Chapter 16 The Knee and Related Structures

CHAPTER 16
The Knee and Related Structures
OVERVIEW

The knee is one of the most complex joints in the human body. It is also one of
the most traumatized joints because many sports place extreme stress on it.
Individuals working with athletes are usually the first to observe the injury;
therefore, they are usually the ones who perform the initial evaluation and provide
immediate care. The earlier the evaluation, the easier it will be to determine the
extent of the injury because subsequent swelling will often mask the full extent of
the injury.
Any evaluation of the knee should include inspection and evaluation of the
patella. Because of the patellas position, function, and its relationship to
surrounding structures, it is exposed to a variety of traumas and diseases related to
sports activities that may cause pain and discomfort for the athlete. All structures
must be thoroughly evaluated in both acute and chronic conditions to rule out more
serious pathological conditions.

LEARNING OBJECTIVES
After studying Chapter 16, the student will be able to:
Identify the bony structures of the knee joint.
Identify the ligamentous structures of the knee joint.
Identify the muscles related to the knee and discuss their functions.
Explain how to prevent knee injuries.
Briefly describe how to assess an injury of the knee joint.
Describe the mechanisms of injury affecting the ligamentous structures of the
knee.
Identify injuries to the knee that can occur either from acute trauma or from
overuse.
Identify injuries that can occur to the patella.
Describe injuries that can occur to the extensor mechanism.

KEY TERMINOLOGY

Apleys Compression Test Used to test the integrity of the lateral and medial
meniscus
Avascular - Devoid of blood circulation
Chondromalacia - Degeneration of the articular cartilage on the posterior aspect
of the patella caused by friction over the femoral condyles.
Hemarthrosis - Blood in a joint cavity
Iliotibial band friction syndrome - Inflammation of the iliotibial band resulting
from varus stresses on the knee; commonly occurs in cyclists and runners
Joint capsule - Soft tissue structures divided into four regions; lined on the
interior by a synovial membrane and externally by various ligamentous and
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Chapter 16 The Knee and Related Structures

muscular structures to help stabilize the joint

Joint mice - Chips of cartilage loose within the joint that cause clicking or locking
of the knee
Jumper's knee - Patellar or quadriceps tendinitis
Lachmans Test Used to test the integrity of the anterior cruciate ligament

Menisci - Two oval-shaped, semilunar fibrocartilages that deepen the facets of

the tibia and provide cushion for stresses on the joint
Osgood-Schlatter's disease A disease that occurs usually in adolescent boys in
which stress on the distal attachment of the quadriceps mechanism causes
repeated avulsion; consequently more bone cells are laid down, forming a
calcification over the attachment of the tendon on the tibial tuberosity
Valgus stress test - Used to test the integrity of the medial collateral ligament
Varus stress test - Used to test the integrity of the lateral collateral ligament

DISCUSSION QUESTIONS
1. What are the various structures that give the knee stability? What are their
functions?
2. What motions occur at the knee? What muscles provide these movements?
3. During flexion and extension what changes occur to the capsular ligaments and
cruciate ligaments?
4. In evaluating a knee injury, what questions should be asked of the athlete to
obtain a history?
5. What visual observations can be made to determine the extent of an injury?
What deviations may have predisposed the athlete to these injuries?
6. What bony and soft tissue structures can be palpated at the knee?
7. What tests can be done for knee ligament stability? How are they performed
correctly?
8. What criteria would be used to determine when the athlete is ready to return to
sports participation?
9. What are some acute injuries to the knee and how are they caused? How should
these injuries be managed? What taping methods or braces could be used to
help stabilize the structures that have been damaged?
10.What are some acute injuries to the patella and their causes?
11.What are some degenerative conditions of the patella and knee that cause pain
for the young athlete?
CLASS ACTIVITIES
1. Invite a local orthopedist to speak on how he/she evaluates and treats knee
injuries, in addition to the new diagnostic tools use to treat the internal
derangements without having to perform extensive surgery. The orthopedist may
have slides or films to demonstrate the use of arthrograms and arthroscopy.
He/She may have information about new techniques used to speed the recovery
of the athlete.
2. Arrangements may be made with the team orthopedist to have students observe
surgeries on the knee or to watch videotapes of surgeries.
3. After proper instruction, the students should pair up and practice palpations at
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Chapter 16 The Knee and Related Structures

4.
5.

6.
7.

the knee and should practice the stress tests used in evaluating the knee and
patella.
Present conditions to the class whereby the signs and symptoms of a particular
condition are given and the students must identify the probable injuries or
conditions that have occurred.
Have students, in groups of four or five, study one serious knee/patella injury per
group (meniscus injury, anterior cruciate rupture, patellar dislocation, etc.). Each
group prepares a three- to five-page report including the following information:
a. Injury sustained
b. Possible mechanisms that would cause that injury
c. Immediate management
d. Stress tests that could be used to verify the extent of injury
e. Possible surgical repair or reconstruction that may be needed
f. Exercises that could be performed before and after surgery
g. General goals for a total rehabilitation program
h. Contraindicated exercises during the rehabilitation program
Have each student prepare a report on the relationship of gender to increased
knee and patellofemoral problems.
Have each student prepare a one or two-page report on the causes of
patellofemoral pain or chondromalacia.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.
5.
6.

h
a
e
d
b
c

7.
8.
9.
10.
11.
12.

j
f
i
g
l
k

13.
14.
15.
16.
17.
18.

d
c
e
f
a
b

Short Answer
19.Flexion and extension
20.The prepatellar bursa and the deep infrapatellar bursa
21.Immobilize the knee in the position it is found in (do not try to straighten the
knee), ice should be applied around the joint, transport the athlete to MD.
22.Pain on the anterior aspect of the knee while walking, running, going up and
down stairs, or squatting. There may be recurrent swelling around the kneecap
and a grating sensation when flexing and extending the knee.
23.The meniscus on the periphery because of the blood supply that is present there
Listing
24.Medial collateral ligament
25.Lateral collateral ligament
26.Anterior cruciate ligament
27.Meniscal injuries
28.Biceps femoris
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Chapter 16 The Knee and Related Structures

29.Semimembranosus
30.Semitendinosus
31.Rectus femoris
32.Vastus medialis
33.Vastus intermedius
34.Vastus lateralis
35.Knee is hyperflexed from falling with full weight on the anterior aspect of the
bent knee with the foot in plantarflexion or from a posteriorly directed force to
the front of the bent knee
36.Medially directed valgus force from the lateral side or from external rotation of
the tibia
37.Laterally directed varus force from the medial side or from internal rotation of
the tibia
38.Most likely occurs with deceleration, rotation, and a valgus stress to the knee.
39.Weight bearing combined with a rotational force while extending or flexing the
knee
Essay
40-44.To avoid knee injuries, the athlete must be as highly conditioned as possible,
meaning total body conditioning that includes strength, flexibility,
cardiovascular and muscle endurance, agility, speed, and balance. The
muscles surrounding the knee joint must be as strong as possible. Wear
cleats that have a large number or cleats that are short and broad. Also an
athlete may wear a functional/prophylactic knee brace.

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Chapter 16 The Knee and Related Structures

NAME ______________________________
SECTION__________

CHAPTER 16 WORKSHEET
The Knee and Related Structures
MATCHING: Match the structure with the appropriate name.
_____ 1. Anterior cruciate
ligament
_____ 2. Femur
_____ 3. Fibula
_____ 4. Lateral collateral
ligament
_____ 5. Lateral femoral
condyle
_____ 6. Lateral meniscus
_____ 7. Medial collateral
ligament
_____ 8. Medial femoral condyle
_____ 9. Medial meniscus
_____ 10. Posterior cruciate
ligament
_____ 11. Tibia
_____ 12. Tibial tuberosity
MATCHING: Match the condition with the correct response.
_______
_______
_______
_______
sprain
_______
_______
sprain

13.
14.
15.
16.

Patellar tendinitis
Chondromalacia
Iliotibial band syndrome
Medial collateral ligament

17. Osgood-Schlatter disease

18. Lateral collateral ligament

a. Apophysitis of the tibial tubercle

b. Injured from a direct varus force
c. May be due to abnormal patellar
tracking
d. Also known as jumpers knee
e. Also known as runners knee
f. Injured from a direct valgus force

SHORT ANSWER: Answer the following questions with a brief response.

19.The two principle movements of the knee are _____________ and ________________.
20.The two bursae of the knee that have the highest incidence of irritation in sports
are the _____________ and the _____________.
21.What is the treatment for a dislocated patella?
22.What are the signs and symptoms for chondromalacia patella?
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Chapter 16 The Knee and Related Structures

23.In meniscal tears, what area has the greatest chance of healing and why?

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Chapter 16 The Knee and Related Structures

LISTING: For the following special tests, indicate what structures are tested.
24.Valgus stress test:
25.Varus stress test:
26.Lachmans Test:
27.Apleys compression test:
List the three primary muscles that flex the knee.
28.
29.
30.
List the four primary muscles that extend the knee.
31.
32.
33.
34.
List the mechanisms of injury for the following structures.
35.Posterior cruciate ligament:
36.Medial collateral ligament:
37.Lateral collateral ligament:
38.Anterior cruciate ligament:
39.Meniscus injuries:
ESSAY:
40-44.What are the steps that can be taken to prevent knee injuries?

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.