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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: An indentation in the distal femur where the anterior cruciate descends.

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Knee

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  1. Knee

  2. 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.

  3. Terminology • PesAnserine:“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.

  4. Terminology • Direct trauma: A blow or fall on the knee. • Indirect trauma: violent contracture of the quadriceps • Distal pulses: pulses in the foot. The dorsalispedis 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.

  5. Bones Of The Knee • Femur • Tibia • Fibula • Patella Femur Patella Tibia Fibula

  6. Condyles of the Knee • Lateral Condyle • Medial Condyle

  7. Patellar Tendon Tuberosity

  8. Cartilage known as Menisci

  9. Cruciate ligaments form an “X” http://www.kneeguru.co.uk/KNEEnotes/cruciate-ligament http://www.kneeguru.co.uk/KNEEnotes/node/829

  10. Primary and Secondary Motions of The Knee 1. Primary Motions • Flexion • Extension 2. Secondary Motions • Internal Rotation • External Rotation • Gliding Motion (a little)

  11. Quadriceps • Strongest muscle group in the body • VastusMedialis • VastusIntermedius • VastusLateralis • Rectus Femoris • Responsible for knee extension

  12. Hamstrings • Biceps Femoris (long and short head) • Semimembranosus • Semitendinosus • Responsible for knee flexion

  13. 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)

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. Patellar Subluxation or Dislocation • 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.

  19. 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.

  20. 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.

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

  22. 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

  23. Knee Dislocation Cont. • 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.

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