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The Knee

The Knee. From the Sports Medicine Perspective. Bony Anatomy. Femur Patella Tibia Fibula. Bony Anatomy. Femur: Longest Bone in Body Tibia: WB bone of lower extremity Fibula: Site of Muscle Attachment Patella: Sesamoid Bone A bone that develops within a tendon. Knee Skeletal.

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The Knee

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  1. The Knee

  2. From the Sports Medicine Perspective

  3. Bony Anatomy Femur Patella Tibia Fibula

  4. Bony Anatomy • Femur: Longest Bone in Body • Tibia: WB bone of lower extremity • Fibula: Site of Muscle Attachment • Patella: Sesamoid Bone • A bone that develops within a tendon

  5. Knee Skeletal Lateral Condyle Head of Fibula Femoral Groove Gerdy’s Tubercle TibialTuberosity Pes Anserine

  6. Sagittal MRI View

  7. Knee Connective Tissue

  8. Knee Menisci

  9. Menisci

  10. Menisci Medial Meniscus Lateral Meniscus PCL ACL

  11. Knee Ligaments

  12. Medial Collateral LigamentMCL

  13. MCL • Thick Band of Tissue • Tibia  Femur • Resists Valgus Force

  14. Valgus • Outside to Inside Force • MCL resists this force • Occurs in FRONTAL PLANE

  15. Lateral Collateral Ligament LCL

  16. LCL • Narrow cord like band of tissue • Fibula  Femur • Resists Varus Forces

  17. Varus • Inside to Outside Force • LCL resists this force • FRONTAL PLANE

  18. Increased Valgus

  19. Collateral Ligament Ruptures

  20. Ligament Structures

  21. Anterior Knee

  22. Anterior Cruciate Ligament ACL • Composed of 3 bands • Prevents anterior translation of tibia • Stabilizes against excessive rotation • Stabilizing Ligament

  23. Healthy ACL

  24. Torn ACL

  25. Knee Posterior

  26. Posterior Cruciate Ligament PCL • Stabilizes the posterior aspect of knee • Prevents hyperextension

  27. Cadaver Knee

  28. Quadriceps • Anterior Thigh Musculature • Four Muscles: • Rectus Femoris • Vastus Lateralis • Vastus Medialis • Vastus Intermedius • Extend the Knee

  29. Quadriceps

  30. Rectus Femoris • 2 Joint Muscle • Crosses hip and knee • Flexes Hip • Extend the knee • Converges with rest of quadriceps muscles at tibial tubercle

  31. Hamstrings • Three Muscles • Semimembranosus • Semitendinosus • Biceps Femoris • Common Origin the ischial tuberosity • Flex the Knee

  32. Hamstrings

  33. Popliteus

  34. Popliteus

  35. MCL Sprains • Valgus Force • Tensile Mechanism  MCL • Flexed knee more vulnerable (open pack position = less stable)

  36. MCL Injuries • Direct trauma in frontal plane injures MCL • Combination of rotation can result in ACL and meniscus tears

  37. MCL/LCL Injuries • GRADE I: • No instability • Mild Effusion • ROM full • Mild tenderness w/ palpation

  38. GRADE II: Laxity w/ valgus or varus stress (more with 30 degrees of flexion) Decrease in ROM Increase medial (MCL) or lateral (LCL) pain GRADE III: Complete ligament rupture Complete loss of stability Immediate pain that transitions into dull ache MCL/LCL Injuries

  39. Treatment • Based on severity of injury • RICE • Modify activity • Crutches • Exercises in sagittal plane • Progress to functional exercise

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