© 2009 McGraw-Hill Higher Education. All rights reserved. Chapter 20: The Knee and Related Structures.

© 2009 McGraw-Hill Higher Education. All rights reserved.

Chapter 20: The Knee and Related Structures


• Complex joint that endures great amounts of trauma due to extreme amounts of stress that are regularly applied

• Hinge joint w/ a rotational component• Stability is due primarily to ligaments,

joint capsule and muscles surrounding the joint

• Designed for stability w/ weight bearing and mobility in locomotion


Figure 20-1


Figure 20-2A


Figure 20-2B


Figure 20-3 A-B


Figure 20-3 C


Figure 20-4


Figure 20-5 A & B


Figure 20-5C


Figure 20-6


Figure 20-7


Functional Anatomy• Movement of the knee requires flexion,

extension, rotation and the arthrokinematic motions of rolling and gliding

• Rotational component involves the “screw home mechanism”– As the knee extends it externally rotates because

the medial femoral condyle is larger than the lateral

– Provides increased stability to the knee– Popliteus “unlocks” knee allowing knee to flex


• Capsular ligaments are taut during full extension and relaxed w/ flexion– Allows rotation to occur– Deeper capsular ligaments remain taut to keep

rotation in check• PCL prevents excessive internal rotation, limits

anterior translation and posterior translation when tibia is fixed and non-weight bearing, respectively

• ACL stops excessive internal rotation, stabilizes the knee in full extension and prevents hyperextension


• Range of motion includes 140 degrees of motion– Limited by shortened position of hamstrings, bulk

of hamstrings and extensibility of quads• Patella aids knee during extension, providing a

mechanical advantage– Distributes compressive stress on the femur by

increasing contact between patellar tendon and femur

– Protects patellar tendon against friction– When moving from extension to flexion the patella

glides laterally and further into trochlear groove


• Kinetic Chain– Directly affected by motions and forces

occurring at the foot, ankle, lower leg, thigh, hip, pelvis, and spine

– With the kinetic chain forces must be absorbed and distributed

– If body is unable to manage forces, breakdown to the system occurs

– Knee is very susceptible to injury resulting from absorption of forces


Assessing the Knee Joint• Determining the mechanism of injury is

critical• History- Current Injury

– Past history– Mechanism- what position was your body in?– Did the knee collapse?– Did you hear or feel anything?– Could you move your knee immediately after

injury or was it locked?– Did swelling occur?– Where was the pain


• History - Recurrent or Chronic Injury– What is your major complaint?– When did you first notice the condition?– Is there recurrent swelling?– Does the knee lock or catch?– Is there severe pain?– Grinding or grating?– Does it ever feel like giving way?– What does it feel like when ascending and

descending stairs?– What past treatment have you undergone?


• Observation– Walking, half squatting, going up and down

stairs– Swelling, ecchymosis,– Leg alignment

• Genu valgum and genu varum• Hyperextension and hyperflexion• Patella alta and baja• Patella rotated inward or outward

– May cause a combination of problems

• Tibial torsion, femoral anteversion and retroversion


Figure 20-10 A & B; 20-11 A & B


Figure 20-12 A & B; 20-13 A & B


• Tibial torsion– An angle that measures

less than 15 degrees is an indication of tibial torsion

• Femoral Anteversion and Retroversion– Total rotation of the hip

equals ~100 degrees– If the hip rotates >70

degrees internally, anteversion of the hip may exist

Figure 20-9


Figure 20-14


– Knee Symmetry or Asymmetry• Do the knees look symmetrical? Is there

obvious swelling? Atrophy?

– Leg Length Discrepancy• Anatomical or functional• Anatomical differences can potentially

cause problems in all weight bearing joints• Functional differences can be caused by

pelvic rotations or mal-alignment of the spine


•Palpation - Bony

• Medial tibial plateau• Medial femoral

condyle• Adductor tubercle• Gerdy’s tubercle• Lateral tibial plateau• Lateral femoral

condyle• Lateral epicondyle• Medial epicondyle

• Head of fibula• Tibial tuberosity• Patella• Superior and inferior

patella borders (base and apex)

• Around the periphery of the knee relaxed, in full flexion and extension


•Palpation - Soft Tissue• Vastus medialis• Vastus lateralis• Rectus femoris• Quadriceps and

patellar tendon• Sartorius• Medial patellar plica• Anterior joint capsule• Iliotibial Band• Arcuate complex

• Medial and lateral collateral ligaments

• Pes anserine• Medial/lateral joint

capsule• Semitendinosus• Semimembranosus• Gastrocnemius• Popliteus• Biceps Femoris


• Palpation of Swelling– Intra vs. extracapsular swelling– Intracapsular may be referred to as joint effusion– Swelling w/in the joint that is caused by synovial

fluid and blood is a hemarthrosis– Sweep maneuver– Ballotable patella - sign of joint effusion– Extracapsular swelling tends to localize over the

injured structure •May ultimately migrate down to foot and ankle


• Special Tests for Knee Instability– Use endpoint feel to determine stability– MRI may also be necessary for assessment– Classification of Joint Instability

• Knee laxity includes both straight and rotary instability

• Translation (tibial translation) refers to the glide of tibial plateau relative to the femoral condyles

• As the damage to stabilization structures increases, laxity and translation also increase


– Collateral Ligament Stress Tests (Valgus and Varus)• Used to assess the

integrity of the MCL and LCL respectively

• Testing at 0 degrees incorporates capsular testing while testing at 30 degrees of flexion isolates the ligaments


– Anterior Cruciate Ligament Tests• Drawer test at 90 degrees of flexion

– Tibia sliding forward from under the femur is considered a positive sign (ACL)

– Should be performed w/ knee internally and externally to test integrity of joint capsule

Figure 20-18 A-C


• Lachman Drawer Test– Will not force knee

into painful flexion immediately after injury

– Reduces hamstring involvement

– At 30 degrees of flexion an attempt is made to translate the tibia anteriorly on the femur

– A positive test indicates damage to the ACL

Figure 20-19 A


• A series of variations are also available for the Lachman Drawer Test– May be necessary if athlete is large or

examiner’s hands are small– Variations include

• Rolled towel under the femur• Leg off the table approach with athlete supine• Athlete prone on table with knee and lower leg

just off table


• Pivot Shift Test– Used to determine

anterolateral rotary instability

– Position starts w/ knee extended and leg internally rotated

– The thigh and knee are then flexed w/ a valgus stress applied to the knee

– Reduction of the tibial plateau (producing a clunk) is a positive sign


– Jerk Test• Reverses direction of the pivot shift• Moves from position of flexion to extension• W/out an ACL the tibia will sublux at 20 degrees of

flexion

– Flexion-Rotation Drawer Test• Knee is taken from a position of 15 degrees of flexion

(tibia is subluxed anteriorly w/ femur externally rotated)

• Knee is moved into 30 degrees of flexion where tibia rotates posteriorly and femur internally rotates


• Posterior Cruciate Ligament Tests– Posterior Drawer Test

• Knee is flexed at 90 degrees and a posterior force is applied to determine translation posteriorly

• Positive sign indicates a PCL deficient knee

– External Rotation Recurvatum Test• With the athlete supine, the leg is lifted by the

great toe• If the tibia externally rotates and slides posteriorly

there may be a PCL injury and damage to the posterolateral corner of the capsule


• Posterior Sag Test (Godfrey’s test)– Athlete is supine

w/ both knees flexed to 90 degrees

– Lateral observation is required to determine extent of posterior sag while comparing bilaterally

Figure 20-25


•Instrument Assessment of the Cruciate Ligaments

• A number of devices are available to quantify AP displacement of the knee

• KT-2000 arthrometer, Stryker knee laxity tester and Genucom can be used to assess the knee

• Test can be taken pre & post-operatively and throughout rehabilitation

Figure 20-26


• Meniscal Tests– McMurray’s Meniscal Test

• Used to determine displaceable meniscal tear

• Leg is moved into flexion and extension while knee is internally and externally rotated in conjunction w/ valgus and varus stressing

• A positive test is found when clicking and popping are felt


Figure 20-27 A-D


• Apley’s Compression Test– Hard downward pressure

is applied w/ rotation– Pain indicates a meniscal

injury

• Apley’s Distraction Test– Traction is applied w/

rotation– Pain will occur if there is

damage to the capsule or ligaments

– No pain will occur if it is meniscal

Figure 20-28


• Girth Measurements– Changes in girth can occur due to

atrophy, swelling and conditioning– Must use circumferential measures to

determine deficits and gains during the rehabilitation process

– Measurements should be taken at the joint line, the level of the tibial tubercle, belly of the gastrocnemius, 2 cm above the superior border of the patella, and 8-10 cm above the joint line

• Subjective Rating– Used to determine patient’s perception

of pain, stability and functional performance


Patellar Examination

• Palpation of the Patella– Must palpate around and under patella to determine

points of pain

• Patella Grinding, Compression and Apprehension Tests– A series of glides and compressions are performed w/

the patella to determine integrity of patellar cartilage


• Q-Angle– Lines which bisect the patella relative to the ASIS and the

tibial tubercle– Normal angle is 10 degrees for males and 15 degrees for

females– Elevated angles often lead to pathological conditions

associated w/ improper patella tracking

• The A - Angle– Patellar orientation to the tibial tubercle– Quantitative measure of the patellar realignment after

rehabilitation– An angle greater than 35 degrees is often correlated w/

patellofemoral pathomechanics


• Functional Examination– Must assess walking, running, turning and

cutting

– Co-contraction test, vertical jump, single leg hop tests and the duck walk

– Resistive strength testing

– Tests should be performed at speed w/out limping or favoring injured limb

– Use baseline for comparison if available


Prevention of Knee Injuries• Physical Conditioning and Rehabilitation

– Total body conditioning is required•Strength, flexibility, cardiovascular and

muscular endurance, agility, speed and balance

– Muscles around joint must be conditioned (flexibility and strength) to maximize stability

– Must avoid abnormal muscle action through flexibility

– In an effort to prevent injury, extensibility of hamstrings, erector spinae, groin, quadriceps and gastrocnemius is important


• ACL Prevention Programs– Focus on strength, neuromuscular control, balance– Series of different programs which address balance

board training, landing strategies, plyometric training, and single leg performance

– Can be implemented in rehabilitation and preventative training programs

• Shoe Type– Change in football footwear has drastically reduced

the incidence of knee injuries– Shoes w/ more short cleats does not allow foot to

become fixed - still allows for control w/ running and cutting


• Functional and Prophylactic Knee Braces– Used to prevent and

reduce severity of knee injuries

– Used to protect MCL, or prevent further damage to grade 1 & 2 sprains of the ACL or to protect the ACL following surgery

– Can be custom molded and designed to control rotational forces


Recognition and Management of Specific

Injuries• Medial Collateral Ligament Sprain

– Etiology• Result of severe blow from lateral side (valgus

force)– Signs and Symptoms - Grade I

• Little fiber tearing or stretching• Stable valgus test• Little or no joint effusion• Some joint stiffness and point tenderness on

lateral aspect• Relatively normal ROM

.


– Management• RICE for at least 24

hours• Crutches if necessary• Follow-up care will

include cryokinetics w/ exercise

• Move from isometrics and STLR exercises to bicycle riding and isokinetics

• Return to play when all areas have returned to normal

• May require 3 weeks to recover Figure 20-38


– Signs and Symptoms (Grade II)• Complete tear of deep capsular ligament and partial tear of

superficial layer of MCL• No gross instability; laxity at 5-15 degrees of flexion• Slight swelling• Moderate to severe joint tightness w/ decreased ROM• Pain along medial aspect of knee

– Management• RICE for 48-72 hours; crutch use until acute phase has resolved• Possibly a brace or casting prior to the initiation of ROM activities• Modalities 2-3 times daily for pain• Gradual progression from isometrics (quad exercises) to CKC

exercises; functional progression activities


– Signs and Symptoms (Grade III)• Complete tear of supporting ligaments• Complete loss of medial stability• Minimum to moderate swelling• Immediate pain followed by ache• Loss of motion due to effusion and hamstring

guarding• Positive valgus stress test

– Management• RICE• Conservative non-operative versus

surgical approach

– Limited immobilization (w/ a brace); progressive weight bearing and increased ROM over 4-6 week period• Rehab would be similar to Grade I & II

injuries


• Lateral Collateral Ligament Sprain– Etiology

• Result of a varus force, generally w/ the tibia internally rotated

• If severe enough damage can also occur to the cruciate ligaments, ITB, and meniscus, producing bony fragments as well

– Signs and Symptoms• Pain and tenderness over LCL• Swelling and effusion around the LCL• Joint laxity w/ varus testing• May cause irritation of the peroneal nerve

– Management• Follows management of MCL injuries depending on severity


• Anterior Cruciate Ligament Sprain– Etiology

• MOI - tibia externally rotated and valgus force at the knee (occasionally the result of hyperextension from direct blow)

• May be linked to inability to decelerate valgus and rotational stresses - landing strategies

• Male versus female• Research is quite extensive in regards to impact of femoral

notch, ACL size and laxity, malalignments (Q-angle) & faulty biomechanics

• Extrinsic factors may include, conditioning, skill acquisition, playing style, equipment, preparation time

• May also involve damage to other structures including meniscus, capsule, and MCL


– Signs and Symptoms• Experience pop w/ severe pain and disability• Positive anterior drawer and Lachman’s • Rapid swelling at the joint line• Other ACL tests may also be positive

– Management• RICE; use of crutches• Arthroscopy may be necessary to determine extent of injury• Could lead to major instability in incidence of high performance• W/out surgery joint degeneration may result• Age and activity may factor into surgical option• Surgery may involve joint reconstruction w/ grafts (tendon),

transplantation of external structures– Will require brief hospital stay and 3-5 weeks of a brace– Also requires 4-6 months of rehab


• Posterior Cruciate Ligament Sprain

– Etiology• Most at risk during 90 degrees of flexion• Fall on bent knee is most common

mechanism• Can also be damaged as a result of a

rotational force– Signs and Symptoms

• Feel a pop in the back of the knee• Tenderness and relatively little swelling

in the popliteal fossa• Laxity w/ posterior sag test


– Management• RICE• Non-operative rehab of grade I and II

injuries should focus on quad strength• Surgical versus non-operative

– Surgery will require 6 weeks of immobilization in extension w/ full weight bearing on crutches

– ROM after 6 weeks and PRE at 4 months


• Meniscal Lesions– Etiology

• Medial meniscus is more commonly injured due to ligamentous attachments and decreased mobility

– Also more prone to disruption through torsional and valgus forces

• Most common MOI is rotary force w/ knee flexed or extended

• Tears may be longitudinal, oblique or transverse


– Signs and Symptoms• Effusion developing over 48-72 hour

period• Joint line pain and loss of motion• Intermittent locking and giving way• Pain w/ squatting• Portions may become detached causing

locking, giving way or catching w/in the joint

• If chronic, recurrent swelling or muscle atrophy may occur


Figure 20-44


– Management• If the knee is not locked, but indications of a tear are

present further diagnostic testing may be required• If locking occurs, anesthesia may be necessary to

unlock the joint w/ possible arthroscopic surgery follow-up

• W/ surgery all efforts are made to preserve the meniscus -- with full healing being dependent on location

• Menisectomy rehab allows partial weight bearing and quick return to activity

• Repaired meniscus will require immobilization and a gradual return to activity over the course of 12 weeks


• Knee Plica– Etiology

• Irritation of the plica (generally, mediopatellar plica and often associated w/ chondromalacia)

– Signs and Symptoms• Possible history of knee pain/injury• Recurrent episodes of painful pseudo-locking• Possible snapping and popping• Pain w/ stairs and squatting• Little or no swelling, and no ligamentous laxity

– Management• Treat conservatively w/ RICE and NSAID’s if the result of

trauma• Recurrent conditions may require surgery


• Osteochondral Knee Fractures– Etiology

• Same MOI as collateral/cruciate ligaments or meniscal injuries

• Twisting, sudden cutting or direct blow• Fractures of cartilage and underlying bone varying

in size and depth

– Signs and Symptoms• Hear a snap and feeling of giving way• Immediate swelling and considerable pain• Diffuse, pain along joint line


– Management• Diagnosed through use of CT and MRI• Treatment dependent on stability of fracture• If stable the patient will be casted• If fragment is loose surgical reattachment will

occur or removal via arthroscopic• Microfracture procedures used to repair

defects in underlying bone– Generates small amounts of bleeding to

stimulate bone growth and healing• Rehabilitation is dependent on location of

fracture• ROM is typically initiated early after surgery

with active strengthening beginning after 6 weeks

• Return to activity at 3-6 months


• Osteochondritis Dissecans– Etiology

• Partial or complete separation of articular cartilage and subchondral bone

• Cause is unknown but may include blunt trauma, possible skeletal or endocrine abnormalities, prominent tibial spine impinging on medial femoral condyle, or impingement due to patellar facet


– Signs and Symptoms• Aching pain with recurrent swelling and

possible locking• Possible quadriceps atrophy and point

tenderness

– Management• Rest and immobilization for children• Surgery may be necessary in teenagers

and adults (drilling to stimulate healing, pinning or bone grafts)


• Joint Contusions– Etiology

• Blow to the muscles crossing the joint (vastus medialis)– Signs and Symptoms

• Present as knee sprain, severe pain, loss of movement and signs of acute inflammation

• Swelling, discoloration• Possible capsular damage

– Management• RICE initially and continue if swelling persists• Gradual progression to normal activity following return of

ROM and padding for protection• If swelling does not resolve w/in a week a chronic condition

(synovitis or bursitis) may exist requiring more rest


• Peroneal Nerve Contusion– Etiology

• Compression of peroneal nerve due to a direct blow

– Signs and Symptoms• Local pain and possible shooting nerve pain• Numbness and paresthesia in cutaneous

distribution of the nerve• Added pressure may exacerbate condition• Generally resolves quickly -- in the event it does

not resolve, it could result in drop foot

– Management

• RICE and return to play once symptoms resolve and no weakness is present

• Padding for fibular head is necessary for a few weeks


• Bursitis– Etiology

• Acute, chronic or recurrent swelling• Prepatellar = continued kneeling• Infrapatellar = overuse of patellar tendon

– Signs and Symptoms• Prepatellar bursitis may be localized swelling above knee that is

ballotable• Swelling in popliteal fossa may indicate a Baker’s cyst

– Associated w/ semimembranosus bursa or medial head of gastrocnemius– Commonly painless and causing little disability– May progress and should be treated accordingly

– Management• Eliminate cause, RICE and NSAID’s• Aspiration and steroid injection if chronic


Figure 20-47


• Patellar Fracture– Etiology

• Direct or indirect trauma (severe pull of tendon)• Semi-flexed position with forcible contraction

(falling, jumping or running)

– Signs and Symptoms• Hemorrhaging and joint effusion w/ generalized

swelling• Indirect fractures may cause capsular tearing,

separation of bone fragments and possible quadriceps tendon tearing

• Little bone separation w/ direct injury

– Management• X-ray necessary for confirmation of findings

• RICE and splinting if fracture suspected• Refer and immobilize for 2-3 months


• Acute Patella Subluxation or Dislocation– Etiology

• Deceleration w/ simultaneous cutting in opposite direction (valgus force at knee)

• Quad pulls the patella out of alignment• Some individuals may be predisposed to injury• Repetitive subluxation will impose stress to medial

restraints

– Signs and Symptoms• W/ subluxation, pain and swelling, restricted ROM,

palpable tenderness over adductor tubercle• Dislocations result in total loss of function


– Management• Reduction is performed by flexing hip, moving patella

medially and slowly extending the knee• Following reduction, immobilization for at least 4 weeks

w/ use of crutches and isometric exercises during this period

• After immobilization period, horseshoe pad w/ elastic wrap should be used to support patella

• Muscle rehab focusing on muscle around the knee, thigh and hip are key (STLR’s are optimal for the knee)

• Possible surgery to release tight structures• Improve postural and biomechanical factors


• Injury to the Infrapatellar Fat Pad– Etiology

• May become wedged between the tibia and patella• Irritated by chronic kneeling, pressure or trauma

– Signs and Symptoms• Capillary hemorrhaging and swelling• Chronic irritation may lead to scarring and

calcification• Pain below the patellar ligament (especially during

knee extension)• May display weakness, mild swelling and stiffness

during movement


• Injury to the Infrapatellar Fat Pad (continued)

– Management• Rest from irritating activities until inflammation

has subsided• Utilize therapeutic modalities for inflammation• Heel lift to prevent irritation during extension• Hyperextension taping to prevent full extension


• Chondromalacia patella– Etiology

• Softening and deterioration of the articular cartilage

• Undergoes three stages– Swelling and softening of cartilage– Fissure of softened cartilage– Deformation of cartilage surface

• Often associated with abnormal tracking• Abnormal patellar tracking may be due to genu

valgum, external tibial torsion, foot pronation, femoral anteversion, patella alta, shallow femoral groove, increased Q angle, laxity of quad tendon


Figure 20-51


– Signs and Symptoms• Pain w/ walking, running, stairs and squatting• Possible recurrent swelling, grating sensation w/ flexion

and extension• Pain at inferior border during palpation

– Management• Conservative measures

– RICE, NSAID’s, isometrics, orthotics to correct dysfunction

• Surgical possibilities– Altering muscle attachments– Shaping and smoothing of surfaces– Drilling– Elevating tibial tubercle


• Patellofemoral Stress Syndrome– Etiology

• Result of lateral deviation of patella while tracking in femoral groove

– Tight structures, pronation, increased Q angle, insufficient medial musculature

– Signs and Symptoms• Tenderness of lateral facet of patella and swelling

associated w/ irritation of synovium• Dull ache in center of knee• Patellar compression will elicit pain and crepitus• Apprehension when patella is forced laterally

– Management• Correct imbalances (strength and flexibility)• McConnell taping• Lateral retinacular release if conservative

measures fail


• Osgood-Schlatter Disease and Larsen-Johansson Disease– Etiology

• Osgood Schlatter’s is an apophysitis occurring at the tibial tubercle

– Begins cartilagenous and develops a bony callus, enlarging the tubercle– Resolves w/ aging– Common cause = repeated avulsion of patellar tendon

• Larsen Johansson is the result of excessive pulling on the inferior pole of the patella

– Signs and Symptoms• Both elicit swelling, hemorrhaging and gradual degeneration

of the apophysis due to impaired circulation



– Signs and Symptoms (continued)• Pain w/ kneeling, jumping and running• Point tenderness

– Management• Conservative

– Reduce stressful activity until union occurs (6-12 months)

– Possible casting, ice before and after activity– Isometrics for quadriceps and hamstrings


• Patellar Tendinitis (Jumper’s or Kicker’s Knee)– Etiology

• Jumping or kicking - placing tremendous stress and strain on patellar or quadriceps tendon

• Sudden or repetitive extension

– Signs and Symptoms• Pain and tenderness at inferior pole of patella

– 3 phases - 1)pain after activity, 2)pain during and after, 3)pain during and after (possibly prolonged) and may become constant

– Management• Ice, phonophoresis, iontophoresis, ultrasound, heat• Exercise• Patellar tendon bracing• Transverse friction massage


Figure 20-54 A&B


• Patellar Tendon Rupture– Etiology

• Sudden, powerful quad contraction• Generally does not occur unless a chronic inflammatory condition

persists resulting in tissue degeneration• Occur primarily at point of attachment

– Signs and Symptoms• Palpable defect, lack of knee extension• Considerable swelling and pain (initially)

– Management• Surgical repair is needed• Proper conservative care of jumper’s knee can minimize chances

of occurring• If steroids are being used, intense knee exercise should be

avoided due to weakening of collagen


• Iliotibial Band Friction Syndrome (Runner’s Knee or Cyclist’s Knee)– Etiology

• General expression for repetitive/overuse conditions attributed to mal-alignment and structural asymmetries

– Signs and Symptoms• IT Band Friction Syndrome

– Irritation at band’s insertion - commonly seen in individual that have genu varum or pronated feet

– Positive Ober’s test• Pes Anserine Tendinitis or Bursitis

– Result of excessive genu valgum and weak vastus medialis– Often occurs due to running w/ one leg higher than the other

(running on a slope or crowned road)


– Management• Correction of mal-alignments• Ice before and after activity• Utilize proper warm-up and stretching

techniques• Avoidance of aggravating activities• NSAID’s and orthotics


Knee Joint Rehabilitation• General Body Conditioning

– Must be maintained with non-weight bearing activities

• Weight Bearing– Initial crutch use, non-weight bearing– Gradual progression to weight bearing while

wearing rehabilitative brace

• Knee Joint Mobilization– Used to reduce arthrofibrosis– Patellar mobilization is key following surgery– CPM units


• Flexibility– Must be regained, maintained and improved

• Muscular Strength– Progression of isometrics, isotonic training, isokinetics

and plyometrics– Incorporate eccentric muscle action– Open versus closed kinetic chain exercises

• Neuromuscular Control– Loss of control is generally the result of pain and swelling– Through exercise and balance equipment proprioception

can be enhanced and regained


• Bracing– Variety of braces for a variety of

injuries and conditions– Typically worn for 3-6 weeks after

surgery• Used to limit ranges for a period of time

– Some are used to control for specific injuries while others are designed for specific forces, stability, and providing resistance

• Functional Progression– Gradual return to sports specific skills– Progress w/ weight bearing, move into

walking and running, and then onto sprinting and change of direction


• Return to Activity– Based on healing process - sufficient

time for healing must be allowed– Objective criteria should include

strength and ROM measures as well as functional performance tests

© 2009 McGraw-Hill Higher Education. All rights reserved. Chapter 20: The Knee and Related Structures.

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