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Knee

Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

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Page 1: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Knee

Page 2: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Terminology

• Tibial Tuberosity: Boney protrusion where the patellar tendon inserts.

• Femoral Condyles: Distal end of the femur.• Intercondyler Notch: An indentation in the

distal femur where the anterior cruciate descends.

• Quadriceps Femoris Muscle group: attach to the patella through the quadriceps tendon.

Page 3: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Terminology

• Pes Anserine:“foot of a bird”, the insertion of the semitendinosis, sartorius, and gracilis to the anteromedial tibia

• Unhappy Triad (Terrible Triad): Tearing of the anterior cruciate ligament, medial collateral ligament and the medial meniscus.

• Varus Stress: Stress applied to the medial aspect of the knee.

• Valgus Stress: Stress applied to the lateral aspect of the knee.

Page 4: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Terminology

• Direct trauma: A blow or fall on the knee.• Indirect trauma: violent contracture of the

quadriceps• Distal pulses: pulses in the foot. The dorsalis

pedis and the posterior tibial pulse. • Chondromalacia: A degenerative condition in

which there is a wearing away of the cartilage on posterior patella.

• Subchondral: Below the cartilage.

Page 5: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Bones Of The KneeOFemurOTibiaOFibulaOPatella

Femur

Patella

TibiaFibula

Page 6: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Condyles of the Knee

Lateral CondyleMedial Condyle

Page 7: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Patellar Tendon

Tuberosity

Page 8: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Cartilage known as Menisci

Page 9: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Cruciate ligaments form an “X”

http://www.kneeguru.co.uk/KNEEnotes/cruciate-ligament

http://www.kneeguru.co.uk/KNEEnotes/node/829

Page 10: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Primary and Secondary Motions of The Knee

1. Primary Motions• Flexion• Extension2. Secondary Motions• Internal Rotation• External Rotation• Gliding Motion (a little)

Page 11: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Quadriceps

• Strongest muscle group in the body• Vastus Medialis• Vastus Intermedius• Vastus Lateralis• Rectus Femoris

• Responsible for knee extension

Page 12: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Hamstrings

• Biceps Femoris (long and short head)• Semimembranosus• Semitendinosus

• Responsible for knee flexion

Page 13: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Bursa

Fluid sac acting as a cushion and lubricant in areas of friction

• Suprapatellar - under patella (running)• Perpatellar - on top of patella (direct blow)• Anserine - below knee (running)

Page 14: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Medial Collateral Ligament Sprain

• MOI: occurs most often in violently adducted and internally rotated knees.

• Path: a tear or sprain in the MCL• S/S: swelling, pain, loss of stability, popping noise, (+)

valgus stress test on MCL (may vary depending on degree of injury)

• Tx: RICE, rehab-light weights, straight leg raises, whirl pool (if available), crutches for discomfort and degree of injury, MCL taping

Page 15: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Lateral Collateral Ligament Sprain

• MOI: blow to inside of the knee (varus force)• Path: partial to complete tear of ligament• S/S: pain on lateral side of knee, swelling, positive varus stress test• Tx: RICE, crutches and referral to physician

Page 16: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Anterior Cruciate Ligament Sprain (ACL)

• MOI: twisting of the knee, hyperextension of the knee, forward movement of the tibia on the femur

• Path: Stretching or tearing of the ACL; secondary injuries: medial meniscus tear and medial collateral ligament sprain – Terrible Triad: ACL pathology WITH secondary injuries

• S/S: A pop followed by immediate disability, pain, rapid swelling at the joint, feels like knee is coming apart

• Tx: RICE, crutches, refer to doctor.

Page 17: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Meniscus Tear

• MOI: sudden twisting and compression• Path: tear of the meniscus• S/S: locking, swelling, pain, giving way• Tx: RICE, crutches, refer to doctor.

Page 18: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

• MOI: athlete plants their foot and changes direction.

• Path: the quadriceps muscles attempt to pull in a straight line and in a result pulls the patella laterally.

Patellar Subluxation or Dislocation

Page 19: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Patellar Subluxation or Dislocation Cont.

S&S: Complete loss of knee function; pain and swelling

Tx: immobilize in the position it is in, place ice around the joint, see physician, use crutches.

Page 20: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Patellar Fractures

• MOI: caused by direct or indirect trauma. Forcible muscle contraction, falling, jumping, and running can also cause a fracture.

• Path: a severe pull of the patellar tendon against the femur when knee is semi flexed resulting in a fracture

• S/S: causes hemorrhage and joint effusion, resulting in generalized swelling. – An indirect fracture causes capsular tearing, separation of

bone. Tearing of the quadriceps tendon is also a sign.– Direct fracture involves bone separation.

Page 21: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Patellar Fracture Cont.

• Tx: a cold wrap should be applied, followed by elastic compression wrap, splinting, crutches and Doctor referral.

Page 22: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

Knee Dislocation

• The most Serious knee injury is the dislocation of the tibiofemoral joint. THIS IS AN EMERGENCY!

• http://emedicine.medscape.com/article/1250829-overview

Page 23: Knee. Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch:

• MOI: Direct blow to the anterior proximal tibia, forceful twisting, lateral blow to the knee.

• S/S: Grossly displaced tibia, sever pain, swelling, and may have absence of distal pulses.

• Tx: Calm athlete down, splint, and immediate transport to the hospital. Check distal pulses.

Knee Dislocation Cont.