The Knee Knee Joint — “Modified” Hinge Joint — Movement in flexion/extension — Some internal/external tibia rotation

— Synovial Joint — Fibrous joint capsule — Filled with synovial fluid Bones • Femur • Tibia • Fibula • Patella (Sesamoid Bone)

• Reduces tendon friction, enhances mechanical advantage of the joint. Ligaments

— Cruciate — ACL/PCL

— Collateral — MCL/LCL Ligament Stress

Normal Adducted/Varus Abducted/Valgus

Adducted /Varus: LCL Abducted/Valgus: MCL Ligament Stress

PCL Injury ACL Injury

Posterior translation of Tibia on Anterior Translation of Femur Tibia on Femur Cartilage — Articular — Provides frictionless surface

— Fibrous — “Fibrocartilage” — Meniscus- shock absorbing — Deepen articular facets — Medial Meniscus — C –shaped — Lateral Meniscus — O-shaped Meniscal Blood Supply

Red Zone: Outer 1/3rd of the meniscus that receives good blood supply & is repairable and easier to heal

Red-White Zone: Area in between the Red & White Zones of the meniscus where there is some blood supply, and becomes harder to repair and heal

White Zone: Inner 2/3rds of the meniscus that receives little to no blood supply and is harder to repair and rarely heals. Bursae — Fluid filled sacs — Synovial in nature — Purpose: Reduce friction in mobile areas (muscle and tendon movement over joint) Musculature: Quadriceps — Rectus Femoris — Action: Extends leg, flexes thigh — Origin: Illium & Iliac Spine — Insertion: Tibial Tuberosity vis quadriceps/patella tendon

— Vastus Lateralis — Action: Extends leg — Origin: Greater Trochanter — Insertion: Tibial Tuberosity vis quadriceps/patella tendon Musculature: Quadriceps — Vastus Medialis — Action: Extends leg — Origin: Lesser Trochanter — Insertion: Medial Patella, Tibial Tuberosity vis quadriceps/patella tendon

— Vastus Intermedius — Action: Extends Leg — Origin: Proximal Femur — Insertion: Tibial Tuberosity vis quadriceps/patella tendon Musculature: Hamstrings — Biceps Femoris — Action: Flexes leg, Extends thigh — Origin: Ischial Tuberosity, Sacrum — Insertion: Lateral Fibula Head, Lateral Tibia Condyle — Semitendinosus — Action: Flexes Leg — Origin: Ischial Tuberosity — Insertion: Medial Tibial Shaft

— Semimembranosus — Action: Flexes Leg — Origin: Ischial Tuberosity — Insertion: Medial Condyle Of Tibia Musculature: Abductors

— Gluteus Maximus — Action: Abducts thigh, External Rotation of hip — Origin: Illium, Sacrum, Coccyx — Insertion: Gluteal Tuberosity

— Gluteus Medius — Action: Abducts thigh, Internal Rotation of hip — Origin: Illium, Illiac Crest — Insertion: Greater Trochanter

— Gluteus Minimus — Action: Abducts thigh, Internal Rotation of hip — Origin: Illium — Insertion: Greater Trochanter Musculature: Abductors

— Tens or Fa s c i a e Latae — Action: Abducts thigh — Origin: Illiac Crest — Insertion: Lateral Tibial Condyle, IT Band

— Sartorius — Action: Abducts thigh, flexes knee, externally rotates hip — Origin: Illium — Insertion: Medial proximal tibia Musculature: Adductors

— Gracilis — Action: Adducts thigh, Flexes knee — Origin: Pubis — Insertion: Medial Shaft of Tibia

— Adductor Longus — Action: Adducts thigh — Origin: Pubis — Insertion: Shaft of Femur Musculature: Adductors

— Adductor Brevis — Action: Adducts thigh — Origin: Pubis — Insertion: Lesser Trochanter

— Adductor Magnus — Action: Adducts thigh — Origin: Pubis — Insertion: Posterior Medial Condyle of Femur Prevention — Proper hamstring to quadriceps strength ratio — There needs to be equal amounts of force muscular strength between the hamstrings & quadriceps — Flexibility of hamstrings, quadriceps, hip flexor, and lower leg musculature — Agility & Proprioceptive Training — Bracing Injuries Ligament Sprains:

Grade Characteristics

Grade 1 Fibers stretched, minimal to no laxity, minimal swelling, pain

Grade 2 Some fibers torn, noticeable laxity and or instability, moderate swelling, increased pain Grade 3 Complete rupture, severe laxity and or instability, severe swelling, severe pain that dissipates Ligament Sprains: MOI/Treatment — ACL — MOI — Non-contact: Foot planted with pivoting at thigh — Axial load (rotational) with tibial internal rotation and valgus stress — Contact: Hyperextension from blow to knee (damage to other structures) — S/S — Athlete feels a “pop” — Immediate disability — Rapid swelling — “knee is shifting” — Increased ligament/joint laxity Ligament Sprains: MOI/Treatment — ACL — Tx: — Grade 1: RICE — Immobilize 2-3 days — Recovery: 1-3 weeks — Grade 2: RICE — Immobilize about 1 week — Recovery: ≥ 3 weeks Evaluation: — Grade 3: RICE • Anterior Drawer — Surgery • Lachman’s — Recovery up to 1 year • Pivot Shift — Rehabilitation: • Lever’s Sign — Post Surgery — Extension ROM and Isometrics immediately — ROM after immobilization — Progressive strength training (focus on quads strengthening) — Brace for first 6 weeks; Brace for RTP Ligament Sprains: MOI/Treatment — PCL — MOI: — Blow to anterior tibia — Fall on flexed knee — “Dashboard injury” – car accident causing knee to hit dashboard forcing tibia posteriorly — S/S: — “pop” in posterior knee — Posterior knee laxity — Evaluation: — Posterior Drawer — Godfrey’s 90/90 Ligament Sprains: MOI/Treatment — PCL — Tx: — Grade 1: RICE — Immobilize 2-3 days — Recovery: 1-3 weeks — Grade 2: RICE — Immobilize about 1 week — Recovery: ≥ 3 weeks — Grade 3: RICE — Surgery? — Recovery > 4 months

— Rehabilitation — Post Surgery — Immobilize for 6 weeks — ROM/Strength after — ROM/Progressive Strength — Quad strengthening Ligament Sprains: MOI/Treatment — MCL/LCL — MOI: — MCL: Valgus — LCL: Varus stress — S/S: — MCL: — Laxity on medial side — Tenderness on medial side — Swelling centralized on medial aspect Evaluation: — LCL: — Laxity on lateral side • MCL: Varus Stress Test • LCL: Valgus Stress Test — Tenderness on lateral side — Less common Ligament Sprains: MOI/Treatment — Tx: — Grade 1: RICE — Immobilize 2-3 days — Recovery: 1-3 weeks — Grade 2: RICE — Immobilize about 1 week — Recovery: 4-6 weeks — Grade 3: RICE — Immobilize/brace 2-3 weeks — Surgery? — Recovery time varies — Rehabilitation — ROM after immobilization — Strength – all knee musculature — Balance & plyometrics — Brace Meniscus Tear — Meniscectomy — Partial or complete removal of meniscus — MOI: — RTP 1-2 weeks but could lead to — Plant and cut arthritis in long term — Forced extension — Int rotation of femur — S/S: • Evaluation: — Joint line pain • McMurray’s Test • — Swelling Apley’s Compression & Distraction Test — Locking/giving out • Thessaly Test — Clicking — Pain with squatting — Tx: — RICE — NSAIDS — Immobilize — Refer-Surgery — Red zone – Surgery, — White zone –Not recommended IT Band Syndrome — MOI: — Frequent distance running — Tight musculature — Foot pronation — S/S: — Painful — PPT at insertion site — Tight ITB — Tx: — Stretching — Hip strengthening — Ice, Massage, etc. Osgood-Schlatter Disease

— Excessive calcification of tibial — Tx: tuberosity (Apoyhysis) — Decrease activity — Common in young athletes — Ice — MOI: — Isometric strengthening — Repeated pulling of patellar — 6 months – 1 yr to heal tendon on tibial tuberosity — S/S — Pain with kneeling, jumping, running — Point tenderness over tubercle — Enlarged tibial tubercle Patella Fracture — MOI: — Tx: — Direct Trauma — Immediate splint — Forced quad contraction — Possible surgery when knee is flexed. — Immobilize for 2-3 months — S/S: — Regain ROM/strength — Pain — Can take several months — Swelling — Immobility — Visible or palpable deformity Patellar Dislocation — MOI: — Tx: — plant and cut in opposite — Immobilize for ≥4 weeks direction of planted foot — Regain ROM/strength — Most occur laterally — 1-2 months — Caused by muscular — Surgery if frequent imbalance dislocation — S/S: — Pain — Swelling — Immobility — Visible misalignment Patellar Tendinitis — MOI: — Treatment ideas: — “jumper’s knee” — Ice, Switch to heat before — Excessive jumping, activity , massage, running ultrasound — Tight quads — Stretching/ Strengthening — S/S: — Pain between patella and tibial tuberosity — Stage 1: pain after activity — Stage 2: pain during and after activity — Stage 3: Pain during and long after activity — Crepitus Patellar Tendon Rupture — MOI: — Tx: — Chronic inflammation — Surgically repair tendon — Sudden quad contraction — Recovery ≈ 4 months — S/S: — ROM/Strength — Patella migrates superiorly — Cannot extend knee — Swelling — Sharp pain that dissipates