THE KNEE

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THE KNEE
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KNEE ANATOMY

• Bony Structures
• Femur thighbone
• Tibia larger shinbone
• Fibula smaller shinbone
• Patella Provides anterior protection and
  increased leverage with knee extension

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KNEE ANATOMY

• Menisci Medial and Lateral
• Absorbs shock
• Provides stability to the knee
• Disperses lubrication synovial fluid
• Poor blood supply, no nerves or lymphatic
  channels almost impossible to heal itself

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KNEE ANATOMY

• Stabilizing Ligaments
• Cruciate Ligaments
• ACL (Anterior Cruciate Ligament)
• PCL (Posterior Cruciate Ligament)
• Join the femur to the tibia in the center of the
  knee joint
• Provides large degree of stability for the knee
  joint
• Function To prevent the femur and tibia from
  sliding and rotating away from each other

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KNEE ANATOMY

• Stabilizing Ligaments
• Collateral Ligaments
• Medial Collateral Ligament
• Lateral Collateral Ligament
• Function To prevent excessive sideways bending
  of the femur and tibia/fibula

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ACUTE KNEE INJURIES

• Include ligament strains (most common), cartilage
  tears, kneecap dislocations, kneecap fractures
• May be caused by a twist of the knee that forces
  the bones of the joint to separate (i.e. changing
  directions or rapidly decelerating when running)
• Symptoms Immediate pain, swelling and
  instability

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ACL SPRAIN

• ACL sprain is a stretch, tear, or complete
  rupture of the ligament
• Cause
• A violent knee twist, usually when the foot is
  fixed in place (as when cleats are stuck in the
  ground) and the upper leg and/or body is rotated

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ACL SPRAIN

• Symptoms
• Immediate pain and a pop at the time of the
  injury
• A sensation as if the knee is coming apart
• Immediate dysfunction and instability followed by
  swelling
• Athlete will not be able to walk without
  assistance

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ACL SPRAIN

• Athletes at Risk
• Primarily those involved in contact sports or any
  sport where there are rapid changes of direction
  when running (i.e. football, basketball, soccer,
  field hockey)

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ACL SPRAIN

• Concerns
• The Terrible Triad - The medial collateral
  ligament and medial meniscus are often injured
  along with the ACL

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ACL SPRAIN

• Recovery Time
• If surgery is required, nine to twelve months of
  rehabilitation is necessary before the athlete
  can resume vigorous activities, though it may be
  possible to start light running or cycling in
  three months.

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MENISCUS INJURIES

• Involves damage to one or both of the two flat,
  crescent-shaped pieces of cartilage that lie in
  the knee joint between the femur and the tibia
• Medial meniscus (inner knee) is five times more
  likely to be injured than the lateral meniscus
  (outer knee)
• Meniscus injuries almost never heal by
  themselves, therefore, surgery is often required

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MENISCUS INJURIES

• Cause
• Excessive twisting, turning, and compression of
  the knee joint, possibly preceded by a single
  small tear that worsens over time.

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MENISCUS INJURIES

• Symptoms
• Onset of symptoms is usually gradual
• Pain on the inner side of the knee joint during
  sports
• Pain when pressing on the joint line on the
  inner side of the knee
• Clicking or locking in the joint (caused by the
  torn portion of the meniscus catching on the end
  of the femur)

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MENISCUS INJURIES

• Concerns
• Left untreated, a torn meniscus may worsen to the
  point where the entire meniscus has to be removed
  instead of just repaired.

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MENISCUS INJURIES

• Recovery Time
• After arthroscopic surgery, the athlete can
  expect to return to activities that put
  rotational stress on the knee joint within four
  to eight weeks afterwards
• Strengthening exercises for the muscles of the
  thigh should continue even after the athlete
  returns to sports

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OVERUSE INJURIES

• Include meniscus wear tear, kneecap wear
  tear, tendonitis conditions, and bursitis
• Onset of symptoms is gradual
• Caused by excessive sports activity, but often
  have an underlying risk factor
• Risk factors are either internal or external

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RISK FACTORS

• Internal
• Usually involve deficits in strength and
  flexibility of the surrounding muscles, tendons,
  and ligaments
• Also include anatomical abnormalities, such as
  leg length discrepancies, abnormalities in hip
  rotation or the position of the kneecap, bowlegs,
  knock-knee, or flat feet

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RISK FACTORS

• External
• Include training errors, improper footwear, and
  improper technique
• Key Management of Overuse Injuries EARLY
  INTERVENTION

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Causes
• It is believed that most kneecap pain is caused
  by problems with kneecap alignment brought on by
  various types of anatomical abnormalities or
  deficits in strength and/or flexibility
• This misalignment can lead to damage to the back
  surface of the kneecap chondromalachia patella

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Anatomical abnormalities contributing to PFPS
• Flat feet
• Thighs that turn inward from the hip
• Q-angle greater than 15-20 degrees
• High-riding kneecaps
• Shallow femoral groove
• Looseness of the quadriceps tendon

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Strength and flexibility deficits that may
  contribute to PFPS
• Weakness and/or tightness in the quadriceps,
  hamstrings, and calves
• Weak inner quad muscle (vastus medialis) and a
  comparatively strong outer quad muscle (vastus
  lateralis) causing the kneecap to be pulled to
  the outside

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Symptoms
• Onset of symptoms is gradual
• Usually, there is pain in front of the kneecap,
  and frequently, in both kneecaps
• Pain may be spread out, or localized along the
  inner or outer edge of the kneecap
• Pain intensifies during sports activity and
  ceases when participation stops
• Usually there is no swelling, although there may
  be occasional puffiness in the knee

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Symptoms (Contd)
• Typically, pain develops when the person sits for
  extended periods with the knee bent (i.e. long
  car ride), as well as when walking up stairs
• There may be an audible crunching, crackling in
  the knee
• Athlete may complain of the knee giving way

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Symptoms (Contd)
• Symptoms usually intensify with increased sports
  activity levels and decrease when activity levels
  decline

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Athletes at risk
• Primarily those engaged in sports involving
  excessive amounts of running/squatting
• Females gt Males
• Concerns
• Unlikely to clear up unless true causes are
  identified and addressed

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PATELLOFEMORAL PAIN SYNDROME (PFPS)

• Recovery Time
• Both nonoperatively and after surgery, this
  condition takes between six to twelve weeks to
  resolve

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PATELLAR TENDONITIS JUMPERS KNEE

• Prevalent among athletes in jumping sports
• An inflammation of the tendon that connects the
  tibia to the kneecap
• One of the most common and troublesome overuse
  injuries in sports
• Develops in three phases

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PATELLAR TENDONITIS JUMPERS KNEE

• Phase one (mild) Pain is felt after activity
  only and there is no effect on performance
• Phase two (moderate) Pain is felt during and
  after activity. The athlete can perform at a
  satisfactory level.
• Phase three (severe) Pain during and after
  activity, and it is more prolonged. Pain may be
  felt during daily activities. Sports performance
  is affected.

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PATELLAR TENDONITIS JUMPERS KNEE

• Causes
• Repetitive jumping both the muscle contraction
  necessary for the push-off and the impact forces
  of the landing stress the tendon
• Weak or inflexible thigh muscles predispose the
  athlete to this condition

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PATELLAR TENDONITIS JUMPERS KNEE

• Athletes at risk
• Those engaged in sports that require dynamic
  jumping, such as basketball and volleyball, as
  well as weightlifters who perform squats
• Concerns
• Healing is very slow because of poor blood supply
  to tendons

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PATELLAR TENDONITIS JUMPERS KNEE

• Recovery Time
• Depending on the severity, this condition can
  take anywhere from two weeks to several months to
  resolve

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WHAT YOU CAN DO

• Depending on the severity of the injury, it may
  be necessary to seek medical treatment as soon as
  possible

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Questions