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Lower Extremity:Knee

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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