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The Knee

The Knee. Introduction to Athletic Training Fall 2013. The Knee 101. The knee is a hinge joint What motions occur at the knee? Flexion Extension What do you already know about the knee?. Bones of the Knee. Femur Tibia Fibula Patella. Bony Landmarks of the Femur. Lateral epicondyle

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The Knee

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  1. The Knee Introduction to Athletic Training Fall 2013

  2. The Knee 101 • The knee is a hinge joint • What motions occur at the knee? • Flexion • Extension • What do you already know about the knee?

  3. Bones of the Knee • Femur • Tibia • Fibula • Patella

  4. Bony Landmarks of the Femur • Lateral epicondyle • Medial epicondyle • Patellofemoral groove

  5. Bony Landmarks of the Tibia • Tibial tuberosity • What attaches here? • Patella tendon • Tibial plateau • What rests here? • Medial & lateral menisci

  6. Bony Landmarks of the Fibula • Fibular head

  7. Ligaments of the Knee • Anterior Cruciate Ligament • Posterior Cruciate Ligament • Medial Collateral Ligament • Lateral Collateral Ligament

  8. Purpose of Knee Ligaments? • ACL • Prevent anterior translation (forward movement of tibia on femur) • PCL • Prevent posterior translation (backwards movement of tibia on femur) • LCL • Provide lateral stability • MCL • Provide medial stability

  9. Bone & Ligament Palpations • Medial femoral epicondyle • Lateral femoral epicondyle • Patella • Tibial tuberosity • Tibial plateau • Tibia • Fibula • Fibular Head • Lateral Collateral Ligament • Medial Collateral Ligament

  10. Muscles of the Anterior Knee • Quadriceps • Rectus femoris • Vastusmedialis • Vastuslateralis • Vastusintermedius • Cause what action? • Extension

  11. Muscles of the Posterior Knee • Hamstrings • Biceps femorus • Semimembranosis • Semitendinosis • Cause what action? • Knee flexion

  12. Muscles of the Posterior Knee • Calf Muscles = Gastroc-soleus Complex • Gastrocnemius • Soleus • Cause what action? • Gastroc. helps with knee flexion

  13. Muscle Palpations • Patella tendon • Quadriceps tendon • Quadriceps • Rectus femoris • Vastusmedialis • Vastuslateralis • Hamstrings • Biceps femoris & tendon • Semimembranosus • Semitendinosus • Gastrocnemius tendons • Gastrocnemius

  14. Range of Motion • Knee flexion • ~135 degrees • Knee extension • 0-10 degrees • Measuring ROM • Fulcrum – lateral epicondyle of femur • Stationary arm – midline of fibula • Moving arm – midline of femur

  15. Knee Injuries • Leandro Barbosa (basketball) http://www.youtube.com/watch?v=klZwj_EJVN4 • Victoria Azarenka http://www.youtube.com/watch?v=dsIj73UTfK8 • Sara Tucholsky http://www.youtube.com/watch?v=jocw-oD2pgo • Jamaal Charles http://www.youtube.com/watch?v=QrvHzaDxBug

  16. Knee Injury Prevention • What stabilizes the knee? • Menisci, ligaments, tendons, muscles • What can we do to make the knee more stable? • Strengthen surrounding musculature (hamstrings, quads)

  17. Predisposing Factors to Knee Injury • Excess weight • “For every pound of weight lost, there is a four pound reduction in knee joint stress.” • Biomechanical problems • Leg length discrepancy, patellar tracking, angle of hips/knees • Lack (or imbalance!!) of muscular strength or flexibility • Certain sports • Example: female soccer and basketball players predisposed to ACL injury • Previous injury

  18. ACL Prevention Program Project • PEP Program • Designed by the Santa Monica Sports Medicine Research Foundation • 5 Sections • Warm Up • Strengthening • Plyometrics • Agilities • Stretching

  19. Bone Knee Injuries • PatellofemoralSyndrome (Chondromalacia) • S/S • Achiness around patella • Increases with prolonged sitting • Grinding with flexion and extension • Treatment/prevention • Strengthen quadriceps (especially vastusmedialis) • Quad./hamstring flexibility

  20. Bone Knee Injuries • Patellar Dislocation • of Injury • Patella is forced laterally • Occurs when knee is bent and forced into internal rotation. Soccer patella dislocation: http://www.youtube.com/watch?v=6-JNFiXkXfc

  21. Patellar Dislocation • Signs/symptoms • Deformity • Pain • Should AT’s reduce a patellar dislocation? • NO!!! • Refer to physician • Rehabilitation • Brace for support • Restore ROM • Improve strength

  22. Muscle & Tendon Knee Injuries • Patellar Tendinitis • Chronic • Predisposing factors • Running • Jumping • Signs/symptoms? • 3 Stages • 1: Pain after activity • 2: Pain during & after activity • 3: Pain during & after for a prolonged amount of time. • Rehab/Prevention? • Rest/Avoid aggravating activities • Chopat strap • Strengthening leg muscles • Stretching leg muscles • If untreated, can lead to? • Patella tendon rupture (tear)

  23. Muscle & Tendon Knee Injuries • Osgood – Schlatter Disorder • Repeated avulsion fractures at the tibial tuberosity. • More common in young athletes • Peaks around 16 – 17 years old • Predisposing factors? • Running • Jumping • Treatment?

  24. Ligament Injuries • Anterior Cruciate Ligament • ACL prevents what? • Anterior translation of tibia against femur • Mechanism of Injury • Quick change of direction • Twisting motion at the lower leg • Hyperextension

  25. Ligament Injuries • Signs and Symptoms of ACL Tear • A small pop can be heard or felt • Limited ROM due to swelling, pain • Swelling • Instability • Pain in back of knee • Immediate Treatment? • PRICES • Long Term Treatment? • Surgery (3 Graft types – patella tendon, hamstring, cadaver) • Post – Op rehabilitation for ~6 months

  26. Ligament Injuries • Posterior Cruciate Ligament • Prevents? • Posterior translation of tibia against femur • Mechanism of Injury • Falls and lands on bent knee • Forced hyperflexion • Blow to front of tibia

  27. Ligament Injuries • PCL • Signs/symptoms • Pop may or may not be heard • Mild swelling • Initial Treatment? • PRICES • Long term treatment? • Surgery not required depending on individual • Rehabilitation • Strengthening of quadriceps • How does a PCL tear differ from an ACL tear?

  28. Ligament Injuries • Medial Collateral Ligament • Mechanism of Injury • Valgus stress • S/S • Grades • 1 – 3 (mild  severe) • Treatment/Rehab • PRICES • Mild – elastic wrap for compression/support • Moderate/Severe – immobilizer • Strengthen which muscles? • Hip adductor muscles

  29. Ligament Injuries • Lateral Collateral Ligament • Mechanism of Injury • Varusforce • Blow from the medial side • S/S • Grades 1 – 3 (mild  severe) • Treatment/Rehab • Surgery required to repair • Similar to MCL injury • EXCEPT… • Strengthen the hip abductors instead

  30. Cartilage Injuries • Function of menisci • Shock absorption • Stability • M.O.I. • Twisting movement • Hyperflexion/hyperextension • S/S • Pain the joint line • Weight bearing • Catching and locking • Loss of motion (both flexion & extension)

  31. Cartilage Injuries • Treatment/Rehabilitation • Need for surgery depends on what? • Severity of tear • Rehabilitation depends on type of surgery… • Menisectomy (removal of tear) • 4 – 6 weeks until athlete may return to play • Meniscus repair (stitch the tear and anchor to joint capsule) • 3 – 6 months until athlete may return to play

  32. Scenario 1 You are covering a girls’ soccer game. During a transition in game play one of the players goes down and does not get back up. When you get over to her, she is in considerable pain. She says she felt a pop “inside” her knee when she changed directions. She has some loss of motion and swellingon either side of her patella. After you help her up to move off the field she is hesitant to put weight on it because it’s painful and feels like it’s going to give out again. ACL Tear

  33. Scenario 2 • A middle school basketball player enters the athletic training room complaining of pain in the anterior part of his right knee along his patellar tendon. He used to just have pain after he finished practices and games, but is starting to have pain during AND after activity. It has been bothering him for about a month. There is some thickening of the patellar tendon and it is painful to palpate. Patellar tendinitis

  34. Scenario 3 • A tennis player enters the athletic training room with knee pain. She says that during a match yesterday she planted her foot and pivoted, trying to make a play. She doesn’t remember feeling or hearing any pops, but has been having a significant amount of pain in her knee that hasn’t gotten any better. She says that her pain increases when she goes up or down the stairs. She’s also starting to notice that her knee feels like it’s catching or locking when she flexes and extends it. Upon palpation you notice that most of her pain is located along the tibial plateau (or joint line). Meniscus tear

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