The Knee: Anatomy and Injuries - PowerPoint PPT Presentation

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The Knee: Anatomy and Injuries

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Title: The Knee: Anatomy and Injuries


1
The Knee Anatomy and Injuries

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2 Joints at the Knee
  • Tibiofemoral Joint formed between the femur
    (femoral condyles), and the tibial plateau
  • A HINGE JOINT
  • Patellofemoral joint formed between the patella
    and the femur
  • A GLIDING JOINT

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Skeletal Anatomy
  • Femur
  • proximal head and neck of femur, greater
    trochanter
  • distal medial and lateral
  • condyles and epicondyles

6
  • Patella largest sesamoid bone in body
  • Tibia tibial plateau forms knee joint with
    femur
  • The fibula is not a part of the knee joint

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Muscles that move the knee and thigh
  • The Quadriceps Knee Extension
  • 1. Vastus Medialis
  • 2. Vastus Lateralis
  • 3. Vastus Intermedius
  • 4. Rectus Femoris 2 joint muscle that
    also acts as a
  • hip flexor

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  • The Hamstrings- knee flexion
  • 3 muscles
  • 1. Biceps Femoris
  • 2. Semimembranosus
  • 3. Semitendinosus

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  • The Adductors (Groin)
  • Adduct the thigh
  • 1. Adductor Longus
  • 2. Adductor Magnus
  • 3. Adductor Brevis
  • 4. Gracilis

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14
  • The Sartorius
  • - flexes, abducts, and laterally rotates thigh
  • - longest muscle in the body, tailors
    muscle
  • - Crosses hip and knee joint

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  • The Iliotibial Tract
  • (IT Band)
  • - neither a muscle or tendon, but a long,
    thick band of tissue that inserts into the
    lateral tibia (Gerdys Tubercle)


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The Major Knee Ligaments
  • ACL Anterior Cruciate Ligament
  • PCL Posterior Cruciate Ligament
  • MCL Medial Collateral Ligament
  • LCL Lateral Collateral Ligament

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The Cruciate LigamentsThe major stabilizing
ligaments of the knee
  • ACL
  • Runs from posterior femur to anterior tibia
  • Prevents anterior displacement of tibia
  • PCL
  • Runs from anterior femur to posterior tibia
  • Prevents posterior displacement of tibia

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The Collateral Ligaments
  • MCL
  • Medial Collateral Ligament
  • Runs from medial femur to medial tibia
  • Prevents valgus force
  • LCL
  • Lateral Collateral Ligament
  • Runs from lateral femur to head of fibula
  • Prevents varus force

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The Meniscus
  • A c-shaped piece of fibrocartilage located in
    the knee joint between the femur and attached to
    the top of the tibia
  • Cartilage meniscus

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Differences between medial and lateral
  • Medial
  • - larger and more C-shaped
  • - more firmly attached to tibia
  • - has attachments to MCL
  • Lateral
  • - smaller and more round or O-shaped
  • - not firmly attached to tibia and LCL

28
Blood Supply to the Meniscus
  • Mostly avascular little or no blood supply
  • Only the outer 20 has a blood supply
  • Does not have the ability to heal itself unless
    there is a small tear in the outer 20

29
Functions of Meniscus
  1. Stability
  2. Shock absorption
  3. Lubrication and nutrition
  4. Allows adequate weight distribution

30
  • Normal
  • Torn

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Total Knee Joint Replacement
  • Surgery to replace a painful damaged or diseased
    knee joint with an artificial joint (prosthesis)
  • Artificial hip invented 1962
  • 1969 first artificial knee in USA

33
The Knee Surgery
  • Thin layer of bone removed from femur thin
    metal replaces it
  • Upper layer of tibia replaced with plastic
  • Back of patella replaced with plastic
  • Parts fastened with bone cement

34
Risks of Knee Joint Replacement
  • Blood clots in large veins
  • Infection
  • Stiffness
  • Implant Loosening/Failure
  • - more of a problem in younger patients

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Knee Injuries and Conditions

39
  • Genu Valgum
  • knock knees

40
  • Genu Varum
  • bowlegs

41
  • Genu Recurvatum
  • hyperextension of the knee joint

42
Patellar Tracking Disorder
  • When your patella is out of balance or the
    patellar cartilage is damaged, you can have knee
    pain while climbing stairs, running, standing up
    from a bent-knee position, squatting, or even
    sitting for a period of time. This kind of pain,
    called anterior knee pain or patellofemoral pain
    syndrome, is sometimes caused by a common kneecap
    problem known as patellar tracking disorder.

43
Causes
  • Quadriceps weakness
  • Tendon and muscle tightness in the leg, foot, or
    hip areas
  • Improper athletic technique or training
  • A blow to the kneecap
  • Excessive body weight, which overstresses the
    knee joint.
  • Genetics

44
  • Genetics (cont.)

- An excessively long patellar tendon - patellar
shape, hip structure, or a shallow femoral
groove for the patella to glide along
45
Patellofemoral Disorders
  • Problems with patella most common cause of knee
    pain
  • Anatomy
  • - Patella is a sesamoid bone formed in
    Quad tendon
  • - Patellofemoral joint patella and femur
  • - Compression forces
  • ltbody weight during walking
  • 2.5 x body weight during stairs

46
Patellar Tendonitis
  • Jumpers Knee
  • Inflammation and degeneration of the tendon that
    connects the kneecap (Patella) to the shin bone
    (Tibia).

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Chondromalacia
  • A gradual degenerative change that occurs beneath
    the patella
  • Caused by acute trauma, repeated microtrauma, or
    improper alignment of the patella in the
    trochlear groove
  • Weak vastus medialis (VMO) can cause improper
    alignment
  • Prevention strengthen quads
  • Minimize squats, downhill running, biking
    with low seat

49
Chondromalacia

50
Patellar Dislocation
  • Dislocation usually occurs as a result of sudden
    direction changes while running and the knee is
    under stress or it may occur as a direct result
    of injury.
  • Usually lateral

51
  • Rehab strengthen quads, especially VMO to hold
    patella in place
  • Each dislocation will damage cartilage which can
    eventually lead to traumatic arthritis

52
Osgood-Schlatter Disease
  • 1. Painful swelling over tibial tuberosity
  • (patellar tendon insertion)
  • 2. Usually occurs between 9-13 years of age
  • 3. Pain increases with activity

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  • The Chopat Strap

55
Iliotibial Band Friction Syndrome
  • Occurs where IT Band rubs over femur at the knee
    joint
  • Common in running (esp. downhill) or any activity
    with repetitive flexion
  • Hills or stairs increase pain
  • Lots of IT Band stretching

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Popliteal Cyst
  • Bakers Cyst
  • Fluid accumulation in posterior knee (popliteal
    space)
  • Patient usually complains of a mass behind the
    knee

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Prepatellar Bursitis
  • Housemaids Knee
  • Tender swelling over the kneecap (prepatellar
    bursa)

60
Pes Anserine Bursitis
  • Pes anserine bursitis is an irritation or
    inflammation of a bursa in your knee. The pes
    anserine bursa is located on the inner side of
    the knee just below the knee joint.
  • Tendons of three muscles attach to the shin bone
    (tibia) over this bursa

61
Knee Sprains
62
ACL Sprain
  • Not most commonly torn knee ligament
  • Higher incidence in females
  • 2-8 times more likely
  • Males contact
  • Females noncontact

63
ACL Sprain
  • 1. MOI twisting of knee
  • forced hyperextension
  • lateral blow to knee
  • foot must be firmly anchored to playing
    surface
  • 2. May describe a pop in knee
  • 35 - 65 of people
  • 3. Knee fills with blood quickly
  • Hemarthrosis
  • 4. Usually immediate loss of motion
  • 5. Knee feels unstable

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  • Anterior Drawer Test
  • examiner attempts to slide the tibia forward
    which may indicate a torn ACL ligament

66
ACL Sprain
  • Who needs surgery?
  • - Activity level?
  • - Level of Competition
  • - Age?

67
ACL Surgery
  • Arthroscopic
  • Graft options
  • Patellar Tendon
  • Semitendinosus
  • Gracilis
  • Cadaver
  • Synthetic

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PCL Sprain
  • MOI excessive hyperextension
  • hyperflexion
  • tibia forced posteriorly
  • (blow to front of knee)
  • dashboard knee
  • Possibly 90 of all PCL injuries due to motor
    vehicle accidents?

71
  1. Mild hemarthrosis
  2. Posterior knee pain
  3. Walk with knee slightly flexed, avoid full
    extension
  4. Posterior sag of tibia
  5. Surgery?

72
MCL Sprain
  • MOI Blow to the outside of the knee Valgus
    Force
  • Possible overuse breaststroke in
    swimmers
  • Commonly associated with meniscal injuries
    attached to medial meniscus
  • No surgery

73
MCL Sprain
74
  • Valgus Stress Test
  • tests for injury to the MCL ligament

75
LCL Sprain
  • MOI Blow to inside of the knee
  • Varus force
  • Grade III tear may require surgery

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  • Varus Stress Test
  • tests for injury to the LCL ligament

78
Injuries to the Meniscus
  1. MOI Rotation of the knee as the knee
    extends during rapid cutting or pivoting

79
  • Signs and Symptoms
  • - pain
  • - joint line tenderness
  • - catching or locking
  • - knee buckling or giving way
  • - swelling
  • - incomplete flexion
  • - clicking on stair climbing

80
  • Surgery?
  • Meniscectomy removal of the meniscus
  • - Total meniscectomy osteoarthritis
  • Depends on location of tear, type of tear,
    and blood supply

81
Types of Meniscal Tears
  • bucket handle
  • Flap tear
  • Transverse tear
  • Horn tear

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Tests for Meniscal Tears
  • Apleys Compression

84
The Unhappy Triad
  • Tear of the medial meniscus, anterior cruciate
    ligament (ACL), and medial collateral ligament
    (MCL)
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