Kines 127 - Quiz 6

Bones of the knee and lower leg

tibia, fibula, femur, patella

Main knee ligaments

Anterior cruciate ligament (ACL), Posterior cruciate ligament (PCL), Medial Collateral Ligament (MCL), and Lateral Collateral Ligament (LCL)

Cartilage in the knee

meniscus (medial and lateral), articular cartilage

Tendons in the knee

Quadriceps tendon, patellar tendon, IT (Iliotibial) band

Varus

Force from the outside of knee, knee goes inward

Valgus

force from inside of knee, knee goes outward

Effusion

swelling inside a joint

Edema

Swelling outside joint

Joints of the lower leg

Tibiofibular joint - plane joint (proximal and distal)

Patellofemoral joint - plane (gliding joint)

Knee - hinge joint (flexion/extension + slight rotation)

Menisci

Medial meniscus shape - “C” shaped

Lateral meniscus shape - “O” shaped

Healing ability - poor blood, limited healing

Acute knee injuries

Sprains, Dislocations, and meniscus tears

Chronic knee injuries

Anterior knee pain and lateral knee pain

ACL Sprains (DEF, MOI and S/S)

DEF: 3rd degree sprain of ACL, forced anterior translation of the tibia on the femur, typically associated with rotation of the femur on the tibia and valgus load

MOI: Non-contact (75%) - Deceleration and change of direction (plant and cut) or contact - valgus overload

S/S: Pop, instability, large effusion

PCL Sprains (DEF, MOI, and S/S)

DEF: Sprain of PCL, forced posterior translation of the tibia on the femur

MOI: Non-contact - hyperextension or contact - direct blow to anterior tibia

S/S: Instability, dashboard injury (hit on front of knee with knee flexed, which drives force posteriorly)

MCL Sprains (DEF, MOI, and S/S)

DEF: sprain of MCL

MOI: Valgus force to lateral knee, “50/50” ball

S/S: Instability, difficulty weight bearing

“traditional unhappy trial”

MCL, ACL, and medial meniscus

LCL Sprain (DEF, MOI, S/S)

DEF: sprain of LCL

MOI: Varus force medial knee

S/S: “Rolled onto” from medial side, may see with awkward landing, rarely isolated

Knee Dislocation (DEF, Severity, MOI, S/S, and Treatment)

DEF: Dislocation of femorotibial joint, multi-ligament injury

Severity: medical emergency (limb threatening and potentially life threatening)

MOI: Varies, often related to significant trauma

S/S: gross demority, instability, possible nerve.blood vessel damage

Treatment: Surgical reconstruction of blood vessels if damaged and surgical recontruction (often phased) of lgaments

Patellar Dislocation (DEF, MOI, and S/S)

DEF: patella often dislocates laterally, may be associated with fractures or disruption of MPFL

MOI: direct contact - impact to the patella or non-contact - change of direction, valgus load

S/S: Gross deformity, pop

Meniscal Tears (DEF, MOI, and S/S)

DEF: The meniscus has a poor blood supply and limited healing potential

MOI: Plant and twist

S/S: Joint line pain, effusion, loss of function, catching, and locking (bucket handle tear)

Anterior knee pain

Patellofemoral pain syndrome (PFPS) - vauge pain around patella, multifactorial issue relating to anatomy, muscle imbalances, and training

Quadriceps Tendinosis/itis - pain superior to patella

Jumper’s knee - tendinosis/itis of the patellar tendon, pain distal to paterlla

Osgood-Schlatter Disease - inflammation of the tibial tuberosity often associated with a young, growing athlete (open growth plate), pain distal to patella on tibia, visible bony growth on tibia

Lateral knee pain

Iliotibial band syndrome (ITBS) - multifactorial issue related to anatomy, muscle imbalances, and training

S/S: pain over lateral knee/distal femur, snapping sensation

Lower leg compartments (separation of muscle tissue by fascia)

anterior, lateral, superficial posterior, and deep posterior

Acute lower leg injuries

Fibularis (peroneal) tendonitis, achilles tendon ruptures, anterior compartment syndrome, and tibia/fibula fracture

Chronic lower leg injuries

medial tibial stress syndrome (MTSS), stress fractures of tibia or fibula, and posterior compartment syndrome

Fibularis (peroneal) tendonitis (DEF, MOI, S/S)

DEF:

MOI: Chronic - overuse, increase in activity, poor footwear or acute - inversion mechanism, avulse the base of the 5th metatarsal

S/S: snapping, lateral ankle pain, which may be assocaited with lateral ankle sprain

Achilles Tendon injury (DEF, MOI, S/S)

DEF: Injury to the achilles tendon from excessive load

MOI: sudden increase in activity, tight or weak calf muscles, poor warm up, and forceful jump or sudden burst of running (rupture)

S/S: feeling of being kicked in their calf, pop, if ruptured, noticeable deformity

Anterior Compartment Syndrome (DEF, severity, MOI, and S/S)

DEF: Pressure rapidly rises in the anterior compartment (muscles) of the lower leg

Severity: a medical emergency

MOI: direct contact to the anterior shin

S/S: Shiny/waxy appearance to skin, decrease in color (pale/ashen), edema present, loss of sensation to distal leg/foot/toes

Posterior (exertional) compartment syndrome (DEF, severity, MOI, and S/S)

DEF: pressure slowly rises in the deep posterior compartment (muscles) of the lower leg

severity: not a medical emergency

MOI: exercise induced

S/S: patient has more pain/pressure with activity, may explain pain/numbness/loss of function, and pain goes away when activity decreases

Tibia and Fibula Fractures (DEF, MOI, S/S)

DEF: often gross displacement of bones from a direct blow

MOI: Direct contact to the shin

S/S: gross deformity (open/closed fracture), loss of sensation, potential loss of pulse distally, unstable (non weight bearing)

How much body weight does the tibia vs. fibula bear

tibia bears 90%

Medial Tibial Stress Syndrome