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Knee pathology


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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
longest strongest bone in body
largest sesamoid bone in body
sesamoid bone
lives in cartilage
movement at tibiofemoral joint
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 handle”
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
contusion complication
myositis ossificans
how many bursae in knee
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
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

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