KNEE INSTABILITY

IMPORTANT STRUCTURES

Cruciate ligaments
Collateral ligaments
Menisci
Articular cartilage
Patellar tendon
 CRUCIATE LIGAMENTS

Control anterior and

posterior movements
Fit inside the
intercondylar fossa
 COLLATERAL LIGAMENTS

Control lateral movement

Exposed to valgus (MCL) and varus (LCL) forces
 MENISCI

Weight distribution

Without menisci the weight of

the femur would be
concentrated to one point on
the tibia
 OTHER IMPORTANT STRUCTURES

Articular cartilage

Patella and patellar tendon

Patella acts like a fulcrum to
increase the force of the
quadriceps muscles
 LIGAMENTS

Knee is like a round ball on a

flat surface

Ligaments provide most of the

support to the knees
 ANTERIOR CRUCIATE LIGAMENT

Femoral : menempel pd dinding lateral pada intercondylar posterior

Tibial : menempel pd anterior tibial
Fungsi dari ligamen : fleksi dan ekstensi. Pergerakan anterior pada tibia,
dan hiperekstensi. Peregangan sekunder pada varus dan angulasi valgus
pada ekstensi penuh.
 ANTERIOR CRUCIATE LIGAMENT
TEARS

Can withstand
approximately 400 pounds
of force
Common injury particularly
in sports (3% of all athletic
injuries)
May hear a pop sound and
feel the knee give away
TYPES OF ACL TEARS
Derajat 1
Robekan mikro pada ligamen.
Umumnya tidak menimbulkan gejala
ketidakstabilan dan dapat kembali
bermain setelah proses penyembuhan

Derajat 2
Robekan parsial dengan perdarahan.
Terjadi penurunan fungsi dan dapat
menimbulkan gejala ketidakstabilan.

Derajat 3
Robekan total dengan gejala
ketidakstabilan yang sangat bermakna.
 CAUSES OF ACL INJURIES

Cutting (rotation)
Hyperextension

When the knee is extended, the ACL is

at its maximal length putting it at an
increased risk of tearing
 DIAGNOSIS OF INJURY

Performed with knee in 20-30

of flexion with femur stabilized
Anterior forced is applied t the
proximal tibia
Displacement is assessed

Subluxation that occurs when the

ACL is nonfunctional.
Plain radiographs May show an avulsion of the insertion of the ACL or
segond fracture

MRI has n overall accuracy of about 90%, show bone bruises

 MANAGEMENT OF INJURY

Initial treatment reduction of pain and swelling and early

restoration of normal joint movement.
Goal to prevent reinjury may lead chondral damage,
meniscal tear, laxity of secondary restraints. (lead to arthritis)
Conservative management
Surgical management
rehabilitation
 WOMEN AND ACL TEARS

Anterior Cruciate Ligament Injuries in Female Athletes:

Why Are Women More Susceptible?

Four times more ACL tears in women than men

basketball players.
Three times more in gymnasts
2.4 times more in football
Higher rates are also found among women in team
handball, volleyball and alpine skiing
 FACTORS

Smaller size of ACL

Larger Q-angle (doubtful)

normal = 17 degrees in women
Normal = 14 degress in men

Weaker hamstrings

Hormones
Estrogen reduces collagen strength
PCL INJURIES
 PCL INJURIES

The posterior cruciate ligament, or PCL, is not injured as

frequently as the ACL.

PCL injuries disrupt knee joint stability because the tibia can
sag posteriorly.

This abrasion may lead to arthritis in the knee.

 MCL (MEDIAL COLLATERAL
LIGAMENT)

MCL menempel secara proksimal pada condilus femoral

medial dan pada bagian distal menempel pada tibial
metafisis, 4-5 cm distal ke medial joint dibawah insersi
dari pes anserius.
 DIAGNOSIS OF INJURY

Look : adanya localized bruises/swelling

Feel : local tenderness
Move :
 MANAGEMENT OF INJURIES

Akut konservative
Incompleted tears of the MCL (sprain) tanpa instabilitas signifikan RICE
pada 48 jam pertama, immobilisasi, dan anti nyeri
 LATERAL COLLATERAL LIGAMENT

Lateral epicondyle of femur, attached distally on

fibular head
DIAGNOSIS OF INJURY
 MANAGEMENT OF LCL

Surgical intervention within 2 weeks of the initial injury

If the LCL popliteofibular ligament ruptured rekonstruksi