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 |