Knee Injuries
Important Structures
Cruciate ligaments
Collateral ligaments
Menisci
Articular cartilage
Patellar tendon
Cruciate ligaments
Control anterior and
posterior movements
Fit inside the
intercondylar fossa
Collateral ligaments
Control lateral movement
Exposed to valgus (MCL) and varus (LCL)
forces
Menisci
Weight distribution
Without menisci the weight of
the femur would be
concentrated to one point on
the tibia
Converts the tibial surface into
a shallow socket
Other Important Structures
Articular cartilage
1/4 inch thick
tough and slick
Patella and patellar
tendon
Tibial tuberoscity
Patellofemoral groove
Patella acts like a fulcrum
to increase the force of the
quadriceps muscles
Ligaments
Knee is like a round ball on a
flat surface
Ligaments provide most of
the support to the knees
Little structure or support
from the bones
Muscles
Quadriceps - extension
Hamstrings - flexion
IT band from the gluteus
maximus and tensor fascia
latae
Acute Knee Injuries
Anterior Cruciate Ligament Tears
Can withstand approximately
400 pounds of force
Common injury particularly in
sports (3% of all athletic
injuries)
May hear a ‘pop’ sound and
feel the knee give away
Types of ACL Tears
Causes of ACL Injuries
Cutting (rotation)
Hyperextension
Straight knee landing
When the knee is
extended, the ACL is at
it’s maximal length
putting it at an
increased risk of
tearing
External factors
Amount of lower body strength
Footwear and surface interaction
Unhappy Triad
1. ACL
2. Medial collateral
ligament
3. Medial meniscus
Lachman Test and Anterior Drawer Test
Normal knees have
2-4 mm of anterior
translation and a solid
end point
ACL injury will have
increased translation
and a soft end point
Women and ACL Tears
Anterior Cruciate Ligament Injuries in Female
Athletes: Why Are Women More
Susceptible?
James L. Moeller, MD; Mary M. Lamb, MD
THE PHYSICIAN AND SPORTSMEDICINE - VOL
25 - NO. 4 - APRIL 97
NCAA
Four times more ACL tears in women than men
basketball players.
Three times more in gymnasts
2.4 times more in soccer
Higher rates are also found among women in
team handball, volleyball and alpine skiing
Factors
Smaller size of ACL
Smaller intercondylar notch
Larger Q-angle (doubtful)
normal = 17 degrees in women
Normal = 14 degress in men
Factors
Weaker hamstrings
Ratio of 10 (quadriceps) to 7 (hamstrings)
Hormones
Estrogen – reduces collagen strength
Relaxin
ACL Reconstruction
Shockwave
Graft Harvest
Drill
Attach
Rehab
Meniscal Tears
Meniscal Tears
One of the most commonly injured parts of the knee.
Symptoms include pain, catching and buckling
Signs include tenderness and possible clicking
Meniscal tears occur during twisting motions with the knee
flexed
Also, they can occur in combination with other injuries such
as a torn ACL (anterior cruciate ligament).
Older people can injure the meniscus without any trauma
as the cartilage weakens and wears thin over time, setting
the stage for a degenerative tear.
PCL Injuries
PCL Injuries
The posterior cruciate ligament, or PCL, is not
injured as frequently as the ACL.
PCL sprains usually occur because the
ligament was pulled or stretched too far,
anterior force to the knee, or a simple
misstep.
PCL injuries disrupt knee joint stability
because the tibia can sag posteriorly.
The ends of the femur and tibia rub directly
against each other, causing wear and tear to
the thin, smooth articular cartilage.
This abrasion may lead to arthritis in the knee.
Treating PCL Injuries
Patients with PCL tears often do not have
symptoms of instability in their knees, so surgery
is not always needed.
Many athletes return to activity without
significant impairment after completing a
prescribed rehabilitation program.
However, if the PCL injury results in an avulsion
fracture, surgery is needed to reattach the
ligament.
Knee function after this surgery is often quite
good
Collateral Ligament Injuries
Collateral Ligament Injuries
Injuries to the medial collateral ligament are
usually caused by contact on the lateral side of
the knee
Accompanied by sharp pain on the inside of
the knee.
If the medial collateral ligament has a small
partial tear, conservative treatment usually
works.
If the medial collateral ligament is completely
torn or torn in such a way that ligament fibers
cannot heal, surgery may needed.
The lateral collateral ligament is rarely injured.
Chronic Injuries
1. Patellar Tendonitis
2. Patellofemoral Pain Syndrome
3. Subluxation of Patella
4. Chondromalacia
5. Osgood-Schlatters Disease
6. IT Band Syndrome
1. Patellar Tendonitist
Patellar Tendonitist
Due to high deceleration or eccentric forces of the quadriceps at
the knee during landing
As you land the hamstrings cause your knee to flex to absorb the
shock of impact
In order to control or decelerate the flexion produced by the
hamstrings, the quadriceps muscles contract eccentricly
Eccentric contractions occur as the muscle is being lengthened or
stretch
Eccentric contractions produces high amounts of force, and
therefore stress to the patellar tendon
Patellar Tendonitist
Prevention: strong quadriceps muscles
Squats Lunges
More Quadriceps Exercises
Leg Extension
Leg Press
More Quadriceps Exercises
Plyometric or Jump Training Uphill Running
2. Subluxation of the Patella
Partial dislocation of the
patella
Complete dislocation is rare
and is due to sudden (acute)
trauma
Weak vastus medialis muscle
may contribute
3. Chondromalacia
A softening & fissuring of the articular
cartilage of the patella
Causes
1. Aging
2. Mechanical defects (next
slide)
Risk Factors: Subluxation and
Chondromalacia
1. Training errors
Increasing intensity too soon
2. Weak vastus medialis muscle
3. Large Q angle
Greater than 25 for women and
20 for men
4. Pronation of the foot causing
the tibia to medial rotate
5. Gender - more common in
women
6. Poor footwear and/or surface
4. Osgood- Schlatter Disease
Overuse, not a diesease.
Inflammation to the patellar tendon at the tibial
tuberoscity
Most common in adolescents (8-13 year olds girls
and 10-15 year old boys); age of rapid bone
growth
Osgood- Schlatter Disease
Anterior pain about 2-3 inches below the
patella
Avulsion fracture
5. IT Band Syndrome - Anatomy
The ITB moves anteriorly
over the lateral condyle of
the femur as the knee
extends
The ITB slides posteriorly
over the lateral condyle of
the femur as the knee
flexes
Recurrent rubbing can
produce irritation and
subsequent inflammation,
especially beneath the
posterior fibers of the ITB,
which are thought to be
tighter against the lateral
femoral condyle than the
anterior fibers.
Causes of ITB Syndrome
Duration (or mileage)
of exercise
Hip abductor
weakness
Tight hip abductors
and/or IT band
