1. Hip Quiz
Which muscle has orign at posterior sacrum and illium and inserts just distal to the greater trochanter?
The gluteus medius is a prime mover in this hip motion?
Which one joint muscle extends the hip?
The bony landmark of the femur located medially and posterior on the proximal end, it is illiopsoas attachment.
What muscles laterally rotate the hip?

2. Knee Joint

3. Knee Joint One of the most frequently injured joints in the body.
Largest joint in the body and a synovial hinge joint.
It mainly flexes and extends, but it does have a rotational component as well.

4. Knee Joint
Patellofemoral joint- articulation between the patella and the femur.
Patella’s main job is to increase the mechanical advantage of the quad muscle and protect the knee joint.

5. Knee Joint
With a longer moment arm, there is more angular force. With a shorter moment arm, the force would be more directed to the joint than the tendon.

6. Knee Joint
Q-angle- angle between the quadriceps muscle and patellar tendon. It ranges from degrees in normal individual in knee extension. It is greater in females. Due to our wider pelvis.
Lets graph our q-angles.

7. Knee Joint-Landmarks
Intercondylar eminence- double pointed prominence on the proximal surface of the tibial plateau.

8. Knee Joint-Landmarks
Medial and Lateral Condyle of the tibia- proximal end of the bone just below the tibial plateau.

9. Knee Joint-Landmarks
Tibial Plateau- proximal end including the medial and lateral condoyles and interdcondylar eminance. The top of the tibia.

10. Knee Joint-Landmarks
Tibial Tuberosity- large projection at the proximal end and anterior side, where the patellar tendon attaches.

11. Knee Joint-Landmarks
Patella- triangular shaped seasmoid bone within the quadriceps tendon.

12. Knee Joint Structures
Cruciate Ligaments- within the joint capsule, they cross. They are intracapsular ligaments and named for their attachment on the tibia.

13. Knee Ligaments
Anterior Cruciate Ligament- It attaches to the anterior side of the tibia just medial to the medial meniscus. It attaches to the posterior side of the femur. It prevents anterior translation of the tibia on the femur.

14. Knee Ligaments
Posterior Cruciate Ligament- attaches to the posterior side of the tibia. It attaches to the anterior femur and prevents posterior translation of the tibia on the femur.

15. Knee Ligaments
Medial Collateral Ligament- Attached to the tibia and femur on the medial side of the knee joint. Also attached to the medial meniscus, so injury to one can result in injury to both.

16. Knee Ligaments
Lateral Collateral Ligament- attached from the femur to the fibula on the lateral side of the knee. Shorter and stronger than the MCL.

17. Knee Joint Structures
Meniscus- medial and lateral meniscus are two half moon, wedge shaped fibrocartilage located on the superior tibia. They provide shock absorption in the knee. Medial is more often torn.

18. Knee Joint Structures
Bursa- fluid filled sac that reduce friction in a joint. The knee has 13 due to all the tendons and their vertical line of pull against bony area.

19. Knee Structures
Popliteal space- area behind the knee that contains important nerves and blood vessels.
The hamstrings and gastronemius make up the diamond shaped boarder.

20. Knee Structures
Pes Anserine muscle group- made up of Sartorius, Gracilis and semiTendinosus. (SGT). They come from posterior to medial anterior knee, there is a bursa under the insertion.

21. Quiz #3
Name the three muscles that attach at the medial anterior knee. They are know as the Pes Anserine group and their abbreviation is SGT.
What does ACL stand for?
What is the shock absorber of the knee?

22. Medial Collateral Ligament Sprain
Causes are blow to the
lateral knee or high speed
twisting motion.
Classified with three grade
scale based on signs
and symptoms
MOI is important

23. Medial Collateral Ligament Sprain
Signs and Sx
Limited ROM
Tenderness at either insertion of MCL or along ligament length.
Various levels of pain and laxity to medial knee
Special Test
Valgus Stress Test
Treatment
RICE and protect
Ice and Interferential
Straight leg strengthening initially.
Immobilize if necessary

24. Lateral Collateral Ligament Sprain
Not as common as the MCL sprain.
Caused by a medial force to the knee joint or a twisting.
Classified with 3 grades like any other sprain.

25. Torn Anterior Cruciate Ligament
Can be a contact or non-contact injuy.
Can be a blow to the lateral or posterior knee.
Non-contact loaded
knee in combined
flexion, valgus
and rotation of the
tibia on the femur.

26. Torn Anterior Cruciate Ligament
Signs and Sx
Hear or feel a pop
Rapid effusion
Buckling of the knee
Guarding will occur quickly so special tests need to be done within 5 minutes of injury
Treatment
Splinting, ice, compressive wrap and crutches.
Surgery for a ACL tear in necessary
Not typically seen with grades, but they do occur
MRI is confirmation for diagnosis

27. Torn Anterior Cruciate Ligament
Female ACL injuries happen 4-6x more often than male ACL injuries.
This is due to
Biomechanical factors- use more quad than hamstring. Land flat footed-don’t know how to jump
Hormonal influences-ligament may loosen during cycle
Anatomic risk factors-Angle of the hips relative to knees.

28. Knee Muscles
Popliteus- muscle responsible for unlocking the knee or initiating knee flexion. It is on the posterior side of the knee in the poplitial space deep to the gastrocnemius.

29. Knee Muscles
Vastus lateralis- spans the quad laterally, starts on the linea aspera and joins with the others at the patellar tendon.

30. Knee Muscles
Vastus Intermedialis- deep to the rectus femoris arises from the anterior surface of the femur, it blends with the other vasti muscles along its length. All extend the knee, only the rectus flexes the hip. Why?

31. Knee Muscles
Rectus Femoris- originates on inferior illiac spine and decends down the center of the thigh, most superficial muscle of quad.

32. Meniscus Tear
Meniscus are cushions in the knee joint that help make it more stable.
Medial meniscus is attached to posterior and medial side, it is more often injured.
Lateral meniscus is more freely moving, less often injured.

33. Meniscus Tear Causes of injury
Twisting of knee when meniscus gets trapped.
When the ligaments are torn, they are attached.
As people age the rubbery meniscus fray

34. Meniscus Tear Signs and Sx Popping, locking, giving way of the knee
Pain in injury area
General knee swelling

35. Osgood-Schlatter
The femur is growing faster than the quad muscle and creates a traction on the tibial tuberosity where the patellar tendon attaches.
Affects males age 12-16
Affects females age 10-14

36. Osgood-Schlatter Signs and Sx Pain and swelling over tibial tuberosity
Increase pain and swelling with activity
Weakness of quadriceps
Visible lump
Pain to touch

37. Osgood-Schlatter Treatment Manage pain swelling and flexibility
Stretch 4x daily-emphasis on hamstrings
Avoid knee extension, squats, power clean and plyo
Do body weight squats, SLR, hamstring curls and calf raises.
Wear knee brace if needed.

38. Patellafemoral Problems
One of the most challenging knee injuries for both athlete and health care provider.
Typical complaint is pain in front of the knee (behind the knee cap), with gradual onset.
The knee may give way and have a grinding noise.

39. Patellar Tendonitis
High force repetitive injury usually a result of jumping and/or abrupt change of direction.
AKA jumpers knee

40. Patellar Tendonitis Signs and Sx: Treatment
Anterior knee pain inferior to patellar tendon
Small amount of swelling
Special Tests-
Tap Test
Clark’s Sign
Treatment
Modified activity to decrease impact
Stretch Quads
Ice after
Massage/US before
Brace and Tape

41. Knee Muscles
Vastus medialis- also comes from the linea aspera and spans the thigh medially and joints with quads at patellar tendon.

42. Knee Muscles
Semitendinosus muscle- longer and narrower distal tendon that moves to the anterior tibia with the grasillis and sartoris after spanning the posterior medial thigh.

43. Knee Muscles
Semimembranosus muscle- runs down medial side of the thigh deep to the semitendinosus muscle and attaches to the medial condyle of tibia.

44. Knee Muscles
Biceps Femoris- has two head and runs down the thigh laterally on the posterior side. The long head starts of the ischial tuberosity, the short head on the linea aspera. Which head flexes the knee and extends the hip?