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Lower Extremity:Knee
| Question | Answer |
|---|---|
| Functional Knee ROM: Gait | Gait: -0°ext for symmetry -60°during in the swing phase |
| Functional Knee ROM: Stairs descent | Stair descent: -90°flexion -May need up to 120°flexion |
| Functional Knee ROM: Sit to stand from toilet/ low chair | 105°flexion |
| Functional Knee ROM: Cycling | ~120°flexion |
| Normal Knee ROM | -Maximally flexed to 60° @ mid-swing and 20° flexion at foot flat -Maximally hyper-extended up to 10° at heel off |
| ACL | -Runs anterior tibia to posterior femur -Attaches centrally & anteriorly on tibia -Runs superior and posterior -Attaches posteriorly on lateral aspect of intercondylar fossa |
| ACL will likely need sx because? | Clotting inhibited by synovial fluid and continual instabillty |
| ACL risk factors: Primary ACL injury | -Non-modifiable Female > Male/ pre-ovulation phase/ narrow intercondylar femoral notch/ post. tib. slope & hyperext. -Modifiable High shoe surface friction&BMI/ loading patterns/ impaired trunk proprioception & kinesthesia/ decreased visual processing |
| ACL risk factors cont. | -Lower strength w/ ACL tears -Low ham to quad ratio |
| ACL control with valgus landing | -Poor control: significant valgus movement/ knee medial to foot -Reduced control: some valgus movement/ knee not entirely medial to foot |
| ACL risk factors: Second ACL injury | -Similar to primary plus excessive hip IR |
| ACL | -Start with internal and progress to external |
| ACL PT Rx: Phase 2 | -Intensive muscle training -Plyometrics -No pivoting |
| ACL PT Rx: Phase 3 | Pivoting begins |
| STG vs BPTB | -STG better -BPTB had inconsistent anterior knee P!, primarily with kneeling |
| PCL | -Thicker and stronger than ACL/ least injured knee ligament -Runs from post. tibia to ant. femur -Attaches centrally & post. on tibia -Runs superior and anterior -Attaches ant. on medial aspect of intercondylar fossa |
| PCL etiology | -Hyperflexion -Hyperextension- also may damage ACL |
| PCL tests and measures | -Quad active test -Sag-most sensitive |
| PCL PT Rx | -Similar to ACL except -For a PCL, avoid 60°flexion maximum initially -Emphasize quad strengthening and coordination to limit post. tibial gliding |
| MCL | -Most commonly injured knee lig. -Flat, broad lig. -Runs from medial condyles of femur and tibia -Attaches to; medial meniscus/ pot. capsule/ adjacent mm & tendon units - |
| MCL | -Tight during extension -Taut with tibial ER -Slack with flexion |
| MCL tests | Valgus stress |
| MCL PT Rx | -Limit valgus and tibial ER stress in maximal protectionphase -Most will not need sx |
| LCL | -Strong, seldom injuried -Etiology- excessive varus stress -Round, cordlike -Attaches lateral condyle of femur to fibular head -No attachment to menisci -Slack in flex. -Varus stress test |
| LCL PT Rx | -Limit varus and tibial ER stress in max protection phase -Most wont need sx |
| Sprains PT Rx | -Mod.: CPM showed weak support -Man. ther. -Ther. ex.: supervisied + HEP=mod. support open/ closed chain exer.= strong support coordination training= mod. support |
| Menisci | -2nd most common knee injury -Nearly circular, wedge shaped fibrocartilage disc -Attached to tibia -Purpose: tension>shock absorption & stability |
| Medial Meniscus | -Torn more frequently -Attachment to MCL |
| Lateral Meniscus | -more mobile w/out ligamentous attachment |
| Meniscus risks | -Acute- soccer and rugby -Degeneration'-Previous knee injury |
Created by:
alovedaytn
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