![Page 1: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/1.jpg)
What is the most complex joint in the body?
![Page 2: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/2.jpg)
What is the most complex joint in the body?
The KNEE joint
![Page 3: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/3.jpg)
Knee joint!
It takes a pounding as a hinge joint between two substantial bones…
One of the most common operations performed in the U.S. – ???
![Page 4: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/4.jpg)
Knee joint!
One of the most common operations performed in the U.S. – knee arthroplasty (TKR)
Total Knee Replacement
![Page 5: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/5.jpg)
Total Knee Replacementhttps://youtu.be/tKji04oFGdU
(animation )
Surgery:
https://youtu.be/Nmb5-e3cwBw
![Page 6: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/6.jpg)
![Page 7: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/7.jpg)
THE KNEE
![Page 8: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/8.jpg)
The knee
-Largest joint in the body.-Hinge joint-greatest ROM is in flexion-highly susceptible to injury-not protected by layers of fat and muscle-easily palpable
![Page 9: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/9.jpg)
The knee (anterior)
![Page 10: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/10.jpg)
The knee (posterior)
![Page 11: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/11.jpg)
![Page 12: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/12.jpg)
![Page 13: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/13.jpg)
Meniscus and ligaments and anatomy
http://youtu.be/_q-Jxj5sT0g?t=5m29s
![Page 14: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/14.jpg)
![Page 15: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/15.jpg)
![Page 16: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/16.jpg)
Knee Meniscus
http://youtu.be/hwnFgm6jiKY
http://youtu.be/OuiIXMgTlyI
![Page 17: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/17.jpg)
Knee ACL repair
http://youtu.be/rRVAjHJxmX8
http://youtu.be/q96M0jRqn7k
![Page 18: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/18.jpg)
bursas
![Page 19: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/19.jpg)
Goniometer
![Page 20: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/20.jpg)
![Page 21: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/21.jpg)
![Page 22: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/22.jpg)
Knee Flexion
Testing Position: Prone with hip and knee in neutral
Stabilization: Trunk and pelvis stabilized by body weight and position
Goniometer Axis: Lateral epicondyle of the femur
Proximal Arm: Parallel to the long axis of the femur & pointing at the greater trochanter
Distal Arm: Parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement: The hip and knee are flexed as the heel moves toward the buttock
Expected ROM: 135°
*Alternate Position: Supine lying with the femur stabilized.
![Page 23: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/23.jpg)
![Page 24: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/24.jpg)
Alternate position
![Page 25: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/25.jpg)
Alternate position
![Page 26: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/26.jpg)
![Page 27: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/27.jpg)
Knee Extension
Testing Position: Prone with hips and knees in neutral rotation; upper leg on bolster
Stabilization: Trunk and pelvis stabilized by body weight and position
Goniometer Axis: Lateral Epicondyle of the femur
Proximal Arm: Parallel to the long axis of the femur & pointing at the greater trochanter
Distal Arm: Parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement: Knee extension
Expected ROM: 0°. Hyperextension may be present up to -10°
*Alternate Position: Supine with bolster under ankle
![Page 28: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/28.jpg)
![Page 29: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/29.jpg)
Alternate position- supine for knee extension
![Page 30: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/30.jpg)
![Page 31: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/31.jpg)
Goniometry Lab
- Disadvantages:
![Page 32: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/32.jpg)
Goniometry Lab
- Disadvantages: - It is sometimes difficult to position and
maintain the arms of the goniometer along the bones of the segments throughout the measurement
- Intertester reliability- Coordination
![Page 33: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/33.jpg)
Differences between R/L side measurements
![Page 34: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/34.jpg)
Prone vs. Supine knee flexionSupine Prone
![Page 35: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/35.jpg)
Common injuries to knee
![Page 36: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/36.jpg)
![Page 37: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/37.jpg)
Common injuries to knee
-Patellar dislocation
- ACL tear
-PCL tear
- Collateral ligament tears
-Meniscal tears
-Tendon tears
![Page 39: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/39.jpg)
ACL tear Changing direction rapidly or landing from a jump
incorrectly can tear the ACL. About half of all injuries to the ACL occur along with damage to other structures in the knee (articular cartilage, meniscus or other ligaments)
![Page 40: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/40.jpg)
PCL tearPCL is generally injured from a blow to the front of the knee while the knee is bent. This often occurs in motor vehicle crashes and sports-related contact. PCL tears tend to be partial tears with the potential to heal on their own.
![Page 41: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/41.jpg)
Collateral Ligament tears- lateralInjuries to the collateral ligaments are usually caused by a force that pushes the knee sideways. Injuries to the MCL are usually caused by a direct blow to the outside of the knee, and are often sports-related. Blows to the inside of the knee that push the knee outwards may injure the LCL. (LCL tears occur less frequently than other knee injuries.)
![Page 42: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/42.jpg)
Lateral collateral ligament
![Page 43: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/43.jpg)
Collateral Ligament tears- medial
![Page 44: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/44.jpg)
Meniscal Tears
Sudden meniscal tears often happen during sports. ◦ Tears in the meniscus can occur when twisting, cutting, pivoting, or being tackled.
Meniscal tears may also occur as a result of arthritis or aging. ◦ Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have
weakened with age.
![Page 45: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/45.jpg)
![Page 46: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/46.jpg)
Meniscal Tears
![Page 47: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/47.jpg)
Tendon tears The quadriceps and patellar tendons can be stretched and torn. Although anyone can injure these tendons, tears are more common among middle-aged people who play running or jumping sports. Falls, direct force to the front of the knee, and landing awkwardly from a jump are common causes of knee tendon injuries.
![Page 48: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/48.jpg)
Patellar tendon tear
![Page 49: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/49.jpg)
Quadriceps tendon tear
![Page 50: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/50.jpg)
Patellar tendonitis
![Page 51: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/51.jpg)
Manual Muscle TestingManual Muscle Testing Grading System
Grading Scale Range: 0 to 5
0 None No visible or palpable contraction
1 Trace Visible or palpable contraction with no motion
2 Poor Full ROM gravity eliminated
3 Fair Full ROM against gravity
4 Good Full ROM against gravity, moderate resistance
5 Normal Full ROM against gravity, maximal resistance
![Page 52: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/52.jpg)
Manual Muscle testing -Knee
◦ -quadriceps◦ - hamstrings
![Page 53: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/53.jpg)
MMT- quads and hamstrings http://youtu.be/ZkjP9Mw_1gk
1) Have patient go through full ROM first.
2) Then, have patient repeat full ROM while you offer resistance.
3) At the end of the motion, perform a brake test.
4) Record your results (do flexion and extension on both sides).
![Page 54: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/54.jpg)
MMT- knee -Record your results for both the left and right LE.
![Page 55: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/55.jpg)
Bony Landmarks of Knee
- Patella- Tibial tuberosity- Femoral condyles- Tibial condyles
![Page 56: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/56.jpg)
Stability Tests -Ligaments
-Meniscus
-Miscellaneous
![Page 57: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/57.jpg)
Flexibility Tests -SLR (80-90 degrees is a desirable score)
-Thomas Test
http://youtu.be/4mnjUi-41fI
![Page 58: What is the most complex joint in the body?. The KNEE joint](https://reader036.vdocument.in/reader036/viewer/2022062309/5697bfc51a28abf838ca6dbf/html5/thumbnails/58.jpg)
- Review medical abbreviations for quiz