-
Knee Complex
- suprapatellar and infrapatellar tendon
- 5 posterior facets w/ hyaline cartilage
- facets articulate w/ femoral condyles
- Q angle= 15 degrees
- influenced by quads strength and balance, IT band tightness adn Q angle
-
Knee complex structure & support
- medial and lateral ligametous & mm support
- ant/post ligamentous & mm support
- ligamentous support- quadrilateral
- muscular support- triangular & causes glide
- medial capsule prevents valgus forces
- lateral capsul prevents varus
-
-
Injuries knee is susceptible to
- sprains
- strains
- degenerative process
-
What is different about the knee from the hip and ankle
it is not triplanar
-
Mild Ligament Injury
(grade 1)
- incomplete-stretching of fibers
- minimal pain
- minimal or no swelling
- no decrease in jt function
- no instablility
-
Moderate Ligament Injury
(grade/degree 2)
- incomplete tear
- moderate pain
- moderate swelling
- some loss of joint function
- some decrease in stablilty
-
Severe
(grade/degree 3)
- rupture completely torn ligament
- profound pain the area but stress to the ligament itself not painful
- marked swelling
- decreased jt funct
- instability
-
Stress radiograph instability
- mild- 5mm<
- moderate-4-10mm
- severe- >10 mm
-
ACL injury common cause
- noncontact mechanism, from quads, involving deceleration (sudden stopping), twisting of tibia/femur on planted foot
- valgus stress and adds medial meniscus tearing and MCL
- whic becomes the "unholy triad" "terrible triad"
-
ACL Injury physiological response
- hemoarthorsis indicated by rapid swelling, tense, & extreme pain.
- requires arthrocentesis (aspiration)- means vascular supply was damaged
- increasing # of tears in female athletes
-
Lachmans test
- knee flexed 25 degrees proximal tibia glided anteriorly on fixed femur
- asses pain
- how far does it move?
- Most reliable especially for acute injuries
- Open Packet Position
-
Anterior drawer test
knee flexed 90 degrees proximal tibia glided anterior on fixed femur
-
Treatment of ACL tears
- nonsurgically
- arthroscopic grafting (not good results with suturing ends of torn ligaments)
- usually dont with autotgraft (patients own tissue)
-
Most Common Procedure Name
Central 1/3 bone-patellar-tendon-bone autograph
-
Post allograph
- avascular necrosis of graft for first 6-8 wks
- revascularizes slowly
- at 3 months < 50% original strength
- *Graft os very fragile at this time
- - Pt is feeling better =bad combo
-
Post Allograph Contraindications of Movement
- takes up to one year to mature
- control loads and forces
- -anterior tibial shear
- posterior femoral shear
- rotary forces
-
Post Surgery
- NWB to PWb to WBAT 1st wk
- adjustable rang immobilizer double hinge brace
- -IROM is locked into extension for 1st 1-2 wks
- unlocked to 0-90 after 1-2 wks during WB
-
What stresses the ACL
- forward translation of the tibia on the femur
- greatest stresses occur between 0-20 degree of flexion
- OKC extension 60-0 with resistance on tibia
- -increased ant tibia translation
- CKC squats between 60-90 degress
- -increases tibial translation
-
Rehab Phases
- Max 1-4 wks
- Mod 5-10 wks
- Min 11-24 wks
- Return to activity 6+ months
-
Difference Between Max and Acute
- Max is do's & don'ts
- tx is different to pathology
- Acute tx all the same
-
PCL Injuries
- less common than ACL
- caused by flexion injuries or post shear forces
-
Godfrey posterior tibial sag test
- pt supine with hip and knee flexed 90 degrees
- pt holds heel-tibia sags down
|
|
