The Knee Complex
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Transcript of The Knee Complex
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The Knee Complex
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The Knee Complex
A. General Structure & FunctionB. Structure & Function of Specific JointsC. Muscular Considerations
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General Structure
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Joints of the Knee Complex
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General Function Provides very mobile link in an otherwise
stable lower extremity Transmits loads from tibia/fibula to femur
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Knee Complex Movements
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Sagittal plane• Flexion, extension
Transverse plane• Medial and lateral
rotation
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Knee Complex Movements Frontal plane
Varus, valgus Anteroposterior translation Mediolateral translation
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The Knee Complex
A. General Structure & FunctionB. Structure & Function of Specific JointsC. Muscular Considerations
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Structure & Function of Specific Joints
1. Tibiofibular Joint2. Patellofemoral Joint 3. Tibiofemoral Joint
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Tibiofibular Joint: Bony Structure
Amphiarthrodial membranous syndesmosis joint
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Structure & Function of Specific Joints
1. Tibiofibular Joint2. Patellofemoral Joint 3. Tibiofemoral Joint
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Purpose of Patella Increase leverage of QF Protect joint during knee flexion ↓ pressure and distribute forces on femur Prevent Fcompression on PT in resisted knee
flexion Disadvantage: ANT shear of QF
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Patella Structure Medial facet Lateral facet Odd facet (30%)
ML
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PF Articular Surfaces Largest sesamoid bone Least congruent joint Articular cartilage Vertical ridge Facets
ML
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PF Articular Surfaces Largest sesamoid bone Least congruent joint Articular cartilage Vertical ridge Facets Angle of femoral sulcus
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Patellar Motion INF & SUP Sliding Patellar tilt
11 MT as KN FL
MedLat
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Patellar Motion Lateral rotation
ACC MR of femur 6 through KN FL
Medial rotation ACC LR of femur
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Patellalectomy ↓ MA of QF (↓ strength 49%) Q tendon friction compressive stress on groove by Q tendon Most evident in closed chain EXT
ECC QF in CC Coupled w/ & assisted by hip & ankle movement QF not needed in erect posture of CC
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Little effect overall
Extension
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Noticeable weakness
Slight Flexion
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Noticeable weakness
Extreme Flexion
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From 0° to 60° of Knee Flexion
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0-60 Contact area MA of QF; 60 ANT shear of QF
0-60 Facet contact at 20
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From 60° to 140° of Knee Flexion
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60-140 contact area MA of QF No leverage in full FL
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Overall Medial facet most contact Odd facet least contact
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During Full Extension
Full EXT MA of QF QF length Patella very unstable
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PF JRF Amount of knee FL Strength of QF contraction
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PF Compressive ForcesDescending stairs 4000 NMax isometric extension 6100 NKicking 6800 NParallel squat 14,900 N (7-8X BW)Isokinetic knee extension 8300 NRising from chair 3800 NRunning/jogging 5000 N (3-4X BW)Ascending stairs 1400 NWalking 840-850 N (0.5-1.5X BW)Cycling 880 N
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Compensatory Mechanisms for Compressive Force Distribution Contact area with knee flexion Medial facet contact from 30-70
Thickest hyaline cartilage in body
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Compensatory Mechanisms for Compressive Force Distribution Contact area with knee flexion Medial facet contact from 30-70
Thickest hyaline cartilage in body Largest QF MA 30-70
QF torque as MA decreases QF tendon contacts condyles 70-90
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Normal Patella Tracking
Maintains maximum congruence
Passive restraints Active restraints
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Abnormal Patella Tracking ↓ congruence Stretches capsule & retinacula ↓ contact area
Lateral Medial
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Causes of Abnormal Tracking Skeletal abnormalities Strength imbalance in QF Strength imbalance in fibrous tissues Compensatory movements in knee due to
abnormal foot movement
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Causes of Abnormal Tracking Skeletal abnormalities Strength imbalance in QF Strength imbalance in fibrous tissues Compensatory movements in knee due to
abnormal foot movement
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Skeletal Abnormalities: Q-angle
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Skeletal Abnormalities: Genu Varum & Genu Valgum
Q angle w/ age Varum common in
very young children Valgum seen in
growing children Menisectomy effects
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Skeletal Abnormalities: Patella Alta & Patella Baja
Index of Insall & Salviti LT/LP Normal = 1.0 Patella alta = 0.8 Patella baja = 1.2 Women ratio
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Skeletal Abnormalities: Patella Surface Lateral Border
Appositional forces ↓ in full extension
Prominence of lateral border prevents lateral displacement
Underdevelopment common in children as growing
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Skeletal Abnormalities: Femoral & Tibial Torsion
Lateral tracking
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Causes of Abnormal Tracking Skeletal abnormalities Strength imbalance in QF Strength imbalance in fibrous tissues Compensatory movements in knee due to
abnormal foot movement
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QF Strength Imbalance
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Causes of Abnormal Tracking Skeletal abnormalities Strength imbalance in QF Strength imbalance in fibrous tissues Compensatory movements in knee due to
abnormal foot movement
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Fibrous Tissue Strength Imbalance
IT
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Causes of Abnormal Tracking Skeletal abnormalities Strength imbalance in QF Strength imbalance in fibrous tissues Compensatory movements in knee due to
abnormal foot movement
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Compensatory Movement
Pronation of foot accompanied by medial rotation of tibia medial rotation & medial translation of patella
Pronation coupled w/ forceful quadriceps femoris leads to anterior tilt
EX: jumping, landing, running
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Summary