KNEE INJURIES

Review Gross and Functional Anatomy. Discuss traumatic injuries to the knee. Discuss overuse injuries in and about the knee.

KNEE INJURIES
Discuss the signs and symptoms of the specific injuries. Discuss causes and treatments.

KNEE

(Anterior view)

BEHAVIORAL
CHARACTERISTICS OF STRUCTURES

AROUND THE KNEE

ANTERIOR CRUCIATE LIGAMENT LOCATION

POSTERIOR CRUCIATE LIGAMENT LOCATION

STABILIZING ROLE

OF THE ANTERIOR CRUCIATE LIGAMENT

HEAT SENSITIVE VIEWS

OF THE ANTERIOR CRUCIATE

IN FLEXION

STABILIZING ROLE OF THE

POSTERIOR CRUCIATE LIGAMENT

HEAT SENSITIVE VIEW OF THE POSTERIOR CRUCIATE IN FLEXION AND EXTENSION

A.C.L. and P.C.L. LINKAGE

MEDIAL COLLATERAL LIGAMENT DURING FLEXION AND EXTENSION

LATERAL VIEW OF KNEE FLEXION and EXTENSION

PATELLO-FEMORAL JOINT DURING FLEXION AND EXTENSION

NORMAL KNEE MOTION KNEE FLEXION-EXTENSION takes place between the bottom of the femur and the top of the menisci. TWISTING MOTION takes place between the bottom of the menisci and the tibia.

MENISCUS OF THE KNEE

Purpose: Equalize weight distribution across the knee joint.

Shock absorption.

Coronary Ligament
Medial is tighter than the lateral. Thus, there is less mobility medially.

MENISCAL INJURY
Medial Meniscus: excessive external rotation of the tibia. Lateral Meniscus: excessive flexion of the knee.

MECHANISMS OF INJURY
VALGUS

VARUS
HYPEREXTENSION HYPERFLEXION

INTERNAL ROTATION
EXTERNAL ROTATION

VALGUS
Distal bone of the joint moves away from midline of the body.

Medial Support Complex

Not Shown: Quads
Medial Head of Gastrocnemius

Medial Hamstrings

VARUS
Distal bone of the joint moves towards the midline of the body

Lateral Support Complex

Not Shown:
Poplitius Tendon

Iliotibial Band Biceps Femoris M.

Head of the
Gastrocnemius

ANTERIOR CRUCIATE

ANTERIOR CRUCIATE

Posterior Cruciate Ligament

Impact on anterior tibia.

Rotation Affecting Tension

Valgus with External Rotation of the Knee. M.C.L Deep, Superficial and A.C.L.

Mechanisms of Injury
MCL
ACL

Valgus of Knee
Valgus after MCL

Extension with tibia in internal rotation. Hyperextension.

PCL Valgus after MCL and ACL. Varus after LCL,ACL

Hyperflexion with tibial internal rotation. Blunt trauma to tibial tuberosity.

FCL M.M.

Varus of knee. External rotation of the tibia.

Valgus to knee.
L.M. Hyperflexion of the knee.

SIGNS AND SYMPTOMS OF LIGAMENT INJURY

(Not all symptoms have to be present to indicate injury)
Immediate pain ++++ Feeling of tearing. Hearing unusual noises.
. 2.

.. 2 Signs and Symptoms

Feeling of giving way. Loss of function of the joint Be cautious of the painful and then not very painful knee.

REMOVAL FROM FIELD (Non-weight Bearing)

Feeling of a tearing or popping in the knee. If pain, no pain.

REMOVAL FROM FIELD (Non-weight bearing) If complaining of not feeling right or feeling funny

REMOVAL FROM FIELD Weight bearing Minor pain with full R.O.M.

Stand. Pain? Slowly walk off field with support.

Return to play only after the athlete has been evaluated by a physician.

Patello-femoral Pain Syndrome. Iliotibial Band Friction Syndrome. Osgoode Schlatters Disease.

PATELLO-FEMORAL PAIN SYNDROME Causes: . Excessive Q angle.

. Excessive pronation.
. Weak plantar flexors/inv. . Weak V. Medialis/Tight Ham

Q ANGLE
(Quadriceps)
Two lines; ASIS to MPP; the other from TT to MPP. Angle of intersection called Q angle.

The greater the Q angle, the greater the tendency to move the patella laterally against the lateral femoral condyle. A large Q angle plus strong quad contraction can dislocate pat.

Equal pressure distribution across the back of the patellae ensures proper nutrition by inbibition.

Medial aspect of Patellofemoral Joint has hypopressure. Lateral aspect has hyperpressure.

Signs and Symptoms of Patello-femoral Pain Syn.

Painful crepitus of the knee.

Locking, catching of knee.

Swelling.
Loss of strength. Activity worsens symptoms.

SUGGESTED TREATMENTS
Strengthen Vastus Medialis. Reduce Pronation. Stretch Hamstrings, ITB, and Quads. Modify activities.

The greater the Q angle, the greater the tendency to move the patella laterally against the lateral femoral condyle. A large Q angle plus strong quad contraction can dislocate pat.

 My knee came apart and went back together again.

For example, I was running forward, planted on my right foot, cut to my left and attempted to push off with my right.

SUBLUXED OR DISLOCATED PATELLA

Lateral
Medial

DISLOCATED PATELLA

If the patella is dislocated, slightly flex the hip and slowly extend the knee. Usually the patella relocates. If it does not, do not force the patella medial. There may be some associated fractures (back of the patella, lateral femoral condyle). MEDICAL

Iliotibial Band Friction Syndrome

I.T.B.F.S. Predisposing Factors

Tight Tensor Fascia Lata and weak Gluteus Medius. Genu Varum
Downhill Running Training Errors

I.T.B.F.S. Treatment
Modification of Activity and shoes.

Stretching.
Icing after activity. Strengthening.

Iliotibial Band

And
Hip Abductor Stretch

OSGOODE
SCHLATTERS DISEASE

Osgoode Schlatters
Separation of the traction epiphysis of the quadriceps muscle.
Active pre-pubescent kids.

No gender bias.

Signs and Symptoms:

Pain increase with activity. Tibial tubercle is warm to touch.

Pain on squeezing the tibial tubercle from sides.

 Inform parents.
Stop irritating activity.

Icing the tibial tubercle.

Stove-pipe casts are sometimes applied to ensure rest. Return if asymptomatic.