Knee Joint
Orthopedic 475-
Learning Objectives
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Identify essential parts of knee anatomy
Recognize different knee pathology
Describe abnormal alignment of the knee and its relation to knee injuries
Evaluate knee abnormalities using specific tests
Recognize indication for total knee replacement surgery
Practice PT treatment for miniscus tear
Practice ACL and PCL PT treatment
Practice Total knee PT treatment
THE KNEE
one of the largest joints in the body•
especially important in the function of human •
bipedal locomotion
supporting the body during static and dynamic •
activities. Statically
Statically, in the closed kinematics chain, the knee •
works with the ankle and hip to support the body
weight in the erect position
Dynamically the knee must act in concert with •
the lower kinetic chain structures to efficiently
direct motor forces through to the ground.
Lastly the knee also performs the role of •
positioning the foot in space during open
kinetic chain activities (walking).
• Consist of two joints within same capsule
• 1. Tibial-femoral articulation and the
• 2. Patellar-Femoral articulation.
• Two additional joints
• superior and inferior tibial-fibular articulation.
menisci
• Two asymmetrical fibrocartilaginous joint discs
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called menisci are located on the tibial condyle
Medial meniscus is a semicircle, lateral meniscus
is four-fifths of a ring
The wedge shaped menisci increase the radius
of the curvature of the tibial condyles and
therefore Joint congruity
The medial meniscus is more firmly attached to
the tibia
LIGAMENTOUS COMPONENTS
• Medial collateral (tibial collateral)
• Lateral collateral (Fibular collateral)
• Anterior Cruciate (ACL)
• Posterior Cruciate (PCL)
. KNEE INJURY AND PATHOLOGY
• Ligamentous
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. Meniscus
Fracture
• Tibial plateau fracture
• Intera-articular fracture
• Patella fracture
• Distal femur fracture
Pathology
• Osteochondritis dissecans - partial or
complete detachment of a fragment of
cartilage and subchondral bone
• Chondromalicia patella
• Osgood-Schlatter - partial separation of
the tibial tuberosity
• Geno varus/Valgus
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• DJD or RA
• Recurrent dislocation of the patella
• Baker’s Cyst
• SWELLING:
1. Immediate (1 - 2 hours post injury) consists
of blood, indicates ligament tear,
osteochondral fracture, or peripheral meniscus
tear (doughy, taut)
2.Synovial swelling (8 - 24 hours) indicates
joint irritation (boggy feeling)
3. Infections: Purulent (pus) red, hot, infection
SPECIAL TESTS
• Tests for Ligamentous Integrity
• Valgus Stress Test (Lateral ligament tear)
• Varus Stress Test (medial ligament tear)
• Lachman Test (Anterior Cruciate
ligament)
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Chondromalecia Patella
• Weakness of vastus medialis
• Clark’s sign test (pull the patella down ward
toward the foot and then ask patient to
tighten the quadreceps)
• Treated by vastus medialis strengthening
exercise
• Drawer Sign Test (anterior draw for
anterior cruciate stability)
• Posterior Sign test (for posterior cruciate
stability)
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Meniscal Pathology
• Tests for Meniscal Pathology (Notice
pain or tenderness on the lateral
surfaces of the knee, popping,
snapping with movement, and
inability to fully extend the knee
(locking))
• Apley's Compression Test
• Apley's Distraction Test
• McMurray test
Aply’s Test
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McMurray Test: Tibial IR and Tibial ER
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Tests for Patellofemoral Pathology
• Apprehension test for the patella to assess
for recurrent dislocation
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Q Angle or Patellar Femoral Angle
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Total knee Replacement (TKR)
• Knee replacement usually done for main
reason which is to relieve pain related to
Knee OA
Total knee replacement
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CPM machine
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Total knee physical therapy
procedure
• 1. MD order to start PT, the order should include the
weight bearing status, the rate of the advancement for
ROM when CPM machine used, and the need to use
knee brace when patient standing.
• 2. Isometric strengthening exercise for all the lower
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extremity muscles
3. Active assistive ROM to the knee joint
4. Active ROM to the ankle joint
5. SLR exercise after the full weight bearing order
received from the MD
6. Bed mobility and bed side sitting and standing on
FWW or Parallel bars
• 7. Gait training and ambulation with FWW
• 8. The goal for ROM is to reach 0-90 degree for
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functional purposes
9. Rehabilitation course to include more aggressive ROM
and all of the knee muscles strengthening exercises
10. Advance to ambulate with a cane or one elbow
crutch
11. In the acute case patient may required to apply ice
pack to control post surgery swelling
12. Home exercise and family education
Special strengthening exercise
• Special quadriceps exercises
• Each muscle of the quad has its own
strengthening exercise
• Special hamstring exercises
• You need to separate between hamstring
and gluteal maximums strengthening
exercise