The Knee and Related Structures Chapter 20

KNEE ANATOMY Bones Articulations femur fibula tibia patella tibiofemoral patellofemoral

ANATOMY cont. Menisci Ligaments Medial meniscus Lateral meniscus Blood supply (3 vascular zones) Versus hyaline cartilage Ligaments Medial collateral - MCL (deep & superficial) Lateral collateral - LCL Cruciates - ACL & PCL

ANATOMY cont. Joint Capsule Synovial Capsule Knee musculature quadriceps group hamstrings group iliotibial band gastroc, gracilis, sartorius, popliteus, plantaris Patellar tendon

ANATOMY cont. Additional Knee Structures Bursa Popliteal fossa Fat pads / plica Nerves Blood vessels

KNEE ALIGNMENT DEVIATIONS Patellar malalignments Genu valgum Genu varum Genu recurvatum Q angle

KNEE INJURIES and CONDITIONS FRACTURES DISLOCATION CONTUSIONS SPRAINS MENISCUS TEARS The Unhappy Triad SYNOVIAL PLICA SYNDROME

INJURIES cont. OSTEOCHONDRITIS DISSECANS PATELLAR DISLOCATION/SUBLUX CHONDROMALACIA OSGOOD-SCHLATTER’S DISEASE LARSEN-JOHANSSON JUMPER’S KNEE ILIOTIBIAL BAND SYNDROME ARTHRITIS - DJD

KNEE INJURY EVALUATION HISTORY AND MECHANISM (MOI) How did it happen / what happened? previous injury or problems acute or chronic problem Sounds heard? Returned to play? PHYSICAL EXAM - SYMPTOMS Pain, swelling, ROM, etc. Areas of pain localized if possible

EVALUATION cont. SPECIAL TESTS ADDITIONAL SPECIAL TESTS Valgus / Varus test Drawer test Lachman’s test (alternate Lachman’s?) McMurray’s test ADDITIONAL SPECIAL TESTS X-ray and/or MRI KT-1000 Apley’s, Slocum’s, Rotary instability tests?

Evaluation of Swelling Sweep Test: Determine swelling by manually moving the fluid in the knee from one side of the knee to the other. Ballotable Patella Test: Downward pressure on the patella is applied. A positive test is indicated by the patella bouncing back to its original position.

Tests for ACL Instability Drawer Test Lachman’s Test Alternate Lachman’s Test Modified Lachman’s Test KT 1000 Arthrometer

Tests for PCL Instability Posterior Drawer Test Godfrey’s Test Uses gravity to extenuate the posterior sag as noted by observation. Flex knees bilaterally to 90 degrees.

Tests for Rotary Instabilities Clinically, athletes suffering from rotary instabilities will complain of the knee “going out”. Slocum Drawer for Rotary Instability Drawer test with int. & ext. rotation Pivot Shift Test Crossover Drill

Tests for Meniscal Tears Meniscal injuries may often be in combination with other injuries to the knee, or they can be isolated. Immediate diagnosis is often difficult, but fortunately not an emergency. McMurray’s Test Apley’s Compression/Distraction Test

Additional Conditions Infrapatellar Fat Pad Bursitis Other Patello-femoral conditions Extensor Mechanism problems Osgood-Schlatter’s - Iliotibial band syn. Larsen-Johansson disease - Pes Anserine syn. Jumper’s knee - Collapsing knee Patellar tendon rupture

Knee Rehabilitation General Conditioning Weight Bearing Knee Joint Mobilization Flexibility Muscular Strength Neuromuscular Control Bracing

Summary Knee Injuries are of Increasing Concern Most common injuries are sprains of MCL, ACL, and LCL; meniscal tears, and patello-femoral problems. Prevention Seems to be Difficult Braces have limited effect Evaluation and Management of Knee Injuries Experience Rehabilitation Following Injury will Vary