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muscles
o For mobility + stability
o Anteroposterior stability: cruciate ligaments
o Raises + lower body; move foot in space
o Mediolateral stability: medial (tibial) + lateral
o Supports body when standing
(fibular) collateral ligaments
o 1o fxnal unit in walking, climbing, running + sitting
o Convex: condyles of femur; medial condyle is
activities
longer than lateral (locking mechanism)
STX + FXN o Concave: tibial plateaus + fibrocartilaginous
meninsci. Medial plateau is larger
o Distal femur (2 condyles) + proximal tibia (2 tibial o Meniscus = improve congruency.
plateaus) + large sesamoid bone in qauds tendon
Tibial condyles via coronary ligaments
(patella).
patella via patellomeniscal ligaments
o Proximal tibiofibular jt -> separate jt capsule fxns c
Anterior + Posterior meniscofemoral
ankle
ligaments = lateral meniscus to femur
Medial meniscus = jt capsule + medial
collateral ligament + ant & post cruciate
ligs + semimembranosus ms.
Lateral meniscus = PCL + tendon of
popliteus
**medial meniscus = greater chance of
tear c lat F to knee
o NWB OKC
Concave plateaus same slide
Terminal extension = tibia ER, femur IR
Flexion = tibia IR, femur ER
o FWB CKC
Convex condyle opposite slide
o Screw-home mechanism
JOINTS
Passive stabilizing fxn
o Lax jt capsule Final degrees of ext. = locking
o Tibiofemoral jt Tibia is fixed c foot weight bearing
o Patellofemoral jt Terminal ext = femur IR, tibia ER
o Bursae: Suprapatellar, subpopliteal + Medial condyle slides more post than lat
gastrocnemius bursae condyle
Tibiofemoral Jt.
Patellar Compression
o Patellar contact
Knee ext, patella sup to trochlear groove. o Length/ strength imbalances: pain during walking
Knee 15flex, inf border of patella or running
articulates c sup aspect of groove o Foot impairments
Knee flex = patella slides distally
Major nn subject to injury
o Compression forces
Full ext = no contact of patella on troch *branches of sciatic nn proximal to popliteal fossa
groove, no compression on articular
o Common fibular (peroneal) nn (L2-L4): fibular
surfaces
head. Sensory loss + ms weakness
Quads + patellar tendon pull patella, taut
o Saphenous nn (L2-L4): skin along medial side of
when flexed
knee + leg = chronic pain syndrome
30-60 higher force
Squatting = less force Referred Pain
OKC NWB greatest force at 30 flex; with
o L3 ant knee
variable resistance peak stress at 60 +
o S1-S2 post knee
peak compression at 75
o L3 ant thigh + knee
Inc Q-angle = inc lat facet pressure during
knee flex MANAGEMENT OF KNEE DISORDERS + SURGERIES
KNEE EXT. MUSCLE FXN A. JT. HYPOMOBILITY
o Quads = prime mover for knee ext. (CKC: soleus + 1. Joint Hypomob: Nonop
hams) OA + RA + acute jt trauma. Dec flexibility, adhesion
o CKC: quads controls flex
o Patella: moment arm of extension. Greatest 30-60 o OA = genu varum, knee instability
diminishes at 15-0 o RA = genu valgum
o Torque: for quads occurs at 70-50 dec at 15 o Loss of flexion (more common)
(requires most cxn o Walking, gardening, swimming, athletic +
household activities
KNEE FLEX. MUSCLE FXN
Jt Hypomob: Protection Phase
o Hams = prime knee flex; rot of tibia
o More efficient cxn during hip flex o Control pain + protect jt
o Popliteus = supports post capsule Pt educ
o Pes anserinus (Sartorius, gracilis, semitendinosus) PROM + ms setting
= med stab, affects CKC rot Minimize stair climbing
Elevated seats on commodes
Gait MS control
Avoid deep-seated/low chairs
o Quads = compensation lurch trunk ant during Use of crutches, cane, walker
initial contact (for stab + locking); excessive heel o Maintain soft tissue + jt mobility
rise during fast walking PROM, AAROM, AROM
o Hams = knee snapping into ext during terminal Grade I/II jt distraction ant + post
swing. Progressive genu recurvatum o Maintain muscle fxn + prevent patellar adhesion
o Soleus = hypertext of knee during preswing; loss of Setting exercises: pain free quads + hams
heel rise; lag/slight drop of pelvis ms setting
o Gastroc = hypertext during loading response, loss
Jt. Hypomob: CM + RTF
of PF during preswing + push off
o Progression (stretching, strengthening, stretching)
HIP + ANKLE IMPAIRMENTS
Stationary bicycle
o Hip flexion contracture: knee cannot ext during AROM + Ms setting
terminal stance Alternate activity with rest
o Decrease pain from mechanical stress MC site: weight bearing portion of med +
Assistive devices lat fem condyle, trochlear groove,
Avoid low chairs articulating facets of patella
o Increase joint play + ROM o Size of chondral lesion (greater than 1-2cm2 <4cm2)
Grade III/IV sustained/oscillatory 2. Total knee arthroplasty
techniques to tibiofemoral + o Usually for 70yrs old c arthritis
patellofemoral jt posn at end range. (flex : o Goal: relieve pain + improve pt physical fxn &
IR + post ; ext : ER + ant ; lat glide) quality of life
Stretching (Passive + PNF): low intensity,
Indications
long duration within pt tolerance
MWM o Severe jt pain c weight bearing or motion
o Improve ms performance in supporting ms compromises fxnal abilities
Multiple angle isomets o Extensive destruction of articular cartilage of the
AROM in OKC + CKC knee 2 to advanced arthritis
Ms endurance o Marked deformity of the knee (genu valgum, genu
Fxnal training varus)
Step-up + step-down exercise (forward, o Gross instability or limitation of motion
backward, lateral) o Failure of nonoperative mx or a previous surgical
Wall slides + minisquats to 90 procedure
Partial lunges
Balance activities
Ambulation
o Improve cardiopulmonary endurance
Swimming, water aerobics, aquatic
exercises
Bicycling
High impact activities
POST OP MX
Criteria to Progress develop with premature closure of this epiphyseal
plate
Maximum protection
Indications
control/responses, + minitrampoline
proprioception, balance FWB: unilat balance = partial lunges, step ups/downs
Low intensity agility drilles
4. Flexibility of hip + ankle 4. Stretch ITB + rectus fem
** Plyometrics
Phase
Min