1. Athletic InjuriesATC 222 The Knee Chapter 19

2. Anatomy • bony • muscular • cartilage • ligaments • bursa • etc

3. Functional Anatomy • Motions • flexion/extension • 140 degrees • __________ flexion limited • rotation • last 15 degrees of extension • app. 10 degrees int/ext rotation • referred to as _______ _______ mechanism • rolling and gliding?

4. Functional Anatomy • ACL • generally tight in extension • limits rotation, hyper______, and anterior tibial translation • PCL • tight in flexion • limits rotation, hyperflexion, and _______tibial translation • MCL • tight in extension • limits valgus and external tibial rotation • LCL • tight in extension • limits varus and _______ tibial rotation

5. MCL Sprain • Mechanism • lateral force • external tibial rotation • More severe and common than LCL • part of capsule • attaches to medial __________ • Signs and Symptoms • pain over MCL • none to moderate edema/effusion • possible laxity with valgus stress • possible ROM and strength loss • pain with passive extension and external tibial rotation

6. MCL Sprain Treatment • RICER • Crutches? • Immobilization? • Meniscal involvement? • Rehabilitation

7. LCL Sprain • Mechanism • varus force, internal tibial rotation • Less prevalent that MCL • no ______________ attachment • action of _______________ muscle • common peroneal nerve • Signs and Symptoms • pain over LCL • none to mild edema/effusion • possible laxity with varus stress • possible ROM and strength loss • pain with passive extension and internal tibial rotation • Treatment

8. ACL Sprain • Mechanism • external tibial rotation with valgus • internal tibial rotation • hyper_______ • deceleration • Most common knee ligament to be seriously injured • Signs and Symptoms • heard/felt a “pop” • rapid effusion/hemarthrosis (1-2 hours) • knee “gives out” • positive ligament testing

9. ACL Sprain Treatment • RICER • Crutches? • Immobilization? • Conservative vs surgical intervention • commonly associated with meniscal tear

10. PCL Sprain • Mechanism • force to anterior tibia with knee flexed • hyperflexion • rotation • Signs and Symptoms • “Pop” • Effusion • Positive ligament testing • Treatment • usually non-operative

11. Meniscal Lesions • Mechanism • _______ while weight bearing • MCL or ACL sprain • chronic knee instability or degeneration • Signs and Symptoms • clicking, catching, locking • ------- developing effusion • positive McMurray’s or Apley’s • pain on joint line • chronic effusion • Treatment • healing rate? • Arthroscopic surgery • removal vs repair

12. Patellar Subluxation/Dislocation • Mechanism • external tibial rotation • valgus • functional/structural deviations • Signs and Symptoms • deformity • positive __________ sign • effusion • pain on medial patellar border • Treatment • RICER • immobilization and crutches? • reduction • rehabilitation

13. Patellofemoral Syndrome • Structural/functional deviations • Signs and Symptoms • medial peripatellar pain • pain with stairs • crepitus • pain with stairs/prolonged sitting • Treatment • symptomatic • correct functional/structural deviations

14. Apophyseal Injuries(apophysitis) • Apophysis = __________ Epiphysis • Types • Osgood-Schlatter’s Syndrome • Sinding-Larson-Johanson Syndrome • Signs and Symptoms • pain at tendon attachment • tibial tubercle enlargement • pain with prolonged sitting • Treatment • symptomatic • flexibility • activity modification • straps and sleeves

15. Other Injuries • Tendonitis • Osteochondral defects • ITB syndrome

16. Special Tests of the Knee • tibial/fibular compression/percussion • patellar apprehension • ballotable patella and stroke test • patellar excursion and compression • ** valgus/varus stress • 0 and 30 degrees • **Lachman • **anterior/posterior drawer • **McMurray’s • **Apley’s compression/distraction • **sag test

17. Other Special Considerations • Girth measurements • quality of VMO • leg length discrepancy • Q-Angle • 10 males, 15 females • over ____ is abnormal

18. Assessment • History • Observation • Palpation • Special Testing

19. Rehabilitation • Muscular strength and endurance • ROM and flexibility • Proprioception • Functional exercises