Knee

Question 1

What type of joint is the knee? Why is it vulnerable?

Answer 1

Modified hinge joint-the largest joint in the body

bony stability is sacrificed for stability & it is very exposed

Question 2

What are the two primary joints?

Answer 2

tibiofemoral and patellofemoral

Question 3

What are the ligaments?

Answer 3

Medial and lateral collateral ligaments & the anterior and posterior cruciate ligaments

Question 4

where do the menisci sit?

Answer 4

atop the tibial plateau

Question 5

How do we assess the knee?

History, Observation, Assessment?

Answer 5

History= any sounds, giving way?
Obs = Structure (eg-tibial tuberosity), Gait (walking and running)
Assessment= flexion and extension

Question 6

How do we prevent risk of knee injuries?

Answer 6

Physical conditioning (strength- balance between quads and hamstrings & flexibilty)
Footwear
Appropriate equipment: prophylactic bracing

Question 7

How do we decrease risk for ACL injury specifically?

Answer 7

focus on strenght, NMC and balance….balance boards, single leg training, landing strategies

Question 8

What are the common acute knee injuries? (6)

Answer 8

Ligamentous sprains
Muscle strains
Contusions
Meniscal tears
Patellar dislocation
fractures

Question 9

What are common chronic knee conditions? (5)

Answer 9

Patello-femoral pain syndrome
Bursitis
Patellar tendonitis
Osgood Schlatter’s Disease

Question 10

What defines a first degree ligamentous sprain?

How do we manage it?

Answer 10

No tearing and no laxity: mild stretching
Minimal swelling and few limitations

Rest from sport 7-10 days, RICE, therapeutic modalities, ROM and strengthening exercises, balance and prop, maintain CR fitness, Tape for support

Question 11

What defines a second degree ligamentous sprian?

Management?

Answer 11

Moderate damage with partial tearing: some joint laxity but notable end point, slight swelling and increased pain
Moderate to severe joint tightness ( decreased ROM)

RICE 48-72 hours and use crutch
2-4 week rest from sport
Brace before ROM exercises, 
isometric->closed kinetic chain--> functional progression activities 
mantain CV fitness and balance

Question 12

What defines a third degree ligamentous sprain?

management?

Answer 12

Complete tear of supporting ligaments
loss of stability during motion and loss of motion due to effusion and muscle guarding
Immediate pain the builds as swelling increases
no ligamentous end feel at passive end range

RICE—
can be conservatively or surgically dealt with
immobalize w a brace
Progressive WB and ROM over 4-6 weeks….see 1st and 2nd degree sprain treatment plans

Question 13

Medial Collateral Ligament Sprain:
ET?
S&S?

Answer 13

Result from a valgus force: a blow from the lateral side causing tension on medial knee

swelling and pain dependent on severity (pain is on medial side of knee)

Question 14

Lateral collateral ligament sprain:
et?
s/s?

Answer 14

results from a varus force—usually caused when the tibia is internally rotated

Pain, tenderness and swelling over the lateral joint line
may cause irritation of the peroneal nerve

Question 15

Anterior Cruciate Ligament:
ET? (6 MOI)
S/S?

Answer 15

Caused by both a direct contact and non contact mechanism (80% are non contact)
MOIs: Deceleration, Hyperextension, Unhappy Triad (ACL, MCL and med meniscus are sprained bc of a lateral force), Anterior force to tibia w knee at 90, Internal rotation of the leg while the body is externally rotated, the leg is externally rotated and a valgus force is applied (ie-cutting)

S&S= experience a “pop” w severe pain and disability
sudden giving way and inability to WB
positive special tests
rapid swelling at the joint line, peaking 24-48 hrs after

Question 16

Why are female athletes more likely to suffer an isolated ACL injury than males? (3 reasons)

Answer 16

Hormonal influence: estrogen….our ligaments are more elastic at certain stages of our cycles

Anatomical: women have smaller ACLs and smaller intercondylar notch

Neuromuscular risk factors: core stability, strength, proprioception, intermuscular coordination

Question 17

Posterior Cruciate Ligament sprain
ET
S&S

Answer 17

Most at risk of this during 90 degrees of flexion, or a fall on a bent knee (anterior/posterior forces are the culprits)
“dashboard injury”

Symptoms are similar to an ACL but swelling is less and there is very little instability in most cases
We will see the “sag sign”

(main management is quad strengthening)

Question 18

Meniscal injuries:
ET
S/S
Management

Answer 18

Medical meniscus is most commonly injured bc of : MCL attachment…the triad & it has decreased mobility relative to lateral meniscus
MOI: rotary force while knee is extended or flexed
the type of tear depends on MOI.

Effusion (water in the knee) 48-72 hours after
joint pain and loss of motion
intermittent locking and giving way
Pain w squatting

RICE & protect with spint/crutches

Question 19

Patellar Dislocation
ET
SS
Man

Answer 19

Deceleration w simultaneous cutting in opposite direction creating a valgus force on the knee
Firect blow to patella when knee is flexed and planted
Quad pulls the patella our of alignment
Predisposition (^Q angle)

Pain and swelling
restricted ROM

Immobilize, RICE, immediate medical attn
4-6 weeks on crutches
muscular strengthening

*repetitive subluxation will stress medial constraints

Question 20

Patellar Fracture
Et
SS
M

Answer 20

direct trauma
indirect trauma (pull on tendon)
Semi-flexed position with forcible contraction (falling, jumping or running)

Generalized joint swelling
Pain, disabiliy, deformity

Xray to confirm
RICE & splint

Question 21

Osgoode-Schlatter’s Disease
ET
SS
Man

Answer 21

It’s a traction injury—repetitive stress on immature tibial tuberosity from quad contractions

Swelling
Point tender at tuberosity
enlarged and bony deformation
Pain w kneeling, jumping and running

RICE, modify activity, Cho-Pat brace
Isometrics for quads and hammies

Question 22

Patellofemoral Pain Syndrome
ET
SS
Managm

Answer 22

The underside of the patella and the femoral condyle rub during flexion and extension
caused by lateral deviation of the patella while tracking in the femoral groove because of:
tight structures, high Q angle, insufficient medial musculature.

Tenderness on medial facet during running, jumping, squatting, stairs
dull ache in center of knee,
pateller compression creates pain and grinding
overpronation
movie goers sign

RICE, modify activity, wear patellar prace, correct biomechanical issues (strength, flexability)

Question 23

Patellar Tendonitis
ET
SS
Man

Answer 23

Jumpers knee! Caused by:
Jumping/kicking
Over pronation 
Running on hard surfaces, rapid increase in running
sudden or repetitive extension 

Creates pain in one or more of the following:

1. Inferior pole of the patella- we see grades: pain after, pain during and after, pain during and after and constant (chronic)
2. The mid tendon region
3. Insertion of tibial tuberosity

RICE
Therapeutic modalities; heat, massage, PRP
Exercise
Brace-give tendon new point of pull
Transverse friction massage
Eccentric strengthening (stops and drops)

Question 24

Illiotibial Band Friction Syndrome
ET
SS
Man

Answer 24

Caused by:
Repetitive/overuse injuries
structural mal alignment/asymmetries (leg length..born with or hips are poorly aligned, tight butt, hip weakness)
Training errors (sudden change in surface)
Being bow legged, over pronation
MOI– compressive and friction forces to lateral femoral condyle

SS- pain after running, going up/down stairs; point tenderness at gerdy’s tubercle

RICE, correct mal-alignment, proper warm up, stretching, modify activity, orthotics

Question 25

Bursitis “cleaners knee”
ET
SS
Man

Answer 25

can be acute: result of a single contusion force or
chronic- repeated compression and shearing forces together
- it hurts a lot and is hard to manage

there are like 5 bursa in the knee…
Prepatellar bursitis= balloon swelling above the knee (tear something in the joint capsule)
Subcutaneous prepateller bursa= cleaners knee
Baker’s cyst= swelling in popliteal fossa
Pes anserine bursitis= swelling inframedial to the tibial tuberosity

Ice and compress!! protect, activity modification