Slide 1

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 2

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 3

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 4

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 5

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 6

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 7

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 8

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 9

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 10

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 11

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 12

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 13

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 14

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 15

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 16

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 17

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 18

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 19

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 20

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 21

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 22

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

12
12

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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

13
13

Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

14
14

Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

15
15

Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

16
16

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

17
17

Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

18
18

Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

19
19

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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

20
20

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

21
21

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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22
22

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

23
23


Slide 23

Chapter 18
The Knee

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

1

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

22

The Knee
• One 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

33

OUCH!!!

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

44

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

55

The Knee (cont’d.)
• 2 types of cartilage in the knee joint:
– Articular cartilage
• Thin layer of connective tissue over ends of long
bones

– Menisci
• Medial meniscus
• Lateral meniscus
• Aid in shock absorption, distributing forces, &
improving stability

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

66

The Knee (cont’d.)
 Ligaments
 Medial collateral
ligament (MCL)
 Lateral collateral
ligament (LCL)
 Anterior cruciate
ligament (ACL)
 Posterior cruciate
ligament (PCL)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

77

The Knee (cont’d.)
• Patellofemoral joint
– Point where patella & femur are connected in
trochlear groove
– Patella: “kneecap”
• Inside quadriceps tendon

– Allows knee flexion and extension to occur
with a lesser amount of quadriceps force

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

88

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

99

The Knee (cont’d.)
 Hamstrings (flex knee)
 Biceps femoris
 Semitendinosus
 Semimembranosus

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

10
10

Knee Injuries
• Patellofemoral 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
swelling
• Treatment: correct suspected causes, shoe
inserts, taping and bracing, and stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

11
11

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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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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 antiinflammatory medications

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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Knee Injuries (cont’d.)
• Medial 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 pain
• Treatment: PRICE, protective wrap, a brace or
crutches, rehabilitation

• Lateral collateral ligament (LCL) sprain
– Blow to inside of knee (varus force)
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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Knee Injuries (cont’d.)
• 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, nausea
• Treatment: splinting, icing, and
compressive wrapping, crutches,
reconstructive surgery, rehabilitation (612 months)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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Knee Injuries (cont’d.)
• Posterior 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”
• Treatment: PRICE, physical therapy and
rehabilitation

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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Knee Injuries (cont’d.)
 Epiphyseal (growthplate) injuries
 Knee is subject to sportsinduced 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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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Knee Injuries (cont’d.)
• Osgood-Schlatter
condition
– Group of symptoms
involving the tibial
tubercle epiphysis
• Symptoms: pain,
swelling, weakness,
and a visible lump
(permanent)
• Treatment: preventing
progression, protective
gear, ice, antiinflammatories,
improving flexibility, and
stretching

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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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
©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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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)

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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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

©©2011
Delmar,
Cengage
Learning
2010
Delmar,
Cengage
Learning

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