Knee pathology
Terms
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- knee extensors
- quads (4), all merge into patellar tendon, assist w/ translation stabilization
- knee flexors
- hamstrings (3), all attach tibial tuberosity & are 2 joint muscles assist w/ translation stabilization
- bones of the knee
- femur, tibia, patella, fibula only indirectly
- femur
- longest strongest bone in body
- patella
- largest sesamoid bone in body
- sesamoid bone
- lives in cartilage
- movement at tibiofemoral joint
- flexion/extension
- cartilage in knee
- articular cartilage fibrous cartilage
- articular cartilage in knee
- on condyles & tibial plateau
- fibrous cartilage in knee
- menisci which act as shock absorbers & offer some stability
- ligaments in knee
- anterior cruciate ligament ACL, posterior cruciate ligament PCL, medial collateral ligament MCL, lateral collateral ligament LCL
- function of MCL & LCL
- prevent side to side movement
- function of ACL & PCL
- prevent front to back movement (translation)
- meniscal tear MOI
- rotation w/ compression tear is usually on outer rim “bucket handleâ€
- meniscal tear s/s
- c/o catching locking clicking, knee gets stuck
- meniscal tear palpation & observation
- effusion, aspirate isn’t bloody
- meniscal tear treatment
- surgery to remove torn tissue (meniscetomy)
- RTP for meniscal tear
- partial tear, 3 weeks; repair to sew back together, months
- worse meniscal tear
- medial
- contusion complication
- myositis ossificans
- how many bursae in knee
- 20
- pre-patellar bursa
- on top of patella
- pre-patellar bursitis MOI
- impact to tip of knee cap, direct trauma
- infra-patellar bursa
- between patella & tibia
- infra-patellar bursitis MOI
- overuse
- knee bursitis treatment
- RICE, anti-inflammatories,
- iliotibial band friction syndrome
- ITB rolls over lateral femoral condyle during repetitive flexion & gets irritated
- iliotibial band friction syndrome prevention
- stretching, addressing alignment & biomechanics
- joint mice
- osteochondritis dessicans: osteochondral fractures leading to loose bodies in joint
- joint mice s/s
- c/o locking catching, clicking; effusion w/ bloody aspirate
- joint mice treatment
- surgery to remove bits, rehab to deal w/ damage it did, long term risks of arthritis
- patellar fracture MOI
- direct blow , avulsion
- patellar fracture issues
- can’t flex at all during rehab
- patellar subluxation and dislocation
- usually lateral movement; more common in women
- patellar subluxation and dislocation causes
- being female, tight lateral soft tissue
- patellar subluxation and dislocation MOI
- damage to lateral retiniculum, can be rotational force w/ quad contraction, can have related osteochondral fracture
- chondromalacia patella
- wearing away of articular cartilage under patella
- chondromalacia patella more common
- in women
- chondromalacia patella complications
- can lead to arthritis
- chondromalacia patella treatment
- strengthen quads
- Jumper’s knee
- patellar tendonitis
- Osgood-Schlatter disease
- mini avulsions on tibial tuberosity, usually during growth, very painful but usually self resolving
- Osgood-Schlatter disease observation
- big bump on tibial tuberosity (bone growth)
- more pain going upstairs
- usually meniscus
- more pain going downstairs
- usually patellar-femoral issues
- PCL sprain MOI
- usually hyperextension
- PCL sprain treatment
- not usually surgery, quads are big & strong, so their assistance helps prevent gross instability in translation
- unhappy/ terrible triad
- damage to ACL, MCL, medial meniscus
- ACL sprain MOI
- usually non-contact, hyperextension, can plant tibia & rotate femur to pop ligament
- ACL sprain complication
- usually goes strait to 3rd degree
- ACL sprain s/s
- present w/ effusion, bloody aspirate, audible pop
- ACL sprain treatment
- needs surgery to reconstruct, hamstring strengthening
- MCL sprain MOI
- valgus force, tends to heal on its own
- MCL sprain treatment
- brace that’s slightly flexed, no exercise involving terminal extension
- MCL sprain complication
- 3rd degree involves damage to medial meniscus
- LCL sprain MOI
- varus force, doesn’t heal well on its own
- LCL sprain s/s
- like any sprain, depends on severity
- LCL sprain treatment
- RICE, brace if severe, avoid full extension, surgery may be necessary