 9. Medial Collateral Ligament<br />Superficial ligament(MCL) is separate from the deeper capsular ligament.<br />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)<br />Deep medial capsular ligaments<br />Primary purpose are to attach the medial meniscus to the femur and to allow the tibia to move on the meniscus inferiorly<br />Lateral Collateral Ligament<br />Size of a pencil<br />Attached to lateral epicondyle of the femur and to the head of the fibula.<br />Taut during knee extension but relaxed during flexion<br />
  10. 10.
  11. 11. More Structures of the Knee<br />Joint Capsule<br />Knee joint is surrounded by the LARGEST joint capsule in the body.<br />Contains: infrapatellar pouch, fat,pad, and bursae, MCL, and other ligaments.<br />Divided into Four regions – are reinforced by other anatomical structures<br />Posterolateral & medial<br />Anterolater al & medial<br />
  12. 12. Knee Musculature<br />13+ Muscles <br />Movements of the Knee<br />Knee Flexion & Extension<br />External & Internal Rotation<br />Bursae<br />Reduce friction<br />2 dozen have been identified in the knee<br />Fat Pads<br />Several pads located around the knee<br />Infrapatellar fat pad is the largest<br />Nerve & Blood Supply<br />
  13. 13.
  14. 14. Specific Injuries<br />Medial & Lateral Collateral Sprain<br />Hit from opposite side of leg<br />ACL & PCL Sprain<br />ACL= lower leg is rotated while the foot is fixed (jumping)<br />PCL=fall with full weight on the anterior aspect of the bent knee with the foot in plantar flexion (sliding)<br />Meniscal Lesions<br />Most common= weight bearing combined with a rotary force while running<br />Patellar Conditions<br />Patellar orientation predisposes you to have certain types of injuries<br />Acute patellar subluxation or dislocation<br />Chondromalacia<br />Softening and deterioration of the articular cartilage on the back of the patella<br />Three stages <br />Patellofemoral Stress Syndrome<br />Some lateral deviation of the patella as it tracks in the femoral groove<br />
  15. 15. MCL & LCL Sprain<br />
  16. 16. Meniscal Lesions<br />
  17. 17. Patellar Tracking<br />
  18. 18. Patellar Examination<br />The Q-Angle<br />Quadriceps angle <br />Normal is 10’ Males / 15’ Females<br />20’ (+) predisposed to <br />patellar subluxation/dislocation <br />
  19. 19. Extensor Injuries<br />Osgood-Schlatter Disease<br />Pain at the attachment of the patellar tendon to the tibial tubercle<br />Can lead to avulsion fracture<br />Larsen-Johansson Disease<br />Occurs at the inferior pole of the patella <br />Excessive repeated strain on the patellar tendon<br />Patellar Tendinitis (Jumper’s/Kicker’s Knee)<br />Repetitive trauma <br />Extreme tension on the knee extensor muscle complex<br />Painful at patellar or quadriceps tendon<br />Iliotibial Band Friction Syndrome (runner’s knee)<br />General expression for many repetitive and overuse conditions <br />Malalignment and structural assymetries of the foot and lower leg.<br />
  20. 20. Extensor Injuries<br />
  21. 21. Patellar tendonitis can be classified by the following techniques: <br />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<br />
  22. 22. Knee Joint Rehabilitation<br />General Body Conditioning<br />Weight Bearing<br />Knee-Joint Mobilization<br />Flexibility<br />Muscular Strength<br />Neuromuscular Control<br />Bracing / Taping<br />Functional Progression<br />Return to Activity<br />