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3 Joints of Knee
- - tibiofemoral
- - patellofemoral
- - proximal tibiofibular
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Sesamoid
floats inside quad
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Articular Cartilage
covers ends of bones
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Synovium
the tissue that surrounds the joint
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Synovial Fluid
lubricates the joint
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Effusion
swelling inside joint
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Edema
swelling outside joint
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4 Ligaments
- - ACL - anterior cruciate ligament
- - PCL - posterior curciate ligament
- - MCL - medial collateral ligament
- - LCL - lateral collateral ligament
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4 Quadriceps
- - rectous femoris - hip flexer and knee extender
- - vastus medialis
- - vastus intermedius
- - vastus lateralis
- * vastus are extenders and cross below hip
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Hamstrings
- - biceps femoris
- - semi-membranosus
- - semi-tendinosus
- * flex knee, extend hip
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Menisci
- - medial and lateral
- - fibrocartilageinous rings
- - largely avascular
- - outer 1/3 = minimal to no blood supply
- - functions: weight bearing, joint stability, joint movement
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Common Knee Injuries
- - sprains - grade I, II, III
- - strains
- - subluxations - partial dislocation
- - dislocations (luxations) - total dislocation
- - meniscal lesions/ters
- - fractures (fx)
- - tendinitis/osos
- - bursitis/osos
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ACL Injuries
- - MOI - external rotation of tibia on fixed femur, hyperextension with foot fixed, posterior blow to tibia with foot fixed
- - can be contact or non-contact
- - S/S - experience "pop" with pain and disability, hemarthrosis/ effusion, anterior laxity, rotary instabililty
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Hemarthrosis
bleeding in joint
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Trends of ACL Injuries
- - 70% noncontact
- - 70% occur in sports
- - women 3-4x greater than men
- - anatomy, biomechanics, hormonal
- - osteoarthritis incidence later in life = 10x greater ACL injury
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PCL Injuries
- - MOI - fall on flexed knee, dashboard knee, extreme rotation, hyperextension of knee with fixed foot
- - S/S - mild swelling in popiteal fossa (effusion), posterior instability, rotational instability
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MCL Injuries
- - most common ligament injured in knee
- - MOI - valgus force (force from lateral side), external rotation of tibia on fixed femur
- - S/S - medial tenderness and edema (possible effusion), positive valgus stress test
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LCL Injuries
- - MOI - vargus force (blow to inside of knee), internal rotation of tibia, grade I, II, III
- - concurrent into to common peroneal, BF tendon avulsion, IT band strain
- - S/S - edema- no effusion, positive varus stress test
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Patelloefemoral Pain Syndrome
- - anterior knee pain is extremely common
- - abnormal patellar tracking leads to pain
- - most common in females
- - overuse injury
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PFPS
- - MOI - patella glides too far laterally, gliding over lateral femoral condyle rather than in trochlea, articular cartilage on posterior patella degenerates
- - S/S - anterior knee pain, movie sign, crepitus, edema/effusion
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Patella Subluxations/Dislocations
- - patella slips out of trochlea and spontaneously returns (subluxes) or doesn't (dislocates)
- - deceleration with simultaneous cutting in opposite direction
- - quad pulls patella out of joint
- - almost always lateral
- - traumatic onset
- - predispositions similiar to PFPS
- - more common in females
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Patella Subluxations/Dislcations S/S
- - sublax - pain and swelling, restricted ROM
- - dislocation - total loss of function
- - first time dislocation - assume fracture
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Meniscus Injuries
- - MOI - rotary force with knee flexed or extended while weight bearing, medial more common than lateral due to ligamentous attachment and decreased movement
- - S/S - difficult diagnosis, effusion of 48 - 72 hrs, joint line pain and loss of motion, intermittent locking and giving way, pain with squatting
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Preoatellar Bursitis
- - MOI - direct blow or continued kneeling, acute chronic
- - S/S - localized swelling (ballotable), inflammation
- - bursa - synovial sacs, acts like knee pad
- - feels like water balloon
- - edema swelling
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IT Band Friction Syndrome
- - AKA - runner's knee
- - MOI - malaligament or structural asymmetries, running on uneven surfaces
- - S/S - pain at insertion, signs of inflammation, pain with activity
- - IT - illotibial band and tibia
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Patellar Tendinitis
- - AKA - jumper's knee
- - MOI - repetitive jumping or knee extension with stress or strain on paterllar tendon or quadriceps tendon
- - S/S - pain and tenderness at inferior pole of patella and posterior aspcet of patella with activity
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