What is the most complex joint in the
body?
What is the most complex joint in the
body?
The KNEE joint
Knee joint!
It takes a pounding as a hinge
joint between two substantial
bones…
One of the most common
operations performed in the
U.S. – ???
Knee joint!
One of the most common
operations performed in
the U.S. – knee arthroplasty
(TKR)
Total Knee Replacement
Total Knee Replacement
https://youtu.be/tKji04oFGdU
(animation
)
Surgery:
https://youtu.be/Nmb5-e3cwBw
THE KNEE
The knee
-Largest joint
in the body.
-Hinge joint
-greatest ROM is in flexion
-highly susceptible to injury
-not protected by layers of
fat and muscle
-easily palpable
The knee (anterior)
The knee (posterior)
Meniscus and ligaments and anatomy
http://youtu.be/_q-Jxj5sT0g?t=5m29s
Knee Meniscus
http://youtu.be/hwnFgm6jiKY
http://youtu.be/OuiIXMgTlyI
Knee ACL repair
http://youtu.be/rRVAjHJxmX8
http://youtu.be/q96M0jRqn7k
bursas
Goniometer
Knee Flexion
Testing Position: Prone with hip and knee in neutral
Stabilization: Trunk and pelvis stabilized by body weight and position
Goniometer Axis: Lateral epicondyle of the femur
Proximal Arm: Parallel to the long axis of the femur & pointing at the greater trochanter
Distal Arm: Parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement: The hip and knee are flexed as the heel moves toward the buttock
Expected ROM: 135°
*Alternate Position: Supine lying with the femur stabilized.
Alternate position
Alternate position
Knee Extension
Testing Position: Prone with hips and knees in neutral rotation; upper leg on bolster
Stabilization: Trunk and pelvis stabilized by body weight and position
Goniometer Axis: Lateral Epicondyle of the femur
Proximal Arm: Parallel to the long axis of the femur & pointing at the greater trochanter
Distal Arm: Parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement: Knee extension
Expected ROM: 0°. Hyperextension may be present up to -10°
*Alternate Position: Supine with bolster under ankle
Alternate position- supine for knee extension
Goniometry Lab
- Disadvantages:
Goniometry Lab
- Disadvantages:
- It is sometimes difficult to position and
maintain the arms of the goniometer
along the bones of the segments
throughout the measurement
- Intertester reliability
- Coordination
Differences between R/L side
measurements
Prone vs. Supine knee flexion
Supine
Prone
Common injuries to knee
Common injuries to knee
-Patellar dislocation
- ACL tear
-PCL tear
- Collateral ligament tears
-Meniscal tears
-Tendon tears
Patellar dislocation
http://youtu.be/6-JNFiXkXfc
ACL tear
Changing direction rapidly or landing from a jump
incorrectly can tear the ACL. About half of all injuries
to the ACL occur along with damage to other
structures in the knee (articular cartilage, meniscus or
other ligaments)
PCL tear
PCL is generally injured from a blow to the front of the
knee while the knee is bent. This often occurs in motor
vehicle crashes and sports-related contact. PCL tears
tend to be partial tears with the potential to heal on
their own.
Collateral Ligament tears- lateral
Injuries to the collateral ligaments are usually caused by a force
that pushes the knee sideways. Injuries to the MCL are usually
caused by a direct blow to the outside of the knee, and are often
sports-related.
Blows to the inside of the knee that push the knee outwards
may injure the LCL.
(LCL tears occur less frequently than other knee injuries.)
Lateral collateral ligament
Collateral Ligament tears- medial
Meniscal Tears
Sudden meniscal tears often happen during sports.
◦ Tears in the meniscus can occur when twisting, cutting, pivoting, or being tackled.
Meniscal tears may also occur as a result of arthritis or aging.
◦ Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have
weakened with age.
Meniscal Tears
Tendon tears
The quadriceps and patellar tendons can be stretched and torn. Although anyone can injure
these tendons, tears are more common among middle-aged people who play running or
jumping sports. Falls, direct force to the front of the knee, and landing awkwardly from a jump
are common causes of knee tendon injuries.
Patellar tendon
tear
Quadriceps tendon tear
Patellar tendonitis
Manual Muscle Testing
Manual Muscle Testing Grading System
Grading Scale Range: 0 to 5
0
 None
No visible or palpable contraction
1
 Trace
Visible or palpable contraction with no motion
2
 Poor
Full ROM gravity eliminated
3
 Fair
Full ROM against gravity
4  Good
5
 Normal
Full ROM against gravity, moderate resistance
Full ROM against gravity, maximal resistance
Manual Muscle testing
-Knee
◦ -quadriceps
◦ - hamstrings
MMT- quads and hamstrings
http://youtu.be/ZkjP9Mw_1gk
1) Have patient go through full ROM first.
2) Then, have patient repeat full ROM while you offer resistance.
3) At the end of the motion, perform a brake test.
4) Record your results (do flexion and extension on both sides).
MMT- knee
-Record your results for both the left and right LE.
Bony Landmarks of Knee
-
Patella
Tibial tuberosity
Femoral condyles
Tibial condyles
Stability Tests
-Ligaments
-Meniscus
-Miscellaneous
Flexibility Tests
-SLR (80-90 degrees is a desirable score)
-Thomas Test
http://youtu.be/4mnjUi-41fI
- Review
medical abbreviations for quiz