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Chapter 20: The Knee and
Related Structures
Ligaments
• ACL
– Prevents anterior tibial translation

• PCL
– prevents posterior tibial translation

• Medial Collateral
– Prevents valgus

• Lateral Collateral
– Prevents varus
Patella
• Patella
– aids knee during extension, providing a
mechanical advantage
– Protects patellar tendon against friction
Assessing the Knee Joint
• Determining the mechanism of injury is
critical
• History- Current Injury
– Past history
– Mechanism- what position was your body
in?
– Did the knee collapse?
– Did you hear or feel anything?
– Could you move your knee immediately
after injury or was it locked?
– Did swelling occur?
– Where was the pain
• History - Recurrent or Chronic Injury
–
–
–
–
–
–
–
–

What is your major complaint?
When did you first notice the condition?
Is there recurrent swelling?
Does the knee lock or catch?
Is there severe pain?
Grinding or grating?
Does it ever feel like giving way?
What does it feel like when ascending and
descending stairs?
– What past treatment have you undergone?
• Observation
– Walking, half squatting, going up and down
stairs
– Swelling, ecchymosis,
– Leg alignment
• Genu valgum and genu varum
• Hyperextension and hyperflexion
• Patella alta and baja
Patella Baja and Alta
– Knee Symmetry or Asymmetry
• Do the knees look symmetrical? Is there obvious
swelling? Atrophy?

– Leg Length Discrepancy
• Anatomical or functional
• Anatomical differences
– A true difference in bone length

• Functional differences
– caused by pelvic rotations or mal-alignment of the spine
Obvious swelling
• Types of, and Palpation of Swelling
– Intra vs. extracapsular swelling
• Intracapsular may be referred to as joint
effusion
• Ballotable patella - sign of joint effusion

– Extracapsular swelling tends to localize
over the injured structure
• May ultimately migrate down to foot and ankle
Q Angle
• Lines which bisect the patella relative to
the ASIS and the tibial tubercle
• Normal angle is 10 degrees for males
and 15 degrees for females
Q-angle
Knee Injuries
Knee Sprains - MCL
Knee Sprains - MCL
• Mechanism of Injury
– Valgus Force
– Pivoting
Knee Sprains - LCL
Knee Sprains - LCL
• Mechanism of Injury
– Varus Force
Knee Sprains - ACL
Knee Sprains - ACL
• Mechanism of Injury
Cutting

Pivoting
Knee Sprains - ACL
• Mechanism of Injury
• Anterior tibial
translation on a fixed
femur.
Knee Sprains - ACL
• Mechanism of Injury
Valgus
Varus
Knee Sprains - PCL
Knee Sprains - PCL
• Mechanism of Injury
Hyperextension
Knee Sprains - PCL
• Posterior tibial
translation on a fixed
femur.
Injury Videos
http://www.youtube.com/watch?v=A9-KkUH8yt8
http://www.youtube.com/watch?v=-pKaBW99GgY
http://www.youtube.com/watch?v=j_Mdm4v-ty8
The MOI of an MCL injury is:
1.
2.
3.
4.
5.
6.

Valgus force
Varus force
Pivoting
Hyperextension
All of the above
All but 2

17%

1

17%

2

17%

17%

3

4

17%

5

17%

6
The MOI of an LCL injury is:
1.
2.
3.
4.
5.
6.

Valgus force
Varus force
Pivoting
Hyperextension
All of the above
All but 1

17%

1

17%

2

17%

17%

3

4

17%

5

17%

6
The ACL is most commonly
injured by:
1.
2.
3.
4.
5.
6.

Valgus force
Varus force
Hyperextension
Pivoting
All of the above
All but 2

17%

17%

17%

17%
17%

17%

1

2

3

4

5

6
• Function

Meniscus

– Shock Absorption
– Centering Mechanism (stability)
– Production of Synovial Fluid (joint oil)
Meniscus Injuries
• Usually occurs with a hyperflexion or
twist (pivot) while weight bearing
Meniscus Injuries
Meniscus Injuries
Meniscus Injuries
• Signs & Symptoms
–
–
–
–
–
–

Awkward Mechanism
“Shift” or “pop”
Deep knee pain
Loss of terminal ext. or flex.
Delayed swelling
Jointline tenderness
Meniscal injuries are caused
by:
1.
2.
3.
4.
5.

Hyperextension
Hyperflexion
Pivoting
All of the above
None of the above

20%

20%

20%

20%
20%

1

2

3

4

5
Patello-femoral Disorders
Patello-femoral Disorders
•

Chondromalacia

•

Patello-femoral pain syndrome

•
•

*Acute patellar dislocation
*Patellar tendinitis (jumpers knee)

•

*Osgood Schlatter’s

– Softening of articular cartilage
– Pain/inflammaton under patella

– Quadriceps tendinitis
– apophysitis

Why are patellar tracking problems
Often lateral?
**Read about the differences in
your text!!!
Patello-femoral Disorders
• Dislocation/Subluxation
Patello-femoral Disorders
• Patellar tendonitis
Patello-femoral Disorders
• Osgood Schlatter
Runner’s Knee
• Due to overuse
– The IT Band rubs
Over the lateral
Condyle of the femur
• Results in tendinitis of the
IT band
Pes Anserine Tendinitis
• Tendinitis/Bursitis of the distal insertion
of the sartorius, gracilis, and
semitendinosis
The difference between
runner’s knee and Pes
Anserine tendinitis is:
1. Runner’s knee is
lateral
2. Runner’s knee is
uncommon
3. There is no
difference

33%

33%

33%

1

2

3

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Knee