Knee

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Knee

  1. 1. Chapter 20: The Knee and Related Structures
  2. 2. Ligaments • ACL – Prevents anterior tibial translation • PCL – prevents posterior tibial translation • Medial Collateral – Prevents valgus • Lateral Collateral – Prevents varus
  3. 3. Patella • Patella – aids knee during extension, providing a mechanical advantage – Protects patellar tendon against friction
  4. 4. Assessing the Knee Joint • Determining the mechanism of injury is critical • History- Current Injury – Past history – Mechanism- what position was your body in? – Did the knee collapse? – Did you hear or feel anything? – Could you move your knee immediately after injury or was it locked? – Did swelling occur? – Where was the pain
  5. 5. • History - Recurrent or Chronic Injury – – – – – – – – What is your major complaint? When did you first notice the condition? Is there recurrent swelling? Does the knee lock or catch? Is there severe pain? Grinding or grating? Does it ever feel like giving way? What does it feel like when ascending and descending stairs? – What past treatment have you undergone?
  6. 6. • Observation – Walking, half squatting, going up and down stairs – Swelling, ecchymosis, – Leg alignment • Genu valgum and genu varum • Hyperextension and hyperflexion • Patella alta and baja
  7. 7. Patella Baja and Alta
  8. 8. – Knee Symmetry or Asymmetry • Do the knees look symmetrical? Is there obvious swelling? Atrophy? – Leg Length Discrepancy • Anatomical or functional • Anatomical differences – A true difference in bone length • Functional differences – caused by pelvic rotations or mal-alignment of the spine
  9. 9. Obvious swelling
  10. 10. • Types of, and Palpation of Swelling – Intra vs. extracapsular swelling • Intracapsular may be referred to as joint effusion • Ballotable patella - sign of joint effusion – Extracapsular swelling tends to localize over the injured structure • May ultimately migrate down to foot and ankle
  11. 11. Q Angle • Lines which bisect the patella relative to the ASIS and the tibial tubercle • Normal angle is 10 degrees for males and 15 degrees for females
  12. 12. Q-angle
  13. 13. Knee Injuries
  14. 14. Knee Sprains - MCL
  15. 15. Knee Sprains - MCL • Mechanism of Injury – Valgus Force – Pivoting
  16. 16. Knee Sprains - LCL
  17. 17. Knee Sprains - LCL • Mechanism of Injury – Varus Force
  18. 18. Knee Sprains - ACL
  19. 19. Knee Sprains - ACL • Mechanism of Injury Cutting Pivoting
  20. 20. Knee Sprains - ACL • Mechanism of Injury • Anterior tibial translation on a fixed femur.
  21. 21. Knee Sprains - ACL • Mechanism of Injury Valgus Varus
  22. 22. Knee Sprains - PCL
  23. 23. Knee Sprains - PCL • Mechanism of Injury Hyperextension
  24. 24. Knee Sprains - PCL • Posterior tibial translation on a fixed femur.
  25. 25. Injury Videos http://www.youtube.com/watch?v=A9-KkUH8yt8 http://www.youtube.com/watch?v=-pKaBW99GgY http://www.youtube.com/watch?v=j_Mdm4v-ty8
  26. 26. The MOI of an MCL injury is: 1. 2. 3. 4. 5. 6. Valgus force Varus force Pivoting Hyperextension All of the above All but 2 17% 1 17% 2 17% 17% 3 4 17% 5 17% 6
  27. 27. The MOI of an LCL injury is: 1. 2. 3. 4. 5. 6. Valgus force Varus force Pivoting Hyperextension All of the above All but 1 17% 1 17% 2 17% 17% 3 4 17% 5 17% 6
  28. 28. The ACL is most commonly injured by: 1. 2. 3. 4. 5. 6. Valgus force Varus force Hyperextension Pivoting All of the above All but 2 17% 17% 17% 17% 17% 17% 1 2 3 4 5 6
  29. 29. • Function Meniscus – Shock Absorption – Centering Mechanism (stability) – Production of Synovial Fluid (joint oil)
  30. 30. Meniscus Injuries • Usually occurs with a hyperflexion or twist (pivot) while weight bearing
  31. 31. Meniscus Injuries
  32. 32. Meniscus Injuries
  33. 33. Meniscus Injuries • Signs & Symptoms – – – – – – Awkward Mechanism “Shift” or “pop” Deep knee pain Loss of terminal ext. or flex. Delayed swelling Jointline tenderness
  34. 34. Meniscal injuries are caused by: 1. 2. 3. 4. 5. Hyperextension Hyperflexion Pivoting All of the above None of the above 20% 20% 20% 20% 20% 1 2 3 4 5
  35. 35. Patello-femoral Disorders
  36. 36. Patello-femoral Disorders • Chondromalacia • Patello-femoral pain syndrome • • *Acute patellar dislocation *Patellar tendinitis (jumpers knee) • *Osgood Schlatter’s – Softening of articular cartilage – Pain/inflammaton under patella – Quadriceps tendinitis – apophysitis Why are patellar tracking problems Often lateral? **Read about the differences in your text!!!
  37. 37. Patello-femoral Disorders • Dislocation/Subluxation
  38. 38. Patello-femoral Disorders • Patellar tendonitis
  39. 39. Patello-femoral Disorders • Osgood Schlatter
  40. 40. Runner’s Knee • Due to overuse – The IT Band rubs Over the lateral Condyle of the femur • Results in tendinitis of the IT band
  41. 41. Pes Anserine Tendinitis • Tendinitis/Bursitis of the distal insertion of the sartorius, gracilis, and semitendinosis
  42. 42. The difference between runner’s knee and Pes Anserine tendinitis is: 1. Runner’s knee is lateral 2. Runner’s knee is uncommon 3. There is no difference 33% 33% 33% 1 2 3

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