knee chapter review

• PNF patterns for KNEE

  • D1 flexion: flex or ext
  • D1 Extension: ext or flex
  • D2 flexion: flex or ext
  • D2 extension: ext or flex
• Anterior cruciate ligament sprain

  • common during hyperext or landing on unbalanced limb, quick deceleration, planting of limb with twisting motion, or hypervalgus motion (contact/non) hyperflexion-multiplanar motions
  • grades of sprains (tears)
  • 1: over stretch to min tear, mild pain/swelling
  • 2: min to mod, mod pain/swelling; min instability
  • 3: severe to complete tear, severe pain & swelling; substantial instability; Loss of ROM
  • MUST KNOW GRAFT SITE
  • ACL has poor blood supply as cannot heal self with complete tear
• types of grafts:

  • Autologous: from body of pt. taken from involved extremity.
  • Hamstring & patellar tendons are most commonly harvested. easy to collect. & allow return of pts proprioceptive response. maintain strength.
  • Allogeneic: tissue taken from another human body. has a risk of disease transmission & problems with sterilization procedures.
• medial collateral ligament sprain

  • resulting jt laxity
  • typically with planted foot with forced flex/valgus/tibial rot.
  • 4-8 weeks typical return to function, total structural healing take up to 3-6 months.
  • Signs: pop heard with pain in medial knee. tenderness, limited ROM flex/ext, decreased strength, lack of balance, antalgic gait
• Patellofemoral Pain Syndrome (PFS/PFPS)

  • damage to articular cartilage of patella = softening to complete cartilage damage- leading to exposed subchondral hone
  • SIGNS: stiffness of patella, tracks too far LAT in ext, pain over time with activities, burning & pain with prolonged sitting.
  • pt has increased Q angle
• Arthrokinematics

  • during open chain, rolling & sliding occur in same direction, concave tibia moves on convex femur.
  • during closed chain, rolling & sliding opposite directions, convex femur moves on concave tibia
• closed kinetic chain exercises

  • 1-quarter step ups
  • step downs
  • single leg toe raises
  • side lunges
  • plyometric exercise
  • resisted walking
  • agility & balance drills
• open kinetic chain exercises

  • straight leg raise into flexion, extension, abduction, short arc quadriceps using gravity, standing hamstring curls, prone hamstring curls, stool sweep
• PCL tear

  • occurs only with significant trauma such as car accident, landing hyperflexed knee from a jump, hypertextension of knee with foot planted.
  • SIGNS: pain in post aspect of knee, min swelling, maybe instability, depends on severity of tear
  • CKCEs used in rehab of PCL: squats, lunges, & CKC knee ext. balance & proprioceptive are performed.
  • SURGICAL INTERVENTION: post op knee immobilizer, WBAT with crutches, & brace in locked position.
• meniscus injuries

  • cause pain, locking, catching, swelling, & functional impairment
  • injured meniscus may/not heal/ repair itself, depending on location of the tear.
  • zones of meniscal tear: red zone (more likely to heal than tears in middle of meniscus)
  • red-white zone: does not have potential to heal
• hamstring mms

  • Semimembranosus: extend hip, flex knee
  • semitendinosus: extend hip, flex knee, I.R. tibia
  • biceps femoris: extend hip, flex knee & E.R. tibia
• gastrocnemius

  • planter flex ankle & supinate subtalar jt, also flex/ext knee
• iliotibial band

  • maintain knee & hip ext
• sartorius

  • flexes & I.R. tibia
• Osteoarthritis

  • "wear & tear" or "degenerative" condition
  • pt complains of pain with WB activities & pain at rest. loss of motion. mm weakness.
  • conservative intervention: NSAIDS & cortisone injections, prescribed by physician
  • pt education, weight loss, theramal modalities, shoe inserts.
• total knee arthroplasty

  • helps relieve knee pain, improve function, increase social mobility & interaction,
  • pain & loss of function = primary reason for TKA
  • complications with TKA: fat embolism, poor wound healing, infection, periprosthetic fractures
  • INTERVENTION: resistive exercises, deep breathing, active assisted knee flex/ext, ankle pumps, glut sets, heel slides, SLR,
  • FWB is allowed at 6 weeks, based on radiographaphic exam & pts weight
• tendinopathy

  • 2 types: patellar & quadriceps
  • FACTORS: body weight, BMI, waist to hip ratio, leg length difference, quad flexibility & strength, hamstring flexibility, vertical jump performance.
  • Pain on palpation near patellar insertion present in both types.
  • Patellar: pain to inf pole of patella,
  • quadriceps: pain to distal thigh & sup pole of patella
  • during physical activity, pain may feel sharp when jumping/running
  • pain provocation of greater than 24 hrs = irritable
• patellar fractures

  • result of compressive force such as a direct blow, sudden tensile force.
  • types: transverse (most common), vertical, marginal, osteochondral
  • Non-displaced: may be treated with immbolization, cast for 4-6 weeks, hinged brace used when ambulating, program emphasizing ROM & strengthening. once able to perform SLR, brace discontinued
  • Displaced: warrant surgical treatment to maximize potential successful outcomes. important to attain & maintain full knee ext
  • should AVOID pillows under knee