© 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning Chapter 18 The Knee.

© 2010 Delmar, Cengage Learning1© 2011 Delmar, Cengage Learning

Chapter 18

The Knee


Objectives

Upon completion of this chapter, you should be able to:Describe the functions of the kneeDescribe the ligament structure of the kneeExplain the function of the patellofemoral jointList and define various sports-related injuries

of the knee

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The Knee

• One of the most complex joints in the bodyOne of the most complex joints in the body– Most movements and activities depend on it Most movements and activities depend on it

for support and mobility for support and mobility – There is risk of overuse and traumatic injury in There is risk of overuse and traumatic injury in

both contact and non-contact sportsboth contact and non-contact sports

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OUCH!!!

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The Knee (cont’d.)

Composed of 3 bones:FemurTibiaPatella

Condyles: rounded prominences (femur)

Tibial plateau: top, flat portion of tibia

Tibiofemoral joint: where tibia meets femur

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• 2 types of cartilage in the knee joint:2 types of cartilage in the knee joint:– Articular cartilageArticular cartilage

• Thin layer of connective tissue over ends of long Thin layer of connective tissue over ends of long bonesbones

– MenisciMenisci• Medial meniscusMedial meniscus• Lateral meniscusLateral meniscus• Aid in shock absorption, distributing forces, & Aid in shock absorption, distributing forces, &

improving stabilityimproving stability

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LigamentsMedial collateral

ligament (MCL) Lateral collateral

ligament (LCL) Anterior cruciate

ligament (ACL) Posterior cruciate

ligament (PCL)

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• Patellofemoral jointPatellofemoral joint– Point where patella & femur are connected in Point where patella & femur are connected in

trochlear groovetrochlear groove– PatellaPatella: “kneecap”: “kneecap”

• Inside quadriceps tendonInside quadriceps tendon

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

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MusclesQuadriceps: 4 muscles in

front of thigh (extend knee)Vastus medialisVastus intermediusVastus lateralisRectus femoris

Patella tendon: encompasses patella & extends distally across front of knee

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Hamstrings (flex knee)Biceps femorisSemitendinosusSemimembranosus

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Knee Injuries

• Patellofemoral problemsPatellofemoral problems– Articulation of the patella with the femurArticulation of the patella with the femur

• Symptoms: aching pain in the front or behind the Symptoms: aching pain in the front or behind the knee, knee is giving way, knee, knee is giving way, crepitus crepitus (grinding noise (grinding noise or sensation), patellofemoral joint pain, and mild or sensation), patellofemoral joint pain, and mild swellingswelling

• Treatment: correct suspected causes, shoe Treatment: correct suspected causes, shoe inserts, taping and bracing, and stretchinginserts, taping and bracing, and stretching

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Knee Injuries (cont’d.)

• Patellar tendonitis (“jumper’s knee”)Patellar tendonitis (“jumper’s knee”)– Inflammation of the patellar tendonInflammation of the patellar tendon– Caused by high-force, repetitive strain Caused by high-force, repetitive strain

• Symptoms: anterior knee pain and local Symptoms: anterior knee pain and local tendernesstenderness

• Treatment: activity modification, stretching, ice, Treatment: activity modification, stretching, ice, bracing, and taping bracing, and taping

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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 anti-inflammatory medications

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• Medial collateral ligament (MCL) sprainMedial collateral ligament (MCL) sprain– Caused by a blow to the outside of the knee Caused by a blow to the outside of the knee

((valgusvalgus force) or a high-energy twisting force) or a high-energy twisting• Symptoms: limited motion, swelling of the medial Symptoms: limited motion, swelling of the medial

knee, tenderness, and painknee, tenderness, and pain• Treatment: PRICE, protective wrap, a brace or Treatment: PRICE, protective wrap, a brace or

crutches, rehabilitation crutches, rehabilitation

• Lateral collateral ligament (LCL) sprainLateral collateral ligament (LCL) sprain– Blow to inside of knee (Blow to inside of knee (varus varus force)force)

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• Torn anterior cruciate ligament Torn anterior cruciate ligament (ACL)(ACL)– Females are now more susceptibleFemales are now more susceptible– Can occur from contact or Can occur from contact or

noncontact causes noncontact causes • Symptoms: hearing a “pop” followed by Symptoms: hearing a “pop” followed by

effusion, knee buckling, nauseaeffusion, knee buckling, nausea• Treatment: splinting, icing, and Treatment: splinting, icing, and

compressive wrapping, crutches, compressive wrapping, crutches, reconstructive surgery, rehabilitation (6-reconstructive surgery, rehabilitation (6-12 months)12 months)

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• Posterior cruciate ligament (PCL) tear Posterior cruciate ligament (PCL) tear – Most occur during a fall on the flexed (bent) Most occur during a fall on the flexed (bent)

knee with the foot plantar flexed or knee with the foot plantar flexed or hyperflexion (bending too far) of the kneehyperflexion (bending too far) of the knee• Symptoms: positive “sag test”Symptoms: positive “sag test”• Treatment: PRICE, physical therapy and Treatment: PRICE, physical therapy and

rehabilitation rehabilitation

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Meniscus tearsOccur 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 tornSymptoms: 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

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Epiphyseal (growth-plate) injuries Knee is subject to sports-

induced trauma at the centers of bone growth in skeletally immature athletes

May alter the length of the affected boneSerious injury for a

growing athlete

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• Osgood-Schlatter Osgood-Schlatter condition condition – Group of symptoms Group of symptoms

involving the tibial involving the tibial tubercle epiphysis tubercle epiphysis

• Symptoms: pain, Symptoms: pain, swelling, weakness, and swelling, weakness, and a visible lump a visible lump (permanent)(permanent)

• Treatment: preventing Treatment: preventing progression, protective progression, protective gear, ice, anti-gear, ice, anti-inflammatories, inflammatories, improving flexibility, and improving flexibility, and stretching stretching

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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

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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

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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)

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Conclusion

The knee is the largest joint in the body, and one of the most prone to injuryMade up of the femur, tibia, and patellaAlso contains large ligaments that help

control motionThese ligaments connect bones and brace the

joint against abnormal types of motionOther parts of the knee, like cartilage, cushion the

joint and help it absorb shock during motion

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© 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning Chapter 18 The Knee.

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Transcript of © 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning Chapter 18 The Knee.