The Knee and Related Structures

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The Knee and Related Structures

• Chapter 16

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KNEE ANATOMY

• Bones
• femur
• fibula
• tibia
• patella
• Articulations
• tibiofemoral
• patellofemoral

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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

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ANATOMY cont.

• Joint Capsule
• Synovial Capsule
• Knee musculature
• quadriceps group
• hamstrings group
• iliotibial band
• gastroc, gracilis, sartorius, popliteus,
  plantaris
• Patellar tendon

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ANATOMY cont.

• Additional Knee Structures
• Bursa
• Popliteal fossa
• Fat pads / plica
• Nerves
• Blood vessels

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KNEE ALIGNMENT DEVIATIONS

• Patellar malalignments
• Genu valgum
• Genu varum
• Genu recurvatum
• Q angle

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KNEE INJURIESand CONDITIONS

• FRACTURES
• DISLOCATION
• CONTUSIONS
• SPRAINS
• MENISCUS TEARS
• the Unhappy Triad
• SYNOVIAL PLICA SYNDROME

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INJURIES cont.

• OSTEOCHONDRITIS DISSECANS
• PATELLAR DISLOCATION/SUBLUX
• CHONDROMALACIA
• OSGOOD-SCHLATTERS DISEASE
• LARSEN-JOHANSSON
• JUMPERS KNEE
• ILIOTIBIAL BAND SYNDROME
• ARTHRITIS - DJD

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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

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EVALUATION cont.

• SPECIAL TESTS
• Valgus / Varus test
• Drawer test
• Lachmans test (alternate Lachmans?)
• McMurrays test
• ADDITIONAL SPECIAL TESTS
• X-ray and/or MRI
• KT-1000
• Apleys, Slocums, Rotary instability tests?

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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.

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Tests for ACL Instability

• Drawer Test
• Lachmans Test
• Alternate Lachmans Test
• Modified Lachmans Test
• KT 1000 Arthrometer

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Tests for PCL Instability

• Posterior Drawer Test
• Godfreys Test
• Uses gravity to extenuate the posterior sag as
  noted by observation. Flex knees bilaterally to
  90 degrees.

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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

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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.
• McMurrays Test
• Apleys Compression/Distraction Test

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Additional Conditions

• Infrapatellar Fat Pad
• Bursitis
• Other Patello-femoral conditions
• Extensor Mechanism problems
• Osgood-Schlatters - Iliotibial band
  syn.
• Larsen-Johansson disease - Pes Anserine syn.
• Jumpers knee - Collapsing
  knee
• Patellar tendon rupture

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Knee Rehabilitation

• General Conditioning
• Weight Bearing
• Knee Joint Mobilization
• Flexibility
• Muscular Strength
• Neuromuscular Control
• Bracing

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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