The Knee

Injury to the Knee One of the most complex joints in the human body Also one of the most frequently injured Principal Movements of the Knee: Flexion & Extension

The Knee Cartilage: Medial Meniscus, Lateral Meniscus Meniscus Increase Stability of Knee, Cushion from Stresses Ligaments: Connecting the Femur to the Tibia or Fibula Stabilize the Knee ACL: Anterior Cruciate Ligament PCL: Posterior Cruciate Ligament (Cruciate : “Cross”) Medial & Lateral Collateral Ligaments (MCL & LCL)

The Knee fibula

The Knee Four Bones: Femur, Tibia, Fibula, Patella (Kneecap)

Muscles of the Knee Largest & Primary Muscles of the Knee: Quadriceps & Hamstrings “Quads” EXTEND the Knee Hamstrings FLEX the Knee

Prevention of Knee Injury & Assessing Knee Injuries (HOPS) Proper Strength, Flexibility, Agility, Speed, Balance is Key Proper Shoes, Knee Braces H.O.P.S. Special Tests Pg. 361-363 Valgus / Varus Stress Tests : Tests MCL/LCL Drawer Test: Tests the ACL / PCL McMurray Test: Tests the Meniscus (Tear)

Medial Collateral Ligament (MCL) Sprain Causes: A hit from the outside (lateral) side of leg, or sudden rotation Grades I, II, III Pain, Swelling, Stiffness over MCL Joint Instability: Knee will feel “unstable” to walk

MCL Sprain (cont.) Also will have Positive Valgus/Varus Stress Test (Special Test in HOPS) Treatment: R.I.C.E., Crutches, Immobilization, Referral to Doctor Rehabilitation before Return to Play; Knee Brace Usually heals in 2-6 weeks depending on how severe it is

LCL Sprain LCL: Lateral Collateral Ligament LCL Sprain: Similar to MCL Sprain, except on the Lateral (outside) Usually caused by a force to the medial (inside) knee Similar Signs/Symptoms/Treatment

Anterior Cruciate Ligament (ACL) Sprain Often injured during a “cutting” movement, rotation, or quick stop Athlete may feel or hear a “pop”, followed by immediate pain and disability

ACL Sprain Rapid Swelling Positive “Drawer” Test Treatment: First Aid, RICE & Crutches. Immobilize or Wrap with bandage. If torn, surgery is required if athlete wants to return to competitive athletics fibula

ACL Sprain Surgery involves using an Allograft (Cadaver Tendon) or Autograft (Tendon from your own body) to replace the torn ACL Surgery involves a brief hospital stay, bracing, and 4-8 months of rehab

ACL Sprain During Rehab, ROM is improved, strength exercises May require wearing a brace Drawer Test

Posterior Cruciate Ligament (PCL) Sprain Similar Signs/Symptoms, Treatment, and Rehab as that of an ACL Sprain Not as common Some doctors may not suggest surgery, or just wear a brace May result from “hyperextension” of knee Posterior (Back) View of Knee

Meniscus Injury Meniscus is cartilage that helps to cushion the knee Injury usually occurs with rotation of the knee S/Sx: Pain, Swelling, Loss of ROM, “Locking”, “Clicking”, “Giving Way”, Pain when squatting Tx: RICE, Crutches, Referral to Doctor; Arthroscopic surgery may be required

Bursitis Bursa: Fluid filled sacs that help joints move smoothly They can become irritated with Acute or Chronic Trauma S/Sx: Swelling, Some may have large amounts of swelling, Redness (Erythema), Increased temperature, Pain Tx: RICE, Medication, Compression, Drain

Runner’s Knee (Iliotibial Band Friction Syndrome) Overuse injury common in runners (duh!) and cyclists S/Sx: Pain over the Lateral Knee, Swelling Tx: RICE, Medication, Proper Warm-Up, Stretching, Orthotics, Ultrasound

Patella Fracture Caused by a direct hit or indirect trauma (Quads pulling a piece of bone off) S/Sx: Pain, Swelling, Inability to move knee Tx: RICE, Immobilization, X- Rays, Surgery

Dislocated Patella Usually caused during a “cutting” or quick stop movement Patella may dislocate out of its groove, usually LATERALLY S/Sx: Pain, Swelling, Loss of ROM, Deformity Tx: Immobilize knee, Ice, Hospital Physician will “Reduce” the dislocation Immobilize; Splint; Rehab; Brace

Chondromalacia Is Softening & Deterioration of cartilage underneath kneecap Caused by abnormal movement of patella/Overuse S/Sx: Pain when walking, running, stairs, squatting. Swelling around kneecap, “Grating” sensation when bending knee Tx: RICE, immobilization, Splinting, Medication, Rehab

Patellar Tendonitis ( Jumper’s Knee) Overuse Injury From lots of Jumping (duh!) Pain in the “front” of the knee, along Patellar Tendon Tx: RICE, Brace, Quad Strengthening