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Mechanical knee

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

 Bending and squatting

 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

If there is torn meniscus , the fragment can some times be displaced


Into the joint space by rotating the tibia on the femur in flexion
Producing a distinct and painful click.
The test can repeated alternately to decide which meniscus is torn.
Meniscus exam.

Injury to the medial meniscus; Injury to the lateral meniscus


Tenderness can occur over the Pain can occur if the knee
Medial synovial cavity. Is over extended.
Complications
 Pain.
 Locking.
 ???giving way.
 Osteoarthritis.
ACL
ANATOMY
 Collagen tissue

 2 parts: anterior & posterior.

 Covered by synovium.

 In extension - all fiber tight.

 In flexion - anterior fiber tight.


Function of ACL
 Prevent anterior tibial
translation.
 Restrain to internal rotation,
external rotation.
 Restrain for valgus and varus in
extended knee.
Presentation
 In acute stage :
Sever Pain.
effusion.
limited movement.
 In chronic stage :
pain on & off
giving way
recurrent effusion.
Mechanism of Injury
 Twisting
 Hyper extension
 Dislocation
Examintion
 Analysis of mechanism of injury.
 Inspection.
 Palpation.
 Testing range of motion.
 Examintion for stability.
Examination for stability
 Anterior drawer.
 Lachman test.
 Pivot test.
ACL exam.

AD. Anterior drawer test : excessive movement of the tibia


Forward in relation to the femur , indicates injury to medial
Collateral ligament and/or ACL
Lachman’s test :
The anterior drawer test with the knee joint bent to an angle
10ْ-20ْ .
This test is used to examine the integrity of ACL
Hold the thigh on lateral side with one hand and hold the upper
Part of the leg on the medial side.
The lower leg id lifted forward and an anterior drawer sign
Can then be both seen and felt.
Pivot shift test:
This is to evaluate the status of ACL.
Rotate the foot inwards in one hand and press the knee from the
Lateral side by the other hand in fully extended knee.
The knee is pressed inward (in valgus)during passive flexion and
Internal rotation.
At 20ْ-30 ْof flexion,a sublaxation forward of the lateral tibial
Codyle can be seen.
During further flexion 40-60 deg.the lateral condyle reduce and then
The patient experience the giving way phenomena.
Complications
 instability & giving way.
 Pain.
 Osteoarthritis.
 Repeated effusion.
Arthroscopy

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