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The Knee

The Knee. The Knee. Anatomy Injuries Evaluation Surgical procedures Rehabilitation. Anatomy. Bones Ligaments Meniscus Bursa Muscles Tendons. Bones. Femur Tibia Fibula Patella. Ligaments. Medial Collateral Lateral Collateral. Ligaments . Anterior Cruciate Posterior Cruciate.

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The Knee

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  1. The Knee

  2. The Knee • Anatomy • Injuries • Evaluation • Surgical procedures • Rehabilitation

  3. Anatomy • Bones • Ligaments • Meniscus • Bursa • Muscles • Tendons

  4. Bones • Femur • Tibia • Fibula • Patella

  5. Ligaments • Medial Collateral • Lateral Collateral

  6. Ligaments • Anterior Cruciate • Posterior Cruciate

  7. Meniscus • Medial meniscus • Lateral meniscus

  8. Bursa • A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.

  9. Muscles • Quadriceps-function is knee extension.

  10. Muscles • Hamstring-function is knee flexion.

  11. Tendons • Quadriceps tendon • Patellar tendon • Hamstring tendon

  12. Knee Injuries • Quadricep strain • Hamstring strain • Contusion • Patellar/Quadriceps tendonitis • Patellar/Quadriceps tendon rupture • Patellar dislocation • Condromalacia • Osgood-Slatter disease • Bursitis • Meniscal tear • MCL/LCL sprain • ACL/PCL sprain

  13. Quadriceps strain • Grade 1: • What are the symptoms? • Tightness in the thigh. • Unable to walk properly. • Probably not much swelling. • Trying to straighten the knee against resistance probably won't produce much pain.

  14. Quadriceps strain • Grade 2: • What are the symptoms? • Probably cannot walk properly. • Occasional sudden twinges of pain during activity. • The athlete may notice swelling. • Pressing on the muscle causes pain. • Straightening the knee against resistance causes pain. • Unable to fully bend the knee.

  15. Quadriceps strain • Grade 3: • What are the symptoms? • Unable to walk properly without the aid of crutches. • In severe pain. • Bad swelling appearing immediately. • A static contraction will be painful and might produce a bulge in the muscle. • Expect to be out of competition for 3 to twelve weeks.

  16. Hamstring Strain • Grade 1: What does it feel like? • Might have tightness in the thigh. • May be able to walk properly. • Probably won't have much swelling. • Lying on front and trying to bend the knee against resistance probably won't produce much pain.

  17. Hamstring strain • Grade 2: What does it feel like? • Probably cannot walk properly. • May get occasional sudden twinges of pain during activity. • May notice swelling. • Pressing in causes pain. • Bending the knee against resistance causes pain. • Might be unable to fully straighten the knee.

  18. Hamstring strain • Grade 3: What does it feel like? • Unable to walk properly without the aid of crutches. • In severe pain. • Bad swelling appear immediately. • A static contraction will be painful and might produce a bulge in the muscle. • Expect to be out of competition for 3 to twelve weeks or more.

  19. http://www.train.tcu.edu/ross/HAMSTRING2.JPG

  20. Contusion • Caused by a direct blow to the muscle. Most likely to occur in the quadriceps.

  21. Hyperextended knee • In this injury, your knee extends beyond its normally straightened position so that it bends back on itself.

  22. Quadriceps Tendonitis • A person experiencing quadriceps tendonitis will have particular pain straightening the lower leg, or decelerating when walking. The major point of pain coming from above the kneecap.

  23. Patellar Tendonitis • What is patellar tendonitis? • Patellar tendonitis, also called jumper's knee, is inflammation in the band of tissue (the patellar tendon) that connects the kneecap (patella) to the shinbone (tibia). • How does it occur? • The most common activity causing patellar tendonitis is too much jumping. Other repeated activities such as running, walking, or bicycling may lead to patellar tendonitis. All of these activities put repeated stress on the patellar tendon, causing it to be inflamed.

  24. Patellar dislocation • What is a dislocated patella? A dislocated patella occurs when the kneecap (patella) pops out from its normal position. This can occur as the result of force or, is more often related to a developmental condition that leads to an improper alignment of the kneecap with the thighbone (femur). This is sometimes called "unstable kneecap."

  25. Patellar tendon rupture

  26. Patellar fracture

  27. Dislocated Knee

  28. Chondromalacia • Chondromalacia of the patella is the grating or grinding sensation during extension of the knee. The cause is thought to be related to overuse, trauma and/or abnormal forces on the knee, such as a mildly abnormal alignment of the patella (knee cap) and femur. Symptoms include knee tenderness, pain in the knee after sitting for a prolonged period of time, knee pain that is worse with stairs or getting out of a chair, and a grating sensation in the knee.

  29. Chondromalacia

  30. Chondromalacia

  31. Osgood-Slatter disease • Osgood-Schlatter (OS) disease is one of the most common causes of knee pain in the adolescent. • During periods of rapid growth, stress from contraction of the quadriceps is transmitted through the patellar tendon onto a small portion of the partially developed tibial tuberosity. • This may result in a partial avulsion fracture through the a small portion of the partially developed tibial tuberosity. This may result in a partial avulsion fracture.

  32. Osgood-Slatter disease

  33. Bursitis • “Housemaid” or “Carpet layers” knee. This is caused by direct trauma.

  34. Meniscal tear • One may tear the meniscus by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament).

  35. Meniscal tear • Signs and Symptoms • Pain and “clicking” while walking or bending knee. • Pain and clicking while going upstairs. • Remedies: RICE with medication, or surgery.

  36. Meniscal tears

  37. Meniscal injury tests

  38. Medial Collateral injury • What causes Medial Collateral Ligament Sprain?By far the most common cause of medial collateral ligament sprain is a blow or sudden impact to the outside (lateral) of the knee joint. This causes the outside of the knee to collapse inward toward the midline of the body and the inside of the knee (where the medial collateral ligament is located) to widen and open up. This opening up stretches the ligament, which results in the injury.

  39. Medial Collateral injury • What are the Signs & Symptoms of Medial Collateral Ligament Sprain? • The most common symptom of a MCL injury is pain around the inside of the knee joint. Also common is bruising and swelling.

  40. Medial Collateral tests

  41. Lateral Collateral sprain • Apply everything from an MCL injury, except the mechanism of injury is a direct blow from the medial side of the knee.

  42. Anterior Cruciate sprain • How is the anterior cruciate ligament injured?The ACL or anterior cruciate ligament is injured either through twisting the knee or through an impact to the side of the knee - often the outside.

  43. Anterior Cruciate sprain Signs and Symptoms Pain at time of the injury. Athlete and/or people in the area will hear a “pop”. Swelling. In the later stages when the swelling has decreased there may be instability in the joint. For a partial rupture pain may be felt on the Anterior Drawer test where the tibia is pulled.

  44. Female Anterior Cruciate injury • NCAA study showed that women suffered ACL injuries four times more often in basketball; three times more often in gymnastics; and two-and-a-half times more often in soccer.

  45. Q angle

  46. Anterior Cruciate stress tests • Anterior Drawer test

  47. Anterior Cruciate stress tests • Lachman test

  48. Posterior Cruciate sprain • Mechanism of injury • PCL tears can occur when a football or soccer player falls on a bent knee. Motor vehicle accidents are another common cause of injury to the PCL. When the driver or passenger strikes the bent knee just below the kneecap (patella) against the dashboard, the force can tear the PCL and damage other ligaments, bones and muscles.

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