Disorders
Prof.
Salem Al-Zahrani
KNEE JOINT
Most vulnerable to becoming a
cause of pain
Largest and most complex joint.
One of most frequently injured.
Knowledge of knee biomechanics
important in understanding injury
and disorder.
INTERMEDIATE JOINT
FUNCTION:
Weight bearing
Movement
Stopping
STABILITY
Ligament
Muscle
Bony
Meniscus
Atmosphere
Common causes of
injury
Twisting injury that exceed the
normal range of motion.
Collision with opponent in contact
sports.
Combination injuries , more likely
to occur as a result of violent
impact.
Impact against lateral side of
the knee
It forces the joint inwards ( in
valgus).
More common than the medial side
impact.
Impact to medial side of the foot
gives same resulting injury.(e.g. 2
players kick the ball at the same
time with the inside of their feet).
During sporting activities the lateral
side of the knee is most affected by
impact when the foot is under load and
the knee joint is slightly bent.
The knee is forced inwards the tibia
rotated outwards in relation to femur,
causing injury to medial meniscus and
MCL.
In more violent impact the ACL may
tear.
The result is a combination injury to :
* Medial meniscus.
* MCL.
* ACL.
* Joint effusion.
Impact against the
medial side of the knee
joint
Medial side is subject to impact when
the knee is slightly bent and the foot is
under load.
The knee is forced outward and tibia is
twisted inwards.
It cause injury to LCL.
The chance to injure the lateral
meniscus is less,because it is not
attached to LCL.
More violent trauma may injure the ACL.
Combined injury involve LCL,ACL
and heamoarthrosis.
More sever injury may rupture PCL.
Impact causing
hyperextension or
hyperflexion
Impact on the knee from front can
cause hyperextension.
It can occur without body contact.
Falling on a bent knee joint can cause
hyperflexion.
Isolated injury to ACL only or PCL only
can occur but rare.
Injuries to collateral and cruciates are
often combined with damage to
posterior capsule.
Twisting impact without
body contact
It take place during twisting turn
with the foot fixed. ( e.g. when the
studs of the boot get stuck in the
grass).
Can cause both meniscus and
ligament injury.
ACL injury can occur during forced
internal rotation of the tibia.
Symptoms & Diagnosis
History mechanism of injury.
Pain and tenderness.
Swelling (effusion ).
Limitation of movement.
Instability in chronic cases.
General Examination
Analysis of the injury mechanism.
Look.
Feel.
Movement.
Investigation
Plain Xray.
MRI.
Meniscal injury
Menisci consist of semilunar fibrocartilage,
partly filling the space between femoral and
tibial articular surfaces.
They stabilize the joint throuhout its range of
motionand contribute to the limitation of
medial and lateral rotation as well as flexion
and extension.
They serve as shock absorber between tibia
and femur.
Take part in joint lubrication.
Menisci injury can occur in different types of
trauma
Commonest in contact sports.
Can be isolated injury or combined.
Medial meniscus injury is 5 times more than
lateral.
Can happen as result of twisting injury or
flexion /extension injury.
In elderly can happen during normal
movement.
Examination
Analysis of mechanism of trauma.
Inspection.
Palpation.
Testing for range of movement.
Stability examination.
Mc Murry test
McMurray’s test
Covered by synovium.