Section 20: The Knee and Related Structures

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Part 20: The Knee and Related Structures

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Complex joint that perseveres through incredible measures of injury because of extraordinary measures of stretch that are routinely connected Hinge joint w/a rotational segment Stability is expected basically to tendons, joint case and muscles encompassing the joint Designed for solidness w/weight bearing and portability in motion

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Knee and Related Structures Anatomy of the Knee A. Bones i. Femur Medial Condyle Lateral Condyle Medial Epicondyle Lateral Epicondyle ii. Tibia Tibial Plateau Tibial Tuberosity Gerdy's Tubercle Intercondylar Eminence iii. Fibula Head iv. Patella Largest seasmoid bone Located inside the ligament of the quadriceps femoris

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Knee and Related Structures Articulations Femur and tibia Femur and patella Femur and fibula Tibia and fibula Menisci Two oval fibrocartilages that extend the articular features of the tibia Cushion Maintain dividing amongst femur and tibia

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Knee and Related Structures Maintain soundness Medial Meniscus "C" formed Lateral Meniscus "O" molded Blood supply Red-red zone = fringe 1/3 edge = great blood supply Red-white zone = center 1/3 edge = negligible blood supply White-white zone = inward 1/3 edge = avascular = no blood

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Knee and Related Structures Ligaments Anterior Cruciate Ligament (ACL) Anterior average tibia to Posterior parallel femur Prevents femur from moving back amid wt bearing Stabilizes tibial interior turn Main knee tendon stabilizer Posterior Cruciate Ligament (PCL) Posterior horizontal tibia to Anterior average femur Prevents hyperextension Prevents femur from moving front amid wt bering

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Knee and Related Structures Medial Collateral Ligament (MCL) Medial femoral epicondyle to Medial tibial epicondyle Prevent valgus and outside revolution powers Has connection to the average meniscus Lateral Collateral Ligament (LCL) 1. Parallel epicondyle of femur to Head of fibula

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Knee and Related Structures Joint Capsule Components Bursa – Synovial liquid filled pockets Reduce grinding Two dozen in and around the knee Suprapatellar Prepatellar Infrapatellar Deep infrapatellar Fat cushion Cushions front of the knee Separtates patellar ligament from joint case

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Knee and Related Structures Musculature Knee flexion – hamstring bunch Biceps femoris Semitendinosus Semimembranosus Gracilis Sartorius Gastrocnemius Popliteus plantaris

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Knee and Related Structures Knee Extension – Quadriceps Group Vastus Medialis Vastus Lateralis Vastus Intermedius Rectus Femoris

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Knee and Related Structures Nerve Supply Tibial nerve = hamstring and gastrocnemius Common peroneal nerve = proximal fibula head = injury causes tactile and engine shortages distally Femoral nerve Blood Supply i. Popliteal course = stem of femoral supply route

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Knee and Related Structures Leg Alignment Deviations Predispose to harm Patellar malalignment Genu valgum Genu varum Genu recurvatum Leg-Length and Patella Discrepancies Anatomical leg length (genuine leg length) ASIS to Lateral Malleolus Anatomical leg length (practical leg length) Umbilicus to Medial Malleolus Girth Measurement Q-Angle Measurement 1. ASIS to Mid-patella to Tibial Tuberosity

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Knee and Related Structures Special Tests for Knee Joint Stability Valgus Stress Test Varus Stress Test Anterior Drawer Lachman Drawer Test Pivot Shift Test Posterior Drawer Test Posterior Sag Test McMurray's Test Apley Compression Test Apley Distraction Test Patellar Compression, Grinding, Apprehension, Chandelier Tests

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Functional Anatomy Movement of the knee requires flexion, expansion, revolution and the arthrokinematic movements of rolling and floating Rotational segment includes the "screw home mechanism" As the knee augments it remotely turns on the grounds that the average femoral condyle is bigger than the horizontal Provides expanded soundness to the knee Popliteus "opens" knee permitting knee to flex

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Capsular tendons are rigid amid full augmentation and loose w/flexion Allows turn to happen Deeper capsular tendons stay tight to hold turn under control PCL averts intemperate inward turn, controls the knee in flexion, and goes about as drag amid introductory skim period of flexion ACL stops unreasonable inside pivot, balances out the knee in full expansion and avoids hyperextension

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Range of movement incorporates 140 degrees of movement Limited by abbreviated position of hamstrings, main part of hamstrings and extensibility of quads Patella helps knee amid augmentation, giving a mechanical preferred standpoint Distributes compressive weight on the femur by expanding contact between patellar ligament and femur Protects patellar ligament against rubbing When moving from augmentation to flexion the patella coasts along the side and further into trochlear groove

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Kinetic Chain Directly influenced by movements and powers happening at the foot, lower leg, bring down leg, thigh, hip, pelvis, and spine With the motor chain strengths must be assimilated and circulated If body can't oversee powers, breakdown to the framework happens Knee is extremely vulnerable to damage coming about because of ingestion of powers

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Assessing the Knee Joint Determining the component of harm is basic History-Current Injury Past history Mechanism-what position was your body in? Did the knee fall? Did you hear or feel anything? Would you be able to move your knee promptly after damage or would it say it was bolted? Did swelling happen? Where was the torment

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History - Recurrent or Chronic Injury What is your real protestation? At the point when did you first notice the condition? Is there intermittent swelling? Does the knee bolt or catch? Is there serious torment? Crushing or grinding? Does it ever have a craving for giving way? What does it feel like when climbing and plummeting stairs? What past treatment have you experienced?

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Observation Walking, half crouching, going here and there stairs Swelling, ecchymosis, Leg arrangement Genu valgum and genu varum Hyperextension and hyperflexion Patella alta and baja Patella turned internal or outward May bring about a blend of issues Tibial torsion, femoral anteversion and retroversion

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Tibial torsion A point that measures under 15 degrees means that tibial torsion Femoral Anteversion and Retroversion Total pivot of the hip equivalents ~100 degrees If the hip pivots >70 degrees inside, anteversion of the hip may exist INSERT 20-9

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Knee Symmetry or Asymmetry Do the knees look symmetrical? Is there evident swelling? Decay? Leg Length Discrepancy Anatomical or useful Anatomical contrasts can possibly bring about issues in all weight bearing joints Functional contrasts can be brought on by pelvic revolutions or mal-arrangement of the spine

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Medial tibial level Medial femoral condyle Adductor tubercle Gerdy's tubercle Lateral tibial level Lateral femoral condyle Lateral epicondyle Head of fibula Tibial tuberosity Superior and mediocre patella outskirts (base and pinnacle) Around the fringe of the knee loose, in full flexion and expansion Palpation - Bony

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Vastus medialis Vastus lateralis Vastus intermedius Rectus femoris Quadriceps and patellar ligament Sartorius Medial patellar plica Anterior joint case Iliotibial Band Arcuate complex Medial and parallel guarantee tendons Pes anserine Medial/horizontal joint container Semitendinosus Semimembranosus Gastrocnemius Popliteus Biceps Femoris Palpation - Soft Tissue

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Palpation of Swelling Intra versus extracapsular swelling Intracapsular might be alluded to as joint emission Swelling w/in the joint that is brought on by synovial liquid and blood is a hemarthrosis Sweep move Ballotable patella - indication of joint emanation Extracapsular swelling has a tendency to restrict over the harmed structure May at last move down to foot and lower leg

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Special Tests for Knee Instability Use endpoint feel to decide dependability MRI may likewise be important for appraisal Classification of Joint Instability Knee laxity incorporates both straight and rotational shakiness Translation (tibial interpretation) alludes to the coast of tibial level with respect to the femoral condyles As the harm to adjustment structures builds, laxity and interpretation additionally increment Valgus and Varus Stress Tests Used to evaluate the honesty of the MCL and LCL separately Testing at 0 degrees consolidates capsular testing while testing at 30 degrees of flexion detaches the tendons

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Anterior Cruciate Ligament Tests Drawer test at 90 degrees of flexion Tibia sliding forward from under the femur is viewed as a positive sign (ACL) Should be performed w/knee inside and remotely to test respectability of joint case

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Lachman Drawer Test Will not compel knee into excruciating flexion instantly after harm Reduces hamstring association At 30 degrees of flexion an endeavor is made to decipher the tibia anteriorly on the femur A positive test shows harm to the ACL

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Pivot Shift Test Used to decide anterolateral turning insecurity Position begins w/knee augmented and leg inside turned The thigh and knee are then flexed w/a valgus push connected to the knee Reduction of the tibial level (creating a thump) is a positive sign

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Posterior Cruciate Ligament Tests Posterior Drawer Test Knee is flexed at 90 degrees and a back drive is connected to decide interpretation posteriorly Positive sign demonstrates a PCL lacking knee

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Posterior Sag Test (Godfrey's test) Athlete is recumbent w/both knees flexed to 90 degrees Lateral perception is required to decide degree of back droop while looking at respectively

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