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The Knee and Related Structures. Chapter 16. KNEE ANATOMY. Bones femur fibula tibia patella Articulations tibiofemoral patellofemoral. ANATOMY cont. Menisci Medial meniscus Lateral meniscus Blood supply (3 vascular zones) Versus hyaline cartilage Ligaments

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knee anatomy
KNEE ANATOMY
  • Bones
    • femur
    • fibula
    • tibia
    • patella
  • Articulations
    • tibiofemoral
    • patellofemoral
anatomy cont
ANATOMY cont.
  • Menisci
    • Medial meniscus
    • Lateral meniscus
    • Blood supply (3 vascular zones)
    • Versus hyaline cartilage
  • Ligaments
    • Medial collateral - MCL (deep & superficial)
    • Lateral collateral - LCL
    • Cruciates - ACL & PCL
anatomy cont5
ANATOMY cont.
  • Joint Capsule
  • Synovial Capsule
  • Knee musculature
    • quadriceps group
    • hamstrings group
    • iliotibial band
    • gastroc, gracilis, sartorius, popliteus, plantaris
  • Patellar tendon
anatomy cont6
ANATOMY cont.
  • Additional Knee Structures
    • Bursa
    • Popliteal fossa
    • Fat pads / plica
    • Nerves
    • Blood vessels
knee alignment deviations
KNEE ALIGNMENT DEVIATIONS
  • Patellar malalignments
  • Genu valgum
  • Genu varum
  • Genu recurvatum
  • Q angle
knee injuries and conditions
KNEE INJURIESand CONDITIONS
  • FRACTURES
  • DISLOCATION
  • CONTUSIONS
  • SPRAINS
  • MENISCUS TEARS
    • the Unhappy Triad
  • SYNOVIAL PLICA SYNDROME
injuries cont
INJURIES cont.
  • OSTEOCHONDRITIS DISSECANS
  • PATELLAR DISLOCATION/SUBLUX
  • CHONDROMALACIA
  • OSGOOD-SCHLATTER’S DISEASE
    • LARSEN-JOHANSSON
  • JUMPER’S KNEE
  • ILIOTIBIAL BAND SYNDROME
  • ARTHRITIS - DJD
knee injury evaluation
KNEE INJURY EVALUATION
  • HISTORY AND MECHANISM (MOI)
    • How did it happen / what happened?
      • previous injury or problems
      • acute or chronic problem
    • Sounds heard?
    • Returned to play?
  • PHYSICAL EXAM - SYMPTOMS
    • Pain, swelling, ROM, etc.
    • Areas of pain localized if possible
evaluation cont
EVALUATION cont.
  • SPECIAL TESTS
    • Valgus / Varus test
    • Drawer test
    • Lachman’s test (alternate Lachman’s?)
    • McMurray’s test
  • ADDITIONAL SPECIAL TESTS
    • X-ray and/or MRI
    • KT-1000
    • Apley’s, Slocum’s, Rotary instability tests?
evaluation of swelling
Evaluation of Swelling
  • Sweep Test:
    • Determine swelling by manually moving the fluid in the knee from one side of the knee to the other.
  • Ballotable Patella Test:
    • Downward pressure on the patella is applied. A positive test is indicated by the patella bouncing back to its original position.
tests for acl instability
Tests for ACL Instability
  • Drawer Test
  • Lachman’s Test
  • Alternate Lachman’s Test
  • Modified Lachman’s Test
  • KT 1000 Arthrometer
tests for pcl instability
Tests for PCL Instability
  • Posterior Drawer Test
  • Godfrey’s Test
    • Uses gravity to extenuate the posterior sag as noted by observation. Flex knees bilaterally to 90 degrees.
tests for rotary instabilities
Tests for Rotary Instabilities

Clinically, athletes suffering from rotary instabilities will complain of the knee “going out”.

  • Slocum Drawer for Rotary Instability
    • Drawer test with int. & ext. rotation
  • Pivot Shift Test
  • Crossover Drill
tests for meniscal tears
Tests for Meniscal Tears

Meniscal injuries may often be in combination with other injuries to the knee, or they can be isolated. Immediate diagnosis is often difficult, but fortunately not an emergency.

  • McMurray’s Test
  • Apley’s Compression/Distraction Test
additional conditions
Additional Conditions
  • Infrapatellar Fat Pad
  • Bursitis
  • Other Patello-femoral conditions
  • Extensor Mechanism problems
    • Osgood-Schlatter’s - Iliotibial band syn.
    • Larsen-Johansson disease - Pes Anserine syn.
    • Jumper’s knee - Collapsing knee
    • Patellar tendon rupture
knee rehabilitation
Knee Rehabilitation
  • General Conditioning
  • Weight Bearing
  • Knee Joint Mobilization
  • Flexibility
  • Muscular Strength
  • Neuromuscular Control
  • Bracing
summary
Summary
  • Knee Injuries are of Increasing Concern
    • Most common injuries are sprains of MCL, ACL, and LCL; meniscal tears, and patello-femoral problems.
  • Prevention Seems to be Difficult
    • Braces have limited effect
  • Evaluation and Management of Knee Injuries Experience
  • Rehabilitation Following Injury will Vary