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Knee
Terminology
• Tibial Tuberosity: Boney protrusion where the patellar tendon inserts.
• Femoral Condyles: Distal end of the femur.• Intercondyler Notch: An indentation in the
distal femur where the anterior cruciate descends.
• Quadriceps Femoris Muscle group: attach to the patella through the quadriceps tendon.
Terminology
• Pes Anserine:“foot of a bird”, the insertion of the semitendinosis, sartorius, and gracilis to the anteromedial tibia
• Unhappy Triad (Terrible Triad): Tearing of the anterior cruciate ligament, medial collateral ligament and the medial meniscus.
• Varus Stress: Stress applied to the medial aspect of the knee.
• Valgus Stress: Stress applied to the lateral aspect of the knee.
Terminology
• Direct trauma: A blow or fall on the knee.• Indirect trauma: violent contracture of the
quadriceps• Distal pulses: pulses in the foot. The dorsalis
pedis and the posterior tibial pulse. • Chondromalacia: A degenerative condition in
which there is a wearing away of the cartilage on posterior patella.
• Subchondral: Below the cartilage.
Bones Of The KneeOFemurOTibiaOFibulaOPatella
Femur
Patella
TibiaFibula
Condyles of the Knee
Lateral CondyleMedial Condyle
Patellar Tendon
Tuberosity
Cartilage known as Menisci
Cruciate ligaments form an “X”
http://www.kneeguru.co.uk/KNEEnotes/cruciate-ligament
http://www.kneeguru.co.uk/KNEEnotes/node/829
Primary and Secondary Motions of The Knee
1. Primary Motions• Flexion• Extension2. Secondary Motions• Internal Rotation• External Rotation• Gliding Motion (a little)
Quadriceps
• Strongest muscle group in the body• Vastus Medialis• Vastus Intermedius• Vastus Lateralis• Rectus Femoris
• Responsible for knee extension
Hamstrings
• Biceps Femoris (long and short head)• Semimembranosus• Semitendinosus
• Responsible for knee flexion
Bursa
Fluid sac acting as a cushion and lubricant in areas of friction
• Suprapatellar - under patella (running)• Perpatellar - on top of patella (direct blow)• Anserine - below knee (running)
Medial Collateral Ligament Sprain
• MOI: occurs most often in violently adducted and internally rotated knees.
• Path: a tear or sprain in the MCL• S/S: swelling, pain, loss of stability, popping noise, (+)
valgus stress test on MCL (may vary depending on degree of injury)
• Tx: RICE, rehab-light weights, straight leg raises, whirl pool (if available), crutches for discomfort and degree of injury, MCL taping
Lateral Collateral Ligament Sprain
• MOI: blow to inside of the knee (varus force)• Path: partial to complete tear of ligament• S/S: pain on lateral side of knee, swelling, positive varus stress test• Tx: RICE, crutches and referral to physician
Anterior Cruciate Ligament Sprain (ACL)
• MOI: twisting of the knee, hyperextension of the knee, forward movement of the tibia on the femur
• Path: Stretching or tearing of the ACL; secondary injuries: medial meniscus tear and medial collateral ligament sprain – Terrible Triad: ACL pathology WITH secondary injuries
• S/S: A pop followed by immediate disability, pain, rapid swelling at the joint, feels like knee is coming apart
• Tx: RICE, crutches, refer to doctor.
Meniscus Tear
• MOI: sudden twisting and compression• Path: tear of the meniscus• S/S: locking, swelling, pain, giving way• Tx: RICE, crutches, refer to doctor.
• MOI: athlete plants their foot and changes direction.
• Path: the quadriceps muscles attempt to pull in a straight line and in a result pulls the patella laterally.
Patellar Subluxation or Dislocation
Patellar Subluxation or Dislocation Cont.
S&S: Complete loss of knee function; pain and swelling
Tx: immobilize in the position it is in, place ice around the joint, see physician, use crutches.
Patellar Fractures
• MOI: caused by direct or indirect trauma. Forcible muscle contraction, falling, jumping, and running can also cause a fracture.
• Path: a severe pull of the patellar tendon against the femur when knee is semi flexed resulting in a fracture
• S/S: causes hemorrhage and joint effusion, resulting in generalized swelling. – An indirect fracture causes capsular tearing, separation of
bone. Tearing of the quadriceps tendon is also a sign.– Direct fracture involves bone separation.
Patellar Fracture Cont.
• Tx: a cold wrap should be applied, followed by elastic compression wrap, splinting, crutches and Doctor referral.
Knee Dislocation
• The most Serious knee injury is the dislocation of the tibiofemoral joint. THIS IS AN EMERGENCY!
• http://emedicine.medscape.com/article/1250829-overview
• MOI: Direct blow to the anterior proximal tibia, forceful twisting, lateral blow to the knee.
• S/S: Grossly displaced tibia, sever pain, swelling, and may have absence of distal pulses.
• Tx: Calm athlete down, splint, and immediate transport to the hospital. Check distal pulses.
Knee Dislocation Cont.