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Knee - Coggle Diagram
Knee
Anatomy
Osteology
distal femur
landmarks (6)
Medial and lateral condyles
• Medial and lateral
epicondyles
• Intercondylar notch
• Intercondylar (trochlear)
groove
• Medial and lateral grooves
• Lateral and medial facets (for
patella)
proximal tibia/fibula
landmarks (6)
Medial and lateral condyles
which condyle is larger
medial
• Intercondylar eminence
• Anterior and posterior intercondylar
fossa
• Tibial tuberosity
• Soleal (popliteal) line
• Head of fibula
where does the common fibular wrap around
neck of fibula
what is important to know about this area
not in the capsule of the joint
patella
landmarks (6)
Base
• Apex
• Anterior surface
• Posterior surface
• Vertical ridge
• Lateral, medial, and odd facets
where does the patella get most of its compression
at the odd facets
what is the knee known as
largest joint in the body
Muscles
the knee has the capacity for what important thing
high torque production
necessary for motion
how does this occur (3)
• Response to gravity
• Ground reaction forces
• Muscular actions
which m. group produces high force for most activities at the knee
quads
how much force for walking
1-3X BW for walking
how much force for stair climbing
4X BW
what does BW mean
body weight
how much force for climbing
3-4X BW
how much force for unloaded squat
5X BW
Knee flexors (8)
Gastrocnemius
• Sartorius
• Gracilis
• Popliteus
• Plantaris
Hamstrings (3)
Knee rotator mm.
Medial mm. (5)
Popliteus
• Sartorius
• Gracilis
• Semitendinosus
• Semimembranosus
Lateral m.
Biceps femoris
Therapeutic Exercises
whuch exercises are commonly used in rehab (3)
Stretching, manual resistance, isotonic resistance
Joints & ligaments
Joints (2)
Tibiofemoral joint
what type of joint is it (3 characteristics)
Bicondylar, synovial, modified hinge joint
how many degrees of freedom
2
why is it a modified hinge joint instead of just a hinge joint
bc it primarily allows flex and ext, but also permits rotation
what type of rotation
conjunct rotation (what does this mean)
1 more item...
what causes this rotation
size difference in medial and lateral condyle
has what type of angle
vertical angle (how many degrees)
~170-175
aka
normal genu valgum
what degrees is considered excessive genu valgum
less than 165 degrees
genu valgum aka
1 more item...
what degrees is considered genu varum
more than 180 degrees
genu varum aka
1 more item...
is excessive genu valgum or genu varum more non-modifiable
genu varum (why)
1 more item...
what major structure does this joint have
menisci
description
Oval-shaped, fibrocartilaginous discs
functions (5)
Absorb shock
• Increase joint surface contact thru large ROM
• Help stabilize the joint
does this usually when
1 more item...
• Reduce friction between articular cartilages
Increase concavity of tibial condyles
2 different ones
medial
lateral
which one is most loose
lateral
which one is larger
medial
which is most prone to injury
medial
what are the external edges attached to (2)
tibia and joint capsules
which 3 mm. attach to menisci
quads
how
indirect through the capsule to both medial and lateral menisci
semimembraneous
how
medial and lateral menisci
popliteus
how
just lateral menisci
Biomechanics
what direction does it move c flex
posteriorly
what do they do during knee flex
transmit load
1 more item...
what direction does it move c ext
anteriorly
what do they do during knee ext
Increase joint stability
1 more item...
how is the load distributed between the medial and lateral meniscus
• ~ 60 thru medial meniscus
• ~ 40 thru lateral meniscus
how does it heal when injured
poorly (why)
Avascular on inner 2/3
• Partly vascular on outer 1/3
so what usually you dont want to do when meniscus is injured
run
what ligaments are at this joint (4)
Cruciate ligaments (2)
Anterior Cruciate ligament (ACL)
has 2 bundles
posterolateral bundle
when is it most taught
1 more item...
anteromedial bundle
when is it most taught
1 more item...
function
resist anterior translation of tibia
fibers run in what directions (3)
posterior, superior, and lateral direction
where does it begin
1 more item...
where does it attach
1 more item...
common MOI
Non-contact, rotation injuries when the tibia translates anteriorly
while the knee is in slight flexion and valgus positions
what do you focus on when injured
hamstrings
what are 2 test of ACL
anterior drawer test
what do you do
1 more item...
active knee extension
Posterior Cruciate ligament (PCL)
function
resist posterior translation of tibia
when is it most taught
during full flex
common MOIs (3)
Fall on to knee in high degree of flexion
aka
1 more item...
Posterior blow with foot planted
Knee Hyperextension
what do you focus on when injured
quads
what does activating the hamstrings do
1 more item...
fibers run in which directions (2)
vertical and medial
direction
where does it begin
Posterior intercondylar tibial plateau (anterior
lateral and posterior medial)
where does it attach
lateral side of the medial femoral
condyle
what are 2 test of PCL
active knee flex
posterior drawer test
3 characteristics of both of them
Very high tensile strength
Help to guide knee motion
Have their own blood supply
which is slightly thicker
PCL
Injury to either one leads to what
knee instability
which is most frequently injured
ACL
Collateral ligaments (2)
Lateral collateral ligament
medial collateral ligament
function of both
provide support against
varus and valgus stress
how do they seperate
from joint capsule
Osteokinematics
where is the axis of rotation
femoral condyle
2 facts to know about this axis
• Is not fixed
• Migrates thru condyle in a curved path
what is this called
1 more item...
IR and ER
when does rotation at the knee occur more easily
when knee is flexed
what degrees of total rotation available when knee is at 90 degrees
~40-50°
is knee IR or ER more stronger and by how much
• External Rotation >Internal Rotation (2:1)
where does motion occur
May occur tibial on femoral or femoral on
tibial rotation
Arthrokinematics
Loose pack position
25-40° Flexion
Close-pack position
full ext
Patellofemoral joint
what type of joint is it
synovial joint
location
between posterior surface of patella and femoral condyles
how does the patella move
slides on femoral
condyles
Patellofemoral tracking
description
Forces guiding patellar movement on femur
what forces guide the patellar movement (6)
Quadriceps muscle
• Quadriceps tendon
• Patellar ligament
• Iliotibial band
• Patellar retinacular fibers
• Shape of articular surface
Arthrokinematics
Joint orientation
Patella
posterior
femur
anterior
Concave surface
femur
loose-pack position
full ext
close-pack position
30-60° of flex
excessive knee ER usually occurs from what
femur moving away from patella instead of other way around
what mm. do you train to get the femur align again (2)
abductors & ERs
what is the knee triad
ACL, MCL, meniscus
Select Conditions of Knee
• Structural Deviations
genu varum
aka
“bowlegged”
what is the normal degrees
~ 175°
degrees of the Q angle :red_cross:
more than 180°
shouldn't it be a decreased Q angle and genu valgum is increased Q angle
how can it develop (4)
•NM recruitment patterns
what does NM mean
neuromuscular
• Trauma
•DJD
•Variations in growth
how is foot
more supinated
genu valgum
aka
“knock knees”
what is it coupled w it (2)
• Coupled with ↑pronation, tibial internal
rotation
what can the IR cause (2)
meniscus problem
ER at the joint
what is the IR sometimes from
IR of femur
PT interventions (3)
Often address improving NM control
Lessen stress on bony structures, articular
surfaces
Address thru greater control at hip (ER) and
subtalar joint (limit pronation)
degrees of the Q angle and does it increase or decrease :red_cross:
<165 degrees so it decreases?
where is the compressive force
lateral compressive force at the knee
genu recurvatum
what occurs
knee Deviation in the sagittal plane which causes knee extension beyond neutral
what does this extension result from
soft tissue changes
example of these changes (2)
1 more item...
• Ligamentous Injuries (3 types) (description of each right after)
1st degree
minimal damage to connective tissues, no loss of
ligament strength or function
2nd degree
partial tear of ligament, function affected
3rd degree
complete tear, function is compromised
effects which ligaments (4)
MCL
usually results from what
valgus stress
another MOI
“unhappy triad”
LCL
usually results from what
varus stress
PCL
when is it typically injured
posterior stress like hyperextension
often injured by what type of force
posteriorly directed force on proximal
tibia
3 common MOI
Hitting the dashboard
• Anteromedial blow to flexed knee
• Fall on to knee coupled with hyperextension stress
3 common findings during exam
Genu recurvatum
• Typically, little joint effusion
description
1 more item...
• Posterior sag
when does this usually occur
1 more item...
description
1 more item...
ACL
typically injured by...
valgus/rotational force with foot
planted
what is another MOI
medial rotation with hyperextension
usually what type of injury
non-contact injury
how is it different from other cruciate ligament injuries (2)
The most rapid and greatest swelling
Common Interventions for ACL & PCL (2 things)
• Most undergo surgical repair
• Typically phased rehab using physician protocols
• Meniscal Injuries
where does most occur
in the posterior 1/3 of the
meniscus
Types of meniscus tears (5)
Bucket handle tear
description
inner part of the meniscus cartilage tears in a way that resembles a bucket handle, creating an unstable fragment that often cannot return to anatomical position
what does it often result from
locking of knee in flexed
position
Horizontal cleavage tear
how common is this injury
Less common injury as tear is horizontal
rather than vertical
what is it associated with (2)
degenerative changes with
the meniscus and articular cartilage
Vertical tears
radial tear
oblique tear
the meniscus has what 2 zones
white zone
description
zone with limited blood supply so they have limited ability to self repair
location
more posterior, so more deeper on meniscus
red zone
zone with adequate blood supply so they can self repair
location
more anterior, so more superficial on meniscus
Repair
what type of repair is common
surgical repair that is usually an arthroscopic repair
w this repair, there are high incidences of what
degenerative changes (when can this start to occur)
As soon as 5 years post-operatively
what can be challenging about repair
Challenging coordination to facilitate
mechanoreceptors
usually pts only do exercises in what plane to start repair
sagittal plane (how long)
0-3 months before starting in what other plane
transverse plane exercise
• Bursitis
Prepatellar bursitis
how does it usually occur
from patella getting a blow usually from kneeling or falling
aka
"housemaids knee"
location
Lies between skin and anterior patella
what is caused by
friction related to activity
common areas where bursitis occurs (4)
quads
what is the bursa called under the quad tendon
suprapatellar bursa
politeus
medial gastronemius
Pes anserinus
which bursa is the most common for onset of bursitis
prepatellar bursa
• Osteoarthritis
aka
DJD
most common in women or men
women
gait alterations (3)
Slower walking speed, shorter step length, greater
step width
is there clear evidence in literature for best mode of exercise
no, but what is a key factor
intensity
common exam findings (4)
pain, decreased ROM, decreased strength, decreased functional abilities
• Patellar Pathologies (2 types)
Patellofemoral dysfunction
linked to several variables (4)
Lateral tracking
• Abnormal contact pressures (e.g. flexion)
• Increased Q angle
• NM imbalances, such as VMO versus vastus lateralis
what is VMO
vastus medialis oblique
what does this mean
when there's inhibition of the VMO m., there's more activity from vastus lateralis which can move the patella more lateral
what can occur in the feet from this (2)
excessive pronation
what does this lead to
↑ IR of tibia
increased dorsiflexion at the talocrural joint
Patellar Tendinopathy
description
irritation of the patellar tendon (ligament)
where does this occur most commonly
inferior, but may also present superior to patella
common interventions (2)
Symptomatic relief through crossfriction massage, modalities, etc
Progressive concentric to eccentric
strengthening
what is the purpose of this
to increase pt ability to reduce tensile forces during functional activities
• Iliotibial Band Syndrome
often due to what 3 things
Weakness in the hip ER
• Tight TFL
• Tight Glut Max
can cause pain at what parts of knee (3 parts)
lateral knee
usually determined if pt is positive for what test
positive nobles compression test
what occurs
pt extends from 90 degree flex while the PT adds pressure to femoral lateral epicondyle. If pain induced near 30-40 degree flex at epicondyle the test is positive
medial knee
when does this usually occur
MCL sprain 2°to genu valgum
infrapatellar
when does this usually occur
when the patella is pulled laterally by the ITB
can cause pain in what areas (4)
• Groin
• SI joint
• Hip
• Lateral thigh
common causes (4)
• Overuse, as in runners, cyclists, etc
• Exaggerated handedness patterns
• Excessive bed rest
in what position during bed rest can this occur (2)
prolonged hip/knee flex, etc
excessive resisted knee extension w hip flexed
example of this (2)
resisted squats or leg press