Transcript The Knee and Related Structures

The Knee and Related
Structures
Chapter 16
THE KNEE
INTRODUCTION
Recent studies suggest that the knee
has taken over as the most often
injured joint in the body. Whether
this is true or not, the knee is
certainly a common area of injury
in sports today, and an area which
is almost synonymous with modern
sportsmedicine.
KNEE ANATOMY
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Bones
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femur
fibula
tibia
patella
Articulations
• tibiofemoral
• patellofemoral
ANATOMY cont.
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Menisci
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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.
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Joint Capsule
Synovial Capsule
Knee musculature
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quadriceps group
hamstrings group
iliotibial band
gastroc, gracilis, sartorius, popliteus, plantaris
Patellar tendon
ANATOMY cont.
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Additional Knee Structures
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Bursa
Popliteal fossa
Fat pads / plica
Nerves
Blood vessels
KNEE ALIGNMENT
DEVIATIONS
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Patellar malalignments
Genu valgum
Genu varum
Genu recurvatum
Q angle
KNEE INJURIES
and
CONDITIONS
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FRACTURES
DISLOCATION
CONTUSIONS
SPRAINS
MENISCUS TEARS
• the Unhappy Triad
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SYNOVIAL PLICA SYNDROME
INJURIES cont.
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OSTEOCHONDRITIS DISSECANS
PATELLAR DISLOCATION/SUBLUX
CHONDROMALACIA
OSGOOD-SCHLATTER’S DISEASE
• LARSEN-JOHANSSON
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JUMPER’S KNEE
ILIOTIBIAL BAND SYNDROME
ARTHRITIS - DJD
KNEE INJURY EVALUATION
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HISTORY AND MECHANISM (MOI)
• How did it happen / what happened?
• previous injury or problems
• acute or chronic problem
• Sounds heard?
• Returned to play?
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PHYSICAL EXAM - SYMPTOMS
• Pain, swelling, ROM, etc.
• Areas of pain localized if possible
EVALUATION cont.
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SPECIAL TESTS
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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
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Sweep Test:
• Determine swelling by manually moving the
fluid in the knee from one side of the knee to
the other.
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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
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Drawer Test
Lachman’s Test
Alternate Lachman’s Test
Modified Lachman’s Test
KT 1000 Arthrometer
Tests for PCL Instability
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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
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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
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Infrapatellar Fat Pad
Bursitis
Other Patello-femoral conditions
Extensor Mechanism problems
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Osgood-Schlatter’s
- Iliotibial band syn.
Larsen-Johansson disease - Pes Anserine syn.
Jumper’s knee
- Collapsing knee
Patellar tendon rupture
Knee Rehabilitation
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General Conditioning
Weight Bearing
Knee Joint Mobilization
Flexibility
Muscular Strength
Neuromuscular Control
Bracing
Summary
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Knee Injuries are of Increasing Concern
• Most common injuries are sprains of MCL,
ACL, and LCL; meniscal tears, and patellofemoral problems.
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Prevention Seems to be Difficult
• Braces have limited effect
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Evaluation and Management of Knee
Injuries Experience
Rehabilitation Following Injury will Vary