Knee Injuries ronaldo_knee Important Structures pCruciate ligaments pCollateral ligaments pMenisci pArticular cartilage pPatellar tendon Provided by Nucleus Communications, Inc. Cruciate ligaments pControl anterior and posterior movements pFit inside the intercondylar fossa Front_knee_BW Collateral ligaments pControl lateral movement pExposed to valgus (MCL) and varus (LCL) forces valgus varus Menisci pWeight distribution pWithout menisci the weight of the femur would be concentrated to one point on the tibia pConverts the tibial surface into a shallow socket menisci2 Other Important Structures pArticular cartilage n1/4 inch thick ntough and slick pPatella and patellar tendon nTibial tuberoscity nPatellofemoral groove nPatella acts like a fulcrum to increase the force of the quadriceps muscles p patella Ligaments pKnee is like a round ball on a flat surface pLigaments provide most of the support to the knees pLittle structure or support from the bones pointcont Muscles pQuadriceps - extension pHamstrings - flexion pIT band from the gluteus maximus and tensor fascia latae knee Acute Knee Injuries hyperextension Anterior Cruciate Ligament Tears pCan withstand approximately 400 pounds of force pCommon injury particularly in sports (3% of all athletic injuries) pMay hear a ‘pop’ sound and feel the knee give away acl2 Types of ACL Tears acl tear Causes of ACL Injuries pCutting (rotation) pHyperextension nStraight knee landing nWhen the knee is extended, the ACL is at it’s maximal length putting it at an increased risk of tearing acl injury External factors pAmount of lower body strength pFootwear and surface interaction Unhappy Triad 1.ACL 2.Medial collateral ligament 3.Medial meniscus Knee_MCL_tear Knee_buckethandletear Lachman Test and Anterior Drawer Test pNormal knees have 2-4 mm of anterior translation and a solid end point pACL injury will have increased translation and a soft end point lachman test Women and ACL Tears pAnterior Cruciate Ligament Injuries in Female Athletes: Why Are Women More Susceptible? pJames L. Moeller, MD; Mary M. Lamb, MD pTHE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 4 - APRIL 97 NCAA pFour times more ACL tears in women than men basketball players. pThree times more in gymnasts p2.4 times more in soccer pHigher rates are also found among women in team handball, volleyball and alpine skiing Factors pSmaller size of ACL pSmaller intercondylar notch pLarger Q-angle (doubtful) nnormal = 17 degrees in women nNormal = 14 degress in men q angle Factors pWeaker hamstrings nRatio of 10 (quadriceps) to 7 (hamstrings) pHormones nEstrogen – reduces collagen strength nRelaxin ACL Reconstruction acl-torn [USEMAP] Shockwave Graft Harvest mid3rd Provided by Nucleus Communications, Inc. Drill nstep1 Provided by Nucleus Communications, Inc. Attach nstep2 Provided by Nucleus Communications, Inc. Rehab cpm Meniscal Tears meniscus tears Meniscal Tears pOne of the most commonly injured parts of the knee. pSymptoms include pain, catching and buckling pSigns include tenderness and possible clicking pMeniscal tears occur during twisting motions with the knee flexed pAlso, they can occur in combination with other injuries such as a torn ACL (anterior cruciate ligament). pOlder people can injure the meniscus without any trauma as the cartilage weakens and wears thin over time, setting the stage for a degenerative tear. PCL Injuries [FIGURE 1] PCL Injuries pThe posterior cruciate ligament, or PCL, is not injured as frequently as the ACL. pPCL sprains usually occur because the ligament was pulled or stretched too far, anterior force to the knee, or a simple misstep. pPCL injuries disrupt knee joint stability because the tibia can sag posteriorly. pThe ends of the femur and tibia rub directly against each other, causing wear and tear to the thin, smooth articular cartilage. pThis abrasion may lead to arthritis in the knee. p Treating PCL Injuries pPatients with PCL tears often do not have symptoms of instability in their knees, so surgery is not always needed. pMany athletes return to activity without significant impairment after completing a prescribed rehabilitation program. pHowever, if the PCL injury results in an avulsion fracture, surgery is needed to reattach the ligament. pKnee function after this surgery is often quite good Collateral Ligament Injuries collateral tears Collateral Ligament Injuries pInjuries to the medial collateral ligament are usually caused by contact on the lateral side of the knee pAccompanied by sharp pain on the inside of the knee. pIf the medial collateral ligament has a small partial tear, conservative treatment usually works. pIf the medial collateral ligament is completely torn or torn in such a way that ligament fibers cannot heal, surgery may needed. pThe lateral collateral ligament is rarely injured. p Chronic Injuries 1.Patellar Tendonitis 2.Patellofemoral Pain Syndrome 3.Subluxation of Patella 4.Chondromalacia 5.Osgood-Schlatters Disease 6.IT Band Syndrome 7. 1. Patellar Tendonitist patella Patellar Tendonitist pDue to high deceleration or eccentric forces of the quadriceps at the knee during landing pAs you land the hamstrings cause your knee to flex to absorb the shock of impact pIn order to control or decelerate the flexion produced by the hamstrings, the quadriceps muscles contract eccentricly pEccentric contractions occur as the muscle is being lengthened or stretch pEccentric contractions produces high amounts of force, and therefore stress to the patellar tendon p Patellar Tendonitist pPrevention: strong quadriceps muscles p fullsquat1s fullsquat2s bblunge1s bblunge2s Squats Lunges More Quadriceps Exercises legexts legext2s legpress1s legpress2s Leg Extension Leg Press More Quadriceps Exercises wght247_l accelerationgirltreadmill Plyometric or Jump Training Uphill Running 2. Subluxation of the Patella pPartial dislocation of the patella pComplete dislocation is rare and is due to sudden (acute) trauma pWeak vastus medialis muscle may contribute patella_subluxation 3. Chondromalacia pA softening & fissuring of the articular cartilage of the patella pCauses n1. Aging n2. Mechanical defects (next slide) p p osgood-schlatters Risk Factors: Subluxation and Chondromalacia 1.Training errors nIncreasing intensity too soon 2.Weak vastus medialis muscle 3.Large Q angle nGreater than 25 for women and 20 for men 4.Pronation of the foot causing the tibia to medial rotate 5.Gender - more common in women 6.Poor footwear and/or surface n knee forces 4. Osgood- Schlatter Disease pOveruse, not a diesease. pInflammation to the patellar tendon at the tibial tuberoscity pMost common in adolescents (8-13 year olds girls and 10-15 year old boys); age of rapid bone growth osgood2 Osgood- Schlatter Disease pAnterior pain about 2-3 inches below the patella pAvulsion fracture osgood-schlatter 5. IT Band Syndrome - Anatomy pThe ITB moves anteriorly over the lateral condyle of the femur as the knee extends pThe ITB slides posteriorly over the lateral condyle of the femur as the knee flexes pRecurrent rubbing can produce irritation and subsequent inflammation, especially beneath the posterior fibers of the ITB, which are thought to be tighter against the lateral femoral condyle than the anterior fibers. p knee_itb_anatomy03 Causes of ITB Syndrome pDuration (or mileage) of exercise pHip abductor weakness pTight hip abductors and/or IT band knee_itb_anatomy01