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The Knee

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Alex Hartwig

on 10 December 2012

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Transcript of The Knee

The Knee By: Alex Hartwig Basic Anatomy Flexion: 135-145 degrees
Extension: 0 to -10 degrees ROM Knee: Flexion is
more limited
than extension Capsular Pattern Tibiofemoral: Open pack postion is 20-30 degrees of flexion. Closed packed position is Full knee extension with tibial lateral rotaion.
Patellafemoral: Open pack postion is full knee extension and closed packed position is knee flexion. Open and Closed packed positions 1. Knee sprains Common Injuries 4. Osteochondral lesions 3. Meniscal tear 2. Rotational knee instability 5. Joint dislocation MCL Sprains: Most common MOI is a valgus force from a blow to the lateral side of the knee. More common than LCL sprains.
Common S/S: Swelling and pain over area, may have some bruising, pt may C/O instability.
Tx: Most are managed non-operatively due to the high amount of blood supply it has. Protect jt from valgus stress, controlled restoration of ROM, strengthing and proprioception exercises
Special tests: Valgus Stress Test and Slocum drawer test.
Diff Dx: ACL, PCL, medial meniscus, pes anserine bursitis.

LCL Sprains: Basically the same as MCL sprain, but these result from varus force usually from a blow to the medial knee. They can also happen with a varus force and a tibial rotation so ACL and PCL involvement should be cautioned.
Tx: Due to poor healing properties, LCL rehab is usually surgery or late reconstruction.
Diff Dx: lateral meniscus tear, posteriolateral corner injury/instability, IT band inflammation, fibular head fx. Knee Sprains Caused by a force causing anterior displacement of tibia from the femur. Most of these result from non-contact torsion stresses. Occurs more commonly in females.
S/S: Athlete may hear or feel a "pop", immediate loss of knee function, edema is rapid in that area but diffuse edema can occur for the next couple days (75 hours), limited ROM, laxity in the knee.
Tx: Restore ROM, lower extremity strength, proprioception of LE.
Special tests: Anterior drawer and Lachman's Test.
Diff. Dx: PCL sprain, meniscus tear,and hamstring strain. ACL Sprains This occurs from the tibia being pushed posteriorly to the femur, or from hyperflexion or hyperextension. The most common MOI is landing directly on the knee pushing the tibia backwards.
S/S: Directly after incident athlete may be asymptomatic. Over time pn in posterior knee, weakness of hamstring and quads, and reduced ROM during flexion may be seen.
TX: PCL rehabilitation is relatively easy. The athlete needs to rest, ice and use NSAIDs. This is a non-surgical injury.
Special tests: Posterior drawer and Sag test.
Diff. Dx: Posterior capsule sprain, meniscus tear and strain of the medial head of the gastrocnemius. PCL Sprains Anterolateral rotatory instability: Rotational Knee Instabilities This is the most common instability of the knee (ALRI). This leads to greater displacement of the tibia due to ACL and lateral extra-articular restraints. Leads to anterior tibial displacement and internal tibia rotation.
S/S: Instability in the anterior lateral portion of the knee, knee giving way, decreased muscle strength and diminished performance.
Tx: Surgery is used to determine what is causing the instability, and then rehab according to the findings.
Special Tests: Pivot Shift test, Slocum drawer test and crossover test. Acute meniscal tears are derived from rotation and felxion of the knee. These two actions impinge the menisci between the articular condyles of the tibia and the femur. It use to be thought that the meniscus tears only occurred on the medial side, but it is now known they can happen on the lateral side as well. Athletes usually describe a MOI of rotating with flexion and a valgus or varus stress.
S/S: Locking or clicking of the knee, pn along the jt line, decreased ROM, and giving way during acivity.
Tx: Surgical trimming of the meniscus is what most athletes will choose to do so they can then do rehab and return to almost normal function, others choose no treatment and live with the side effects their whole life.
Special Tests: McMurray's test and Apley's compression/distraction.
Diff. Dx: Avulsion fx of the fibular head or ACL/LCL/PCL sprain. Meniscal Tears Used to describe a series of disorders such as osteochondral def defects and osteochondritis desiccans (OCD) which involve a joint's articular cartilage and subchondral bone. We will focus on OCD.
OCD: Fracture of articular cartilage and underlying bone usually caused by compression and shear forces. 80% of OCDs involve medial femoral condyle. Males are affected more often than females 3 to 1.
S/S: Often asymtomatic, diffuse pn in knee, locking and clunking sensations, and the knee giving way. pn is increased with WB activities, there is also a noted increase in pn and decrease in strength in closed kinetic chain activities when compared to open chain activities.
Special tests: Wilson's Test
Tx: Can be managed conservatively depending on location of defect in regards to weight bearing surfaces. Activity would have to be modified to the pn scale of the athlete. In MOST cases the athlete would go ahead and have the surgery to clean the jt up or re-attach the bone fragment if possible.
Diff. Dx: Osteoarthritis, meniscal tear/cyst, patellofemoral jt. dysfunction and tibial femoral epicondyle fx. Osteochondral Lesions Tibiofemoral jt dislocations are MEDICAL EMERGENCIES! There is the potential of permanent disability or loss of a segment of the leg due to trauma of the neurovascular structures. There are different ways to describe the dislocation: Direction of tibial displacement, complete/partial displacement, open or closed and if the trauma was caused by lowe or high velocity forces. This injury is a disruption of ligaments, capsule, tendons, meniscus, articular surfaces and neurovascular elements.
Most of these dislocations are because of uniplanar knee hyperextension, hyperextension combined with tibial rotation, or posterior displacement of the tibia with the knee flexed, and also an extreme force on the jt line. Most of the dislocations occur with the tibia displacing anterior to the femur.
S/S: Severe pn, muscle spasm and obvious deformity in the joint. If there is a dimple sign that is also a sign of dislocation.
Tx: Call 911, continue to check posterior tib and dorsal pedal pulses, distal capillary refill, skin color and temperature. Surgical relocation and sometimes the damaged ligaments need surgical repair, this will result in numerous surgeries. Tibiofemoral Joint Disloaction Houghlum, P.A. (2012). Therapeutic Exercise for
Musculoskeletal Injuries. Champaign, IL: Human Kinetics

Starkey, C., Brown, S.D., Ryan, J. (2010). Examination of
Ortopedic and Athletic Injuries. Philadelphia, PA: EA Davis Company Sources Tibiofemoral jt:
Loose packed position: 20-30 degrees knee flexion
Closed packed position: full knee extension with tibial lateral rotation.
Loose packed position: full knee extension.
Closed packed position: knee flexion. http://ts2.mm.bing.net/th?id=V.4597453996687453&pid=2.1&w=186&h=105&c=4&rs=1 http://www.edheads.org/activities/knee/swf/index.htm

This will use your general knowledge and some of the stuff you learned today about the knee to help do a complete knee replacement! Good Luck! Activity for a full knee replacement!
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