1. Knee Injuries
By Cindy Greene

2. Introduction • Very complex joint
• Most sports place extreme stress on the knees
• Very commonly injured joint

3. Skeletal Anatomy • 4 bones make up the knee joint: • Femur • Tibia
• Fibula
• Patella

5. Meniscus Functions: increases stability
of the joint, cushions stresses •

6. Stabilizing Ligaments
Anterior Cruciate Ligament
(ACL)
• Posterior Cruciate Ligament
(PCL)
• Medial Collateral Ligament (MCL)
• Lateral Collateral Ligament (LCL)
Iliotibial band (IT)

8. ACL ACL: • Prevents anterior translation of the tibia.
• Keeps the tibia from gliding forward.
• Very strong ligament
• Very susceptible to injury.
• Women more prone to tear ACL than

9. PCL PCL: • Prevents posterior translation of the tibia.
• Only 90% of size of ACL.
• It is the strongest of the knee

10. MCL MCL: • Flat, broad ligament located on the inside of the knee
• Prevents a valgus stress on the
knee.
• Part of it attaches to the medial meniscus

11. LCL LCL: • Cordlike ligament located on the outside of the knee.
• Prevents a varus stress on the knee

12. Muscles of the Upper Leg

13. Knee injuries Knee is most injured joint in the body.
25% of all injuries involve the knee
Nearly one million knee surgeries are performed each year.
A knee injury is also the most likely injury to end an athletes career.

14. ACL Injuries Grade I- pain with minimal damage to the ligament.
Grade II-more ligament damage and mild looseness of the joint.
Grade III- The ligament is completely torn and the joint is very loose or unstable.

15. How Does it Occur? Forced twisting motions of the knee
Hyperextension of the knee
Sudden stops that cause the femur to push across the shin bone

16. Diagnosis
History
Physical exam
Xray
MRI

17. Treatment (Minor Injuries)
RICE
R-Use crutches and knee immobolizer
I- Ice knee for minutes every 3-4 hours for 2-3 days or until pain goes away.
C-Wrap an elastic bandage around your knee to keep the swelling from getting worse.
E-Keep knee elevated whenever possible.

18. Treatment (Major)
Intensive Rehabilitation
Surgery

19. Prevention Strengthen thigh and hamstring muscles
Increase flexibility.
Practice exercise (Patient Advisor pg 170)
Heel Slide
Quadriceps Isometrics
Prone Knee Bends
Passive knee extension
Heel raises
Wall squats

20. LCL Injury Causes: twisting motion or a blow to the fibula.
Symptoms: pain on the outer side of the knee, swollen and tender knee, and sound or feel of a pop at the time of injury.
Diagnosis: history, physical, Xray, MRI
Treatment: RICE it!

21. MCL Injury
Causes: blow to the outer side of the knee or twisting of the knee
Symptoms: pain on the inner side of the knee, swollen and tender knee, having the feeling that your knee is “giving way”
Diagnosis: history, physical, Xray, MRI
Treatment: RICE it!

22. Patellar Tendonitis (Jumper’s Knee)
Inflammation of the patellar tendon that connects the patella to the tibia

23. Patellar Tendonitis
Causes: too much jumping, running, walking, improper alignment of the hip, legs, knees, or hips
Symptoms: pain, tenderness and swelling
Diagnosis: history, physical, Xrays, MRI
The doctor will check for tenderness at the patellar tendon and pain with running, jumping, or squatting

24. Patellar Tendonitis Treatment: RICE it!
Wear infrapatellar strap or brace and special orthotics for over-pronation.
Prevention: Wear proper shoes and stretch!

25. Patellar Tendonitis Rehab Exercises
Practice exercises (Patient Advisor pg 201)
Patellar mobility
Standing hamstring stretch
Quadricep stretch
Straight leg raise
Knee stabilization

26. Patellofemoral Pain Syndrome (Runner’s Knee)
Pain behind the patella (includes patellofemoral disorder, patellar malalignment, runner’s knee, and chondromalacia)

27. Patellofemoral Pain Syndrome
Causes: repetitive bending and straightening of the knee
Symptoms: pain behind the knee cap, pain when you walk or run or sit for a long time, swelling, or snapping, popping or grinding in the knee
Diagnosis: history, physical, Xray
Treatment: RICE it! Wear orthotics and/or infrapatellar strap
Prevention: Strengthen thigh muscles

28. Other Knee Injuries Dislocation of the patella
Illiotibial Band Syndrome
Bursitis

29. Sports Specific
Basketball: Result from the player taking a blow to the knee from the side. Also can be caused by changing direction of running abruptly
Football: Can suffer from runner’s knee, jumper’s knee, dislocated knee
Terrible Triad of O’Donahue: tears to the MCL, ACL, and the medial cartilage (“blew out a knee”)

30. Sports Specific
Gymnastic/Cheerleading: Knee injuries can occur secondary to the knee hyperextending when tumbling or dismounting
Runners: Runners can suffer from runner’s knee and illiotibial band syndrome. Foot strike and mechanics plays an important role in the prevention of knee injuries.