Lower Extremity:Knee
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| Functional Knee ROM: Gait | Gait:
-0°ext for symmetry
-60°during in the swing phase
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| Functional Knee ROM: Stairs descent | Stair descent:
-90°flexion
-May need up to 120°flexion
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| Functional Knee ROM: Sit to stand from toilet/ low chair | 105°flexion
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| Functional Knee ROM: Cycling | ~120°flexion
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| Normal Knee ROM | -Maximally flexed to 60° @ mid-swing and 20° flexion at foot flat
-Maximally hyper-extended up to 10° at heel off
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| ACL | -Runs anterior tibia to posterior femur
-Attaches centrally & anteriorly on tibia
-Runs superior and posterior
-Attaches posteriorly on lateral aspect of intercondylar fossa
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| ACL will likely need sx because? | Clotting inhibited by synovial fluid and continual instabillty
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| 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
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| ACL risk factors cont. | -Lower strength w/ ACL tears
-Low ham to quad ratio
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| 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
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| ACL risk factors: Second ACL injury | -Similar to primary plus excessive hip IR
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| ACL | -Start with internal and progress to external
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| ACL PT Rx: Phase 2 | -Intensive muscle training
-Plyometrics
-No pivoting
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| ACL PT Rx: Phase 3 | Pivoting begins
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| STG vs BPTB | -STG better
-BPTB had inconsistent anterior knee P!, primarily with kneeling
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| 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
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| PCL etiology | -Hyperflexion
-Hyperextension- also may damage ACL
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| PCL tests and measures | -Quad active test
-Sag-most sensitive
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| 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
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| 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
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| MCL | -Tight during extension
-Taut with tibial ER
-Slack with flexion
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| MCL tests | Valgus stress
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| MCL PT Rx | -Limit valgus and tibial ER stress in maximal protectionphase
-Most will not need sx
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| 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
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| LCL PT Rx | -Limit varus and tibial ER stress in max protection phase
-Most wont need sx
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| 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
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| Menisci | -2nd most common knee injury
-Nearly circular, wedge shaped fibrocartilage disc
-Attached to tibia
-Purpose: tension>shock absorption & stability
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| Medial Meniscus | -Torn more frequently
-Attachment to MCL
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| Lateral Meniscus | -more mobile w/out ligamentous attachment
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| Meniscus risks | -Acute- soccer and rugby
-Degeneration'-Previous knee injury
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