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k.n.e.e.

The Knee

**New Word**Sesmoid- meaning completely engulfed in tendon.
Ex. The patella is the biggest sesmoid bone in the body.



The ankle is more stable than the knee.


4 major ligaments in the knee

a)MCL
b)LCL
c)ACL
d)PCL
Medial Collateral Sprain
the most common kind of sprain

Mechanism
1)Valgus Stress

*Definition* - Valgus Stress- Gettin hit in the lateral side of the knee.

S+S of a firsh degree sprain
1)Pt tender on Medial Side of knee
2)Minor swelling
3)Pain
4)General Stiffness
2nd degree sprain
1)Pt tender
2)Significant Swelling
3)Pain
4)Laxity with a firm endpoint

**Laxity test used for MCL is the Valgus Stress Test.
Evaluator places a gentle force to the lateral side of the knee to see if the medial side of the joint "opens up" then, bend the leg and do the same thing.

S+S of 3rd degree
The same as the second degree sprain but instead of the valgus stress test having a firm endpoint, there is a mushy endpoint.

Treatment for 1st degree sprain
1)RICE
2)ROM exercizes
3)PRE xercises
Quads and hamstrings
4)Funcional testing
5)Back to play in 3-7 days

2nd degree treatment
1)RICE
2)Knee immobilizer or some kind of splint
3)Dr. Referral
4)Bracing
5)Same treatment as 1st degree
6)Back to play in 2-4 weeks

Treatment of 3rd degree sprain
1)Same as 2nd degree
Return to play in 4-8 weeks

Lateral Knee sprain
1)Lateral Collateral Ligament
Mechanism
1)Varus Stress

**Defintion**- Getting hit from the medial side of the knee
Not nearly as common as valgus stress because the other leg protects

S+S
1)Similar to the Medial sprain except to the lateral side of the knee.
2)Varus Stress test
3)Lateral push out. Test knee in extension and flexion
Treatment
Would be similar to the medial sprains



C. Anterior Cruciate Sprain

1. Mechanism- Rotation of the knee joint. Femor turns but the tibia stays put.
2. S+S
What degree? This kind of sprain is an all or nothing kind of thing because the ACL is very taught (tight), if you tear it even a little bit, it will tear all the way.
a)Pain
b)heard or felt a "pop"
c)bloody effusion-- An effusion is a swelling within a capsule, in this case the patellar capsule. A bloody effusion is an effusion with blood in it. Trainers can't really tell weather it's just an effusion or a bloody effusion but they are treated similarly.
How to tell if it's a bloody effusion-- When the capsule is filled with fluid, the patella, sitting on top of the capsule, will rise up. Look for a blotable patella ei. When you push on the patella, it will rise back up.
d) 2 laxity tests.
1) Anterior drawer test
-pull tibia forward with the knee bent. Relax all muscles, put thumbs on the tibial plateau, elbow on the ankle, pull the tibia forward by pushing with your thumbs.

2) Lachman's Test
-Hand on tibia, other on femur, pull on the tibia and push on the femur.

e)Positive MRI (magnetic ressonance imagery) findings.
3) Treatment
a)RICE
b)Dr Referral
c)Surgery- since the ACL is so taught, it has to be surgically repaired. After years of just putting it back together, we have found that the ligament just goes bad and continues to tear. So, to replace the ACL, doctors remove the top 1/3rd of the patellar tendon. Then they drill a hole in the tibia and femur. They attatch the tendon in the holes and bolt them into place. After the surgery, the top 1/3rd grows back.
d)6-9 months in rehab program because the tendon has to regrow which takes time. If you don't allow it to fully regrow, you could break your patella.
D. Potserior Cruciate Tear
1. Mechanism
hyperextension
not as common as an ACL tear
2. S+S
a. pain
b. hear/feel a pop
c. bloody effusion
Definition-Aspirate- To take fluid out
d. Laxity 3 tests
1) Posterior Drawer Test-- Like the anterior drawer test exept instead of pulling, push
2)Lachman's Test-- Reverse motions in the ACL sprain test.
3)Posterior Sag-- Line up the heels and knees. Bend the knees. Look at he Tibial Tuberosity and look for the tibia to sag downward
e. MRI
3. Same as ACL
E. Unhappy Triad injury
1. Structures involved
a)MCL
b)ACL
c)Medial meniscus. Bones grind into it and tear.
2. Mechanism
a)Valgus Stress
b)Rotation
3. S+S
a)Combine the S+S of an MCL and ACL sprain.
4. Treatment
a)Follow ACL Treatment
II. Meniscal Tears
A. Mechanism
1. Rotation
2. Grinding
B. S+S
1. Effusion - Could be a bloody one. Menisci don't have a good blood supply. 2. Joint line tenderness-- at the junction of the tibia and the femor
3. Pain
4. Describes the feeling of "knees locking".
5. Feels their knees giving out
6. Mcmurray's Test - bend knee, straighten it, twist tibia, look for fluidity in movement- locking and hard movement indicate torn meniscus
7. Apply's Compression Test- Lie on your stomach, push on the tibia with the knee bent. If pain is felt when twisting, the meniscus is torn
8. MRI
C. Treatment
1. R.I.C.E.
2. Dr. Referral
3. If problematic, then surgery is required. a. orthoscope
1)Repair-- if the tear is around the edge, then the surgeons will be able to stitch the wound because the meniscus has a blood supply only around the edge. Usually get back to work at least 1 month.
2)Remove-- If the tear is inside, not near the edge, the tear will not heal because of lack of blood supply. Usually get back whenever you can.
a. grow-- experimental process in which they regrow cartilage.
Chondramalacia
inflamation of the posterior portion of the patella
Mechanism
Overeuse
the edge of the patella constantly rubbing against the wall of the track
Signs and Symptoms
Pain
NOn specific tenderness- pain everywhere in the knee
Crepitis with patellar movement
Crepitis is a crunch or click like packing snow
Pain with steps
Treatment
Ice
Active Rest
Antiinflamatories
TEX
Patellar Stabilization brace
Osgood Schlater's Disesase
Overuse/growth
Inflamation of the Tibial Tuberosity
Seen during adolesent growth spurts
B. S+S
Pt Tenderness over the tibial tuberosity
mild swelling
Pain
C. Treatment
1. Ice message
2. Counter force strap. A strap that wraps around the tibial plateau creating a new point of insertion for the patellar tendon to take stress off the tibial tuberosity
3. Anti Inflamatories
4. Rest
IV. Patellar Tendonitis-Jumper's knee
A. Mechanism
B. S+S
1. Pt. tender over the tendon
2. Mild Swelling
3. Pain
C. Treatment
1. Ice message
2. Mild Swelling
3. Pain
4. Rest


Heres a the test review...


On to the Hip