THE KNEE JOINT CARE & PREVENTION OF ATHLETIC INJURIES MS. HERRERA

FACTS A.K.A “TIBIOFEMORAL JOINT” A hinge joint ROM: flexion and extension Unstable laterally and medially

Anatomy Bones: Femur, tibia, fibula, and patella Muscles: Biceps femoris, semitendonosis, and semimembranosus Rectus femoris, vastus medialis, vastus lateralis, vastus intermedius Sartorius (longest muscle in body) and gastrocnemius

Anatomy Cont’d Mensicus (you have 2) Medial mensicus (C-Shaped) Lateral mensicus (O-shaped) Made of???? Ligaments (purpose of each?) Anterior cruciate ligament Posterior cruciate ligament Medial collateral ligament Lateral collateral ligament

Anatomy Cont’d Bursae As many as 2 dozen in the knee

Medial Collateral Ligament Sprain (MCL) MOI: direct blow from lateral side creating excessive valgus stress Excessive knee twist

MCL Sprain Cont’d Categorized into 3 grades Signs & Symptoms (depends on grade) Ligament fibers torn/stretched Pain, swelling (mild- severe) TTP over MCL and attachment sites Loss of ROM, joint stiffness, weak + valgus stress test Management Conservative tx usually Ice, e-stim, ultrasound, rehabilitation Surgery is indicated if MCL is sprained along with the ACL or PCL

Lateral Collateral Ligament Sprain MOI: Blow to the medial side of the knee causing a varus force Signs & Symptoms: Pain, TTP over LCL, swelling Laxity with varus testing Management: Same as MCL

Anterior Cruciate Ligament Sprain (ACL) Prevents ant. movement of tibia MOI: valgus force with tibia in external rotation Noncontact tears more common in females Why? Several reasons Signs & Symptoms Loud pop Pain, laxity, immediate swelling, and hemoarthrosis (?)

ACL Cont’d Management: Not repairing the ACL can lead to joint degeneration. (examples?) Should be repaired with surgery cause if not it leads to knee instability Before surgery rehab is usually given to strengthen quadriceps. Why? Surgery can be allo- or autoGRAFT difference?

Posterior Cruciate Ligament Sprain Purpose: To prevent posterior translation of the tibia. MOI: Falling directly on a bent knee Signs & Symptoms: Loud “pop” in back of knee pain, swelling, tenderness over posterior knee, laxity

PCL Cont’d Management: Conservative: Rehabilitation-some positive outcomes have been reported. Surgery to repair torn ligament. Time frame for SX?

Mensicus Tears Medial mensicus is MORE commonly injured than lateral mensicus. Why? Lat. mensicus is more mobile MOI: Twisting force while foot is planted, cutting motion when running, tears that occur overtime due to high stress (i.e. running)

Mensicus Tears Cont’d Signs & Symptoms: Swelling Locking, clicking Pain when squatting Giving way Management: Conservative if person is not an athlete or tear is in a vascular zone Surgery: Indicated for high activity individuals Can be repaired or resected depending on case

Joint/Muscle Contusions A.K.A. “Charley Horse” MOI: Direct blow to the thigh Signs & Symptoms: swelling and severe pain Loss of ROM and strength Management: Rest, ice, light stretch Complete ROM exercises Apply pad for protection upon RTP Complications: Myositis ossificans

Patellar Dislocations/Subluxations MOI: planting leg, slowing down, and cutting suddenly (most common MOI) Signs & Symptoms: Obvious deformity, severe pain, swelling, complete loss of knee function

Patellar Dislocations/Subluxations Cont’d Management: Keep athlete still and activate EMS Splint and transfer to ER Reduce dislocation Crutches NWB for 4 weeks + Rehabilitation with focus on quad strengthening

Chondromalacia Patella Wearing away of articular cartilage on the posterior patella MOI: Most common abnormal patellar tracking Causes? Signs & Symptoms: Pain, swelling, crepitus Pain with running, walking, stairs, squatting

Osgood-Schlatter Disease Pain in patellar tendon where it attaches on the tibial tubercle. Occurs in adolescents Athlete may experience multiple avulsions and in severe cases COMPLETE avulsion. Signs & Symptoms: Severe pain when kneeling, running, jumping Inflammation Enlarged tibial tubercle Management: Rest, ice before and after activity, strengthening of quads and hamstrings

Patellar Tendinitis A.K.A. Jumper’s Knee Extreme tension/overuse of the quads. Places stress on patellar tendon Signs & Symptoms: Pain and TTP inferior to the patella Management: Nsaids Rest, Ice, Modalities Rehab Cross friction massage

Patellar Fx MOI: Direct impact Fall on the knee Signs/Symptoms: Obvious deformity Intense Pain Swelling, loss of ROM Unable to contract quads Management: Activate EMS Brace in extension XRAY to confirm Ice Surgery Rehab

Prentice, William E. Arnheim’s principles of athletic training 12 th ed. McGraw-Hill, New York Ny, 2006.