Session IV-The Knee and Related Structures



Session IV-The Knee and Related Structures

1/26/05

I. Anatomy

A. Bones

1. femur

2. tibia

3. fibula

4. patella

B. Joint

C. Meniscus

1. medial

2. lateral

D. Ligaments

1. ACL

2. PCL

3. MCL

4. LCL

E. Bursae

F. Fat Pads

G. Muscles

H. Nerves

I. Fat Pads

II. Prevention

A. Knee Braces

B. Patella Braces

C. Shoes

D. Physical Conditioning

III. Assessing the Knee Joint

A. History

1. hear/feel “pop”

2. locked knee

3. immediate swelling

4. where is the pain?

5. past injuries to the knee

6. grinding/grating sensation

7. locking/catching

8. giving way

9. pain with stairs

10. past treatment received

B. Observation

1. walking, half-squatting, stairs

2. symmetry

3. swelling

4. muscle atrophy

5. gait

6. weight bearing

7. leg length discrepancy

C. Palpation

1. supine/knee bent to 90 degrees

2. bony

3. soft tissue

4. MCL/LCL

5. medial/lateral joint line

D. Special Tests

1. Stability

2. Endpoint

E. Ligament Testing

1. valgus/varus stress tests-reveals laxity of the MCL & LCL. The athlete lies supine with the leg extended. The examiner holds the ankle with one hand while placing the other by the knee. Then the examiner places a force inward/outward in an attempt to “open” the side of the knee. Tests are done with the knee at 0 degrees of knee extension and 30 degrees of knee flexion.

+ test – “gapping” of the joint line compared to non injured side

2. Anterior Cruciate tests

1. Drawer test at 90° flexion – the athlete lies supine with knee flexed to 90 ° and foot flat on ground. The examiner faces the anterior aspect of the athlete’s leg with both hands wrapped around the leg immediately below the knee joint. The examiner pulls the tibia forward.

+ test - if the tibia slides forward from under the femur and increased laxity compared with the non injured side.

2. Lachman test - the athlete lies supine and the examiner positions the knee at 30 ° of flexion. One hand of the examiner stabilizes the leg at the distal thigh, while the other hands grasps the proximal aspect of the tibia and attempts to move it anteriorly.

+ test – same as the anterior drawer test

3. Posterior Cruciate Ligament tests

1. Posterior drawer test – same position as with the anterior drawer test, but the tibia is pushed in a posterior direction on the femur.

+ test – tibia moves posteriorly on the femur and increased laxity compared to the non injured

2. Posterior sag test (Godfrey’s test) - with the athlete supine both knees are flexed to 90°. Observing laterally on the injured side, the tibia will appear to “sag” posteriorly when compared with the opposite extremity.

+ test – increased “sag” of the tibia

4. McMurray test

1. Testing for meniscal tear, the athlete lies supine with the injured leg fully flexed. The examiner places one hand on the foot and the other hand over the top of the knee. The ankle hand scribes a small circle and pulls the leg into extension.

+ test – as the knee is pulled into extension, there is a clicking response felt on the knee

F. Functional Testing

1. Walking (forward, backward, straight line, curve)

2. Jogging (straight, curve, up/down hill)

3. Running (forward, backward)

4. Sprinting (straight, curve, large/small figure 8’s, zig zag, carioca)

5. Deep knee bend/duck walking

6. Hopping (single-leg)

IV. Injuries to the Knee

A. MCL sprain

B. LCL sprain

C. ACL sprain

D. PCL sprain

E. Meniscus injuries

F. Bursitis

G. Illiotibial band friction syndrome (Runner’s knee)

H. Patella subluxation or dislocation

I. Patellofemoral Stress Syndrome

J. Chondromalacia patella (CMP)

K. Patella tendonitis (Jumper’s knee)

L. Osgood-Schlatter disease

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