Class of October 2010
Non-exhaustive notes, just a reminder of a few interesting topics

Knee Joint = Patello-Femoral Joint + Tibio-Femoral Joint + Proximal Tibio-Fibular Joint

Specific questions for Knee joint

1. Pain when ascending or descending stairs ?

Pressure lower on Patello-Femoral Joint when ascending stairs
Because of greater activation of hamstrings and subconsequent reduced action of quadriceps
In closed chain, hamstrings act as knee extensors
On the contrary descending stairs puts the highest stress (pressure) on Patello-Femoral Joint

> Retro patellar pain when descending: Patello-Femoral Joint
> Pain only when ascending stairs: will orientate PT more toward Tibio-Femoral Joint

2. Does the knee lock?

Positive answer is a strong indication for Meniscus tear

3. Age of patient

+50: primary arthrosis
-50: secondary arthrosis caused by: Traumatic event (meniscus lesion, ligament rupture...), weight, Excessive valgum/varum,...

Patellar position

Height: apex of patella at level of joint line
Orientation: no rotation, patellar vertical axis must be in line with tibial tuberosity

Patellar subluxation

Almost always lateral
Often connected with Vastus Medialis weakness (not necessarily cause of luxation)
Often connected with non-congruence of femur trochlea and retro patellar surface
Can be solved by operation: medial shift of tibial tuberosity

Tibio-Fibular Joints

1. Proximal: joint play = lateral + ventral <> medial + dorsal
2. Distal: joint play = ventral <> dorsal

Ankle sprain: lateral ligament (inverted position)
> first fibula pulled downward
> then fibula pulled upward and POSTERIORLY by Biceps Femoris

After ankle sprain: it might be necessary to replace fibula on both tibio-fibular joints
> anteriorly (laterally) for proximal (because displaced posteriorly)
> posteriorly for distal (because displaced anteriorly)

Joint play movements

> Patella - Femur

First lift patella with fingers
1. cranial - caudal: hand and forearm in line with femur or tibia (avoid pressure on patella)
Use thenar or hypothenar. In practice patella always to high (cranial glide not really important)
2. lateral - medial: generally, more movement medially

> Tibia - Femur

Both arms must be as close to the joint line as possible

1. Posterior glide of tibia

Small cushion under femur (LPP).
Fixation: femur with one hand (pressure can be applied on patella)
Moving part: tibia grabbed with other hand (index to thumb) equally distributed over tibial tuberosity
> Press downward (move knee to flexion)

2. Posterior glide of femur on tibia (= anterior movement of tibia)

Small cushion under tibia (LPP).
Fixation: tibia with one hand
Moving part: femur grabbed with other hand under patella (no pressure applied on patella)
> Press downward (move knee to extension)