Athletic Injuries ATC 222 The Knee Chapter 19

Anatomy bony muscular cartilage ligaments bursa etc

Functional Anatomy Motions –flexion/extension 140 degrees __________ flexion limited –rotation last 15 degrees of extension app. 10 degrees int/ext rotation referred to as _______ mechanism –rolling and gliding?

Functional Anatomy ACL –generally tight in extension –limits rotation, hyper______, and anterior tibial translation PCL –tight in flexion –limits rotation, hyperflexion, and _______tibial translation MCL –tight in extension –limits valgus and external tibial rotation LCL –tight in extension –limits varus and _______ tibial rotation

MCL Sprain Mechanism –lateral force –external tibial rotation More severe and common than LCL –part of capsule –attaches to medial __________ Signs and Symptoms –pain over MCL –none to moderate edema/effusion –possible laxity with valgus stress –possible ROM and strength loss –pain with passive extension and external tibial rotation

MCL Sprain Treatment RICER Crutches? Immobilization? Meniscal involvement? Rehabilitation

LCL Sprain Mechanism –varus force, internal tibial rotation Less prevalent that MCL –no ______________ attachment –action of _______________ muscle –common peroneal nerve Signs and Symptoms –pain over LCL –none to mild edema/effusion –possible laxity with varus stress –possible ROM and strength loss –pain with passive extension and internal tibial rotation Treatment

ACL Sprain Mechanism –external tibial rotation with valgus –internal tibial rotation –hyper_______ –deceleration Most common knee ligament to be seriously injured Signs and Symptoms –heard/felt a “pop” –rapid effusion/hemarthrosis (1-2 hours) –knee “gives out” –positive ligament testing

ACL Sprain Treatment RICER Crutches? Immobilization? Conservative vs surgical intervention –commonly associated with meniscal tear

PCL Sprain Mechanism –force to anterior tibia with knee flexed –hyperflexion –rotation Signs and Symptoms –“Pop” –Effusion –Positive ligament testing Treatment –usually non-operative

Meniscal Lesions Mechanism –_______ while weight bearing –MCL or ACL sprain –chronic knee instability or degeneration Signs and Symptoms –clicking, catching, locking – developing effusion –positive McMurray’s or Apley’s –pain on joint line –chronic effusion Treatment –healing rate? –Arthroscopic surgery removal vs repair

Patellar Subluxation/Dislocation Mechanism –external tibial rotation –valgus –functional/structural deviations Signs and Symptoms –deformity –positive __________ sign –effusion –pain on medial patellar border Treatment –RICER –immobilization and crutches? –reduction –rehabilitation

Patellofemoral Syndrome Structural/functional deviations Signs and Symptoms –medial peripatellar pain –pain with stairs –crepitus –pain with stairs/prolonged sitting Treatment –symptomatic –correct functional/structural deviations

Apophyseal Injuries (apophysitis) Apophysis = __________ Epiphysis Types –Osgood-Schlatter’s Syndrome –Sinding-Larson-Johanson Syndrome Signs and Symptoms –pain at tendon attachment –tibial tubercle enlargement –pain with prolonged sitting Treatment –symptomatic –flexibility –activity modification –straps and sleeves

Other Injuries Tendonitis Osteochondral defects ITB syndrome

Special Tests of the Knee tibial/fibular compression/percussion patellar apprehension ballotable patella and stroke test patellar excursion and compression ** valgus/varus stress –0 and 30 degrees **Lachman **anterior/posterior drawer **McMurray’s **Apley’s compression/distraction **sag test

Other Special Considerations Girth measurements quality of VMO leg length discrepancy Q-Angle –10 males, 15 females –over ____ is abnormal

Assessment History Observation Palpation Special Testing

Rehabilitation Muscular strength and endurance ROM and flexibility Proprioception Functional exercises