1. © 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning Chapter 18 The Knee

2. © 2010 Delmar, Cengage Learning 2 © 2011 Delmar, Cengage Learning Objectives Upon completion of this chapter, you should be able to: Describe the functions of the knee Describe the ligament structure of the knee Explain the function of the patellofemoral joint List and define various sports-related injuries of the knee 2

3. © 2010 Delmar, Cengage Learning 3 © 2011 Delmar, Cengage Learning The Knee One of the most complex joints in the bodyOne of the most complex joints in the body –Most movements and activities depend on it for support and mobility –There is risk of overuse and traumatic injury in both contact and non-contact sports 3

4. © 2010 Delmar, Cengage Learning 4 © 2011 Delmar, Cengage Learning OUCH!!! 4

5. © 2010 Delmar, Cengage Learning 5 © 2011 Delmar, Cengage Learning The Knee (cont’d.) Composed of 3 bones: Femur Tibia Patella Condyles: rounded prominences (femur) Tibial plateau: top, flat portion of tibia Tibiofemoral joint: where tibia meets femur 5

6. © 2010 Delmar, Cengage Learning 6 © 2011 Delmar, Cengage Learning The Knee (cont’d.) 2 types of cartilage in the knee joint:2 types of cartilage in the knee joint: –Articular cartilage Thin layer of connective tissue over ends of long bonesThin layer of connective tissue over ends of long bones –Menisci Medial meniscusMedial meniscus Lateral meniscusLateral meniscus Aid in shock absorption, distributing forces, & improving stabilityAid in shock absorption, distributing forces, & improving stability 6

7. © 2010 Delmar, Cengage Learning 7 © 2011 Delmar, Cengage Learning The Knee (cont’d.) Ligaments Medial collateral ligament (MCL) Lateral collateral ligament (LCL) Anterior cruciate ligament (ACL) Posterior cruciate ligament (PCL) 7

8. © 2010 Delmar, Cengage Learning 8 © 2011 Delmar, Cengage Learning The Knee (cont’d.) Patellofemoral jointPatellofemoral joint –Point where patella & femur are connected in trochlear groove –Patella: “kneecap” Inside quadriceps tendonInside quadriceps tendon –Allows knee flexion and extension to occur with a lesser amount of quadriceps force 8

9. © 2010 Delmar, Cengage Learning 9 © 2011 Delmar, Cengage Learning The Knee (cont’d.) Muscles Quadriceps: 4 muscles in front of thigh (extend knee) Vastus medialis Vastus intermedius Vastus lateralis Rectus femoris Patella tendon: encompasses patella & extends distally across front of knee 9

10. © 2010 Delmar, Cengage Learning 10 © 2011 Delmar, Cengage Learning The Knee (cont’d.) Hamstrings (flex knee) Biceps femoris Semitendinosus Semimembranosus 10

11. © 2010 Delmar, Cengage Learning 11 © 2011 Delmar, Cengage Learning Knee Injuries Patellofemoral problemsPatellofemoral problems –Articulation of the patella with the femur Symptoms: aching pain in the front or behind the knee, knee is giving way, crepitus (grinding noise or sensation), patellofemoral joint pain, and mild swellingSymptoms: aching pain in the front or behind the knee, knee is giving way, crepitus (grinding noise or sensation), patellofemoral joint pain, and mild swelling Treatment: correct suspected causes, shoe inserts, taping and bracing, and stretchingTreatment: correct suspected causes, shoe inserts, taping and bracing, and stretching 11

12. © 2010 Delmar, Cengage Learning 12 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Patellar tendonitis (“jumper’s knee”)Patellar tendonitis (“jumper’s knee”) –Inflammation of the patellar tendon –Caused by high-force, repetitive strain Symptoms: anterior knee pain and local tendernessSymptoms: anterior knee pain and local tenderness Treatment: activity modification, stretching, ice, bracing, and tapingTreatment: activity modification, stretching, ice, bracing, and taping 12

13. © 2010 Delmar, Cengage Learning 13 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Fat pad syndrome Infrapatellar fat pad is a region of fatty tissue that lies underneath the patellar tendon Symptoms: pain just below the patella, tenderness, and swelling Treatment: special strengthening exercises, taping, icing, and anti- inflammatory medications 13

14. © 2010 Delmar, Cengage Learning 14 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Medial collateral ligament (MCL) sprainMedial collateral ligament (MCL) sprain –Caused by a blow to the outside of the knee (valgus force) or a high-energy twisting Symptoms: limited motion, swelling of the medial knee, tenderness, and painSymptoms: limited motion, swelling of the medial knee, tenderness, and pain Treatment: PRICE, protective wrap, a brace or crutches, rehabilitationTreatment: PRICE, protective wrap, a brace or crutches, rehabilitation Lateral collateral ligament (LCL) sprainLateral collateral ligament (LCL) sprain –Blow to inside of knee (varus force) 14

15. © 2010 Delmar, Cengage Learning 15 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Torn anterior cruciate ligament (ACL)Torn anterior cruciate ligament (ACL) –Females are now more susceptible –Can occur from contact or noncontact causes Symptoms: hearing a “pop” followed by effusion, knee buckling, nauseaSymptoms: hearing a “pop” followed by effusion, knee buckling, nausea Treatment: splinting, icing, and compressive wrapping, crutches, reconstructive surgery, rehabilitation (6- 12 months)Treatment: splinting, icing, and compressive wrapping, crutches, reconstructive surgery, rehabilitation (6- 12 months) 15

16. © 2010 Delmar, Cengage Learning 16 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Posterior cruciate ligament (PCL) tearPosterior cruciate ligament (PCL) tear –Most occur during a fall on the flexed (bent) knee with the foot plantar flexed or hyperflexion (bending too far) of the knee Symptoms: positive “sag test”Symptoms: positive “sag test” Treatment: PRICE, physical therapy and rehabilitationTreatment: PRICE, physical therapy and rehabilitation 16

17. © 2010 Delmar, Cengage Learning 17 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Meniscus tears Occur when the knee is twisted suddenly and one or both menisci become trapped between the femur and tibia or ligaments in and around the knee are torn Symptoms: slow and mild knee swelling, pain, popping, locking, or giving way of the knee Treatment: compressive wrap, crutches, knee supports, activity modification, medications, and physical therapy 17

18. © 2010 Delmar, Cengage Learning 18 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Epiphyseal (growth- plate) injuries Knee is subject to sports- induced trauma at the centers of bone growth in skeletally immature athletes May alter the length of the affected bone Serious injury for a growing athlete 18

19. © 2010 Delmar, Cengage Learning 19 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Osgood-Schlatter conditionOsgood-Schlatter condition –Group of symptoms involving the tibial tubercle epiphysis Symptoms: pain, swelling, weakness, and a visible lump (permanent)Symptoms: pain, swelling, weakness, and a visible lump (permanent) Treatment: preventing progression, protective gear, ice, anti- inflammatories, improving flexibility, and stretchingTreatment: preventing progression, protective gear, ice, anti- inflammatories, improving flexibility, and stretching 19

20. © 2010 Delmar, Cengage Learning 20 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Iliotibial band syndrome Occurs when there is inflammation of the iliotibial band Irritation usually occurs over the outside of the knee joint, at the lateral epicondyle Treatment: rule out mechanical problems or training errors, proper footwear, ice, and stretching 20

21. © 2010 Delmar, Cengage Learning 21 © 2011 Delmar, Cengage Learning Knee Injuries (cont’d.) Fractures Result of high-energy trauma Vary in location and severity Patella fracture is usually the result of direct impact to the anterior knee Distal femoral and proximal tibial fractures may occur from violent twisting injuries 21

22. © 2010 Delmar, Cengage Learning 22 © 2011 Delmar, Cengage Learning Special Tests Valgus test (MCL) Varus test (LCL) Lachman’s test (ACL) Anterior drawer test (ACL) McMurray’s test (meniscus) IT Band syndrome test (IT band) 22

23. © 2010 Delmar, Cengage Learning 23 © 2011 Delmar, Cengage Learning Conclusion The knee is the largest joint in the body, and one of the most prone to injury Made up of the femur, tibia, and patella Also contains large ligaments that help control motion These ligaments connect bones and brace the joint against abnormal types of motion Other parts of the knee, like cartilage, cushion the joint and help it absorb shock during motion 23