Manual 57-62: Thigh and Patella Osteology Flashcards

1
Q

the knee is a compound joint made of what 2 joints

A
  • condylar joint between condyles of tibia and femur
  • saddle/sellar joint between patella and femur
  • ONE synovial membrane and one cavity
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2
Q

what is the orientation of the condylar joint of knee

A

10-12 degrees from midline

greater than this is genu valgum

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3
Q

what type of joint is the knee

A

condyloid joint

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4
Q

what is the movemnt at knee joitn

A

hinge
glinding
rotation

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5
Q

describe the articualr surface of tibia? fibula?

A
  • flat

- rounded

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6
Q

what is the n supply to the knee joint

A
  • articular branches of femoral
  • obturator
  • common peroneal
  • tibial
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7
Q

blood supply to knee joint

A
  • genicular anastomosis from descending genicular branch of femoral
  • genicular popliteal
  • recurrent branches of anterior tibial
  • descending branch lateral femoral circumflex a
  • circumflex fibular a
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8
Q

where is the articular capsule incomplete

A

anteriorly

replaced by medial/lateral retinacula of quadricps tendon

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9
Q

the tendon of popliteus m pierces the articular capsule ..

A

laterally

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10
Q

continuation of quadriceps tendon

A

patellar ligament

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11
Q

how long is the patellar ligament

A

8 cm

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12
Q

what protects the patellar ligament from tibia

A
  • infrapatellar bursa

- the infrapatellar fat pad - inferior surface separates synovial membrane

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13
Q

what are the attachments of lateral collateral ligament

A
  • lateral epicondyle of femur above groove popliteus m

- head of fibula

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14
Q

what tendons cover the lateral collateral ligament

A

tendon of biceps femoris - splits attach fibular head either side of LCL

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15
Q

is the LCL attahced to the capsule?

A

no

also not attached to lateral meniscus (separated by articular capsule and tendon of popliteus)

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16
Q

how is the tendon of popliteus related to LCL

A

deep

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17
Q

what is the proximal attachment of the anterolateral ligament

A

lateral femoral condyle anterior to proximal attachment of LCL w/ connecting fibers b/w two ligaments
- has an oblique course

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18
Q

what is the distal attachment of anterolateral ligament?

A
  • anterolateral aspect tibia b/w gerdy’s tubercle and apex of fibula
  • attaches also to the lateral meniscus
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19
Q

what is the function of the anterolateral ligament?

A

check internal rotation b/w 30-90 knee flexion

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20
Q

describe the medial collateral ligament. compare to lateral collateral

A
  • broad flat band 10 cm long

- strong round fibrous

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21
Q

what are the proximal and distal attachments of MCL

A

proximal: medial epicondyle femur below adductor tubercle
distal: medial surface tibia 2-3 cm long
- also attaches to medial meniscus

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22
Q

what is above and below the MCL

A
  • SGT cross superiorly

- capsule below ligament

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23
Q

what ligament serves to strengthen knee joint posteriorly

A

oblique popliteal

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24
Q

what ligament is the expansion of semimebranosus m

A

oblique popliteal

- passes obliquely from medial condyle tibia to lateral condyle of femure on the floor of popliteal fossa

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25
Q

what ligament is perforated by medial genicular on its way to knee joint

A

oblique popliteal

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26
Q

thickened capsular fibers over popliteus tendon

A

arcuate popliteal

- course mediallly from lateral condyle tibia and head fibula to posterior intercondylar area of the tibia

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27
Q

what is the function of anterior cruciate ligament

A

prevent hyperextensnion of knee - prevent femur from posterior sliding on tibia

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28
Q

what is the course of anterior cruciate ligament

A

travel superolateral from anterior intercondylar area on tibia to the posterior medial surface of lateral femoral condyle

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29
Q

how does the posterior cruciate ligament compare to the anterior

A

stronger and shorter

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30
Q

describe the course of the posterior cruciate ligament

A
  • travels obliquely upward from the posterior intercondylar tibia crossing over ACL to attach on medial condyl (lateral surface)
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31
Q

what is the function of PCL

A

prevent hyperflexion of knee

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32
Q

what prevents femur forward sliding on tibial plateau

A

PCL

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33
Q

semilunar fibrocartilage discs the deepen the vacity of tibial condyles

A

menisci

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34
Q

which part of menisci are in contact with femoral condyles

A

central area

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35
Q

how much of condyle of tibia are covered by menisci

A

2/3

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36
Q

what is the peripheral attachment of menisci? aka what holds menisci to tibial condyles

A

fibrous capsule (coronary ligament) holds menisci to tibial condyles

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37
Q

shape of menisci

A
medial = semicircular
lateral = almost circular
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38
Q

what are the attachments of the medial meniscus

A
  • attached to tibia anterior to ACL at anterior intercondylar area
  • posterior attachment posterior intercondylar area
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39
Q

what separates the lateral meniscus from LCL

A

tendon of popliteus

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40
Q

span of lateral meniscus

A

from anterior intercondylar area to posterior intercondylar area

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41
Q

what are the anterior/posterior meniscofemoral ligaments

A

posterior side

70% cases fibers extend to medial condyle of femur

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42
Q

what unites two meniscis anteriorly

A

transverse ligament

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43
Q

what facets meet in the superior tibiofibular joint

A
  • fibular facet of lateral tibial condyle

- articular faet of medial aspect head of fibula

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44
Q

what are the shape of facets in superior tibiofibular jt

A

circural shaped

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45
Q

what ligaments are associated with superior tibiofibular jt

A

anterior and posterio superior tibiofibular ligaments

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46
Q

what type of joint is the superior tibiofibular jt

A

plane synovial jt

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47
Q

what type of joint is the distal tibiofibular jt

A

syndesmosis, fibrous jt

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48
Q

what forms the distal tibiofibular jt

A
  • triangular surface of distal fibula (in inferior interoseous border)
  • distal end of tibia
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49
Q

what ligaments are associated with distal tibiofibular jt

A
  • interosseous tibiofibular lig
  • anterior inferior tiiofibular ligament
  • posterior inferior tibiofibular ligament
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50
Q

distal continuation of interosseous membrane

A

interosseous tibiofibular ligament

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51
Q

what shape is the anterior inferior tibiofibular ligament

A

triangular directly inferolaterally

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52
Q

what shape is the posterior inferior tibiofibular ligament

A

quadrangular shape directed inferolaterally

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53
Q

deep pportion of the posterior inferior tibiofibular ligament =

A

inferior transverse ligament (contains fibrocartilage)

  • forms socket for talus
  • extends from lateral malleolar fossa to margin of medial malleolus
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54
Q

the patella forms within …

A

tendon of quadriceps femoris m

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55
Q

shape of head of femur

A

ball-shaped

2/3 spherical covered by hyaline cartilage *not at pit/fovea where the ligament of head of femur attaches

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56
Q

the head of femurs lies ____ in articular capsule of hip joint

A

entirely

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57
Q

where does the femur articulate with hip bones

A

acetabulum

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58
Q

joins head and shaft of femur

A

neck

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59
Q

when is the femoral angle of inclination the greatest

A

at birth

  • sex and body size determine angle
  • adult male 125
  • adult female 105 (wider bony pelvis)
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60
Q

what is the angle of declination

A

projection of neck of femur from the shaft 12-14 degrees

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61
Q

what is the shape of the neck of femur

A

hourglass (thinnest at middle)

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62
Q

what are the two surfaces of neck of femur

A

anterior and posterior

63
Q

describe the anterior surface of neck of femur

A
  • entirely in joint capsule of hip joint
  • convex superior to inferior
  • concave side to side
  • intertrochanteric line
64
Q

where is the intertrochanteric line and what is it?

A
  • between greater and lesser trochanters of femur
  • anterior surface of neck of femure
  • continuous inferiorly with spiral line
65
Q

describe the posterior surface of neck of femur

A
  • more curved than anterior
  • upper 1/2 to 2/3 lies within the joint capsule
  • fewer but larger vascular formaina than anterior
66
Q

which portion of the neck of the femur is grooved by tendon of obturator externus

A

lower portion of posterior surface

67
Q

what forms at the joining of posterior surface of neck of femur with shaft of femur

A

intertrochanteric crest

- ridge of bone b/w greater and lesser trochanters

68
Q

what are the borders of neck of femur

A

superior and inferior

  • superior is short and thick and courses horizontally
  • inferior is long and thin and courses vertically
69
Q

which border of neck of femur ends at greater trochanter? lesser trochanter?

A

superior border

inferior border

70
Q

what is the shape of the greater trochanter

A

qudrilateral-shaped

  • located at lateral end of superior border of neck of femur
  • projects lateral and posterior
71
Q

what two surfaces are on the greater trochanter

A

lateral and medial

72
Q

what is the shape of the lateral surface of greater trochanter

A

quadrilateral

- larger palpable surface (compared to medial)

73
Q

there is an oblique bony ridge on lateral surface of greater trochanter, why?

A

insertion of gluteus medius

74
Q

what divides the lateral surface of greater trochanter into 2 triangular areas

A

oblique bony ridge

  • upper triangular area = bursae for gluteus medius
  • lower triangular area = bursae for gluteus maximus
75
Q

major feature of medial surface of greater trochanter

A

trochanteric fossa

- depression for insertion of obturator externus

76
Q

tendon that inserts anterior to trochanteric fossa on greater trochanter

A

obturator internus tendon

- superior and inferior gemelli m terminate/insert into tendon of obturator internus

77
Q

what are the four borders on greater trochanter

A

superior, inferior, anterior and posterior

78
Q

superior border on greater trochanter is insertion for

A

piriformis

79
Q

anterior border on greater trochanter is insertion for

A

gluteus minimus

80
Q

inferior border on greater trochanter is insertion for

A

vastus lateralis (partial origin)

81
Q

only border or surface of greater trochanter with no muscular attachment

A

posterior border

- free rounded edge inferiorly that blends with intertrochanteric crest

82
Q

location of lesser trochanter

A
  • medial, near junction of femoral neck and shat

- directed posteromedially

83
Q

attachment to lesser trochanter

A

iliopsoas is only attachment

  • psoas major inserts at apex
  • iliacus inserts at base and between spiral and pectineal lines
84
Q

where is the intertrochanteric line located?

A
  • anterior on femur between greater and lesser trochanters at junction of neck and shaft
85
Q

attachments to intertrochanteric line

A
  • iliofemoral ligament (part of fibrous capsule of hip)
  • vastus lateralis (partial origin)
  • vastus medialis (partial origin)
86
Q

where is the intertrochanteric crest

A
  • posterior between greater and lesser trochanters
87
Q

attachments to intertrochanteric crest

A
  • NOT hip joint capsule

- quadratus femoris via the quadrate tubercle

88
Q

site of insertion of quadratus femoris m on intertrochanteric crest

A
  • quadrate tubercle mid-intertrochanteric location
89
Q

describe the quadrate tubercle

A
  • extends vertically 5 cm, superior extent located along itnertrochanteric crest
  • posterior side of femur obvi
  • at times a quadrate line can be present instead of tubercle
90
Q

what are the borders of shaft of femur

A

medial, lateral and posterior

- medial and lateral are rough and poorly defined

91
Q

major feature of posterior border of shaft of femur

A

linea aspera

  • crest, posterior border, middle 1/3 femur
  • medial and lateral lips with rough intermediate area
92
Q

superioly the linea aspera is joined by …

A

3 lines/ridges

  • spiral line
  • pectineal line
  • lateral line
93
Q

describe the spiral line on shaft of femur

A
  • joins linea aspera distally
  • medial line
  • proximally continuous with intertrochanteric line
94
Q

describe the pectineal line of femur

A
  • intermediate line
  • ends proximally at lesser trochanter
  • distally continuous with medial lip of linea aspera
95
Q

what m inserts on pectineal line

A

pectineus m

96
Q

describe the lateral line of femur

A
  • extends from greater trochanter to lateral lip of linea aspera
  • vertical
  • gluteal tuberosity located on line
97
Q

what m inserts on gluteal tuberosity

A

partial insertion of gluteus maximus (also inserts on iliotibial band)

98
Q

if proximal portion of the gluteal tuberosity is enlarged and elongated it is …

A

called the third or guteal trochanter

99
Q

what m. takes partial origin from medial lip of linea aspera

A

vastus medialis

100
Q

what m attaches superiorly b/w adductor magnus and vastus medialis

A

iliacus and pectineus and adductor brevis and adductor longus

101
Q

what m attaches on linea aspera superior to the adductor longus

A

adductor brevis

102
Q

what m attaches on linea aspera inferior to adductor brevis

A

adductor longus

103
Q

what are the attachments on adductor magnus on posterior shaft of femur (LOTS)

A
  • linea aspera (extensive)
  • gluteal tuberosity (superior - partial insertion)
  • lateral line (partial)
  • lateral lip of linea aspera (partial)
  • medial lip of line aspera (lower fiber insertion)
  • medial supracondylar line (lower fiber insertion)
  • adductor tubercle (lower fiber insertion)
104
Q

what m attaches to the gluteal tuberosity superiorly

A

gluteus maximus and adductor magnus both partially

- biceps femoris short head attaches inferior to the glut max

105
Q

what are the posterior attachments on femur of vastus lateralis

A

lateral lip of linea aspera (partial) and greater trochanter (small origin)

106
Q

the lateral and medial lip of linea aspera diverge as ..

A

lateral and medial supracondylar lines/ridges

107
Q

distinct ridge extending toward the lateral epicondyle

A

lateral supracondylar ridge

108
Q

ridge ending at adductor tubercle

A

medial supracondylar ridge

109
Q

the medial and lateral supracondylar ridges form a triangular area called ..

A

popliteal surface of femur

110
Q

m attachments to anterior surface of femur

A

vastus intermedius (upper 2/3) and articualris genu (distal)

111
Q

more pronounced, broader condyle on femur

A

lateral

the medial condyle is longer

112
Q

where does the medial condyle begin

A

adductor tubercle

113
Q

what are the articulations of the medial and lateral condyles of femur

A
  • posterior surface of patella

- repsective condyles of tibia

114
Q

describe the femur’s condyles

A

large, rounded
knob-like
project further POSTERIOR than anterior

115
Q

what do you call the sulcus/groove on each femoral condyle

A

lateral and medial sulci menisci

- separate patellar and tibial surfaces of femoral condyles

116
Q

completely separates patellar surface (lateral femoral condyle) from tibial surface

A

lateral sulci menisci

117
Q

deficient laterallly wehre tibial and patellar surfaces are continuous

A

medial sulcus menisci

118
Q

separates femoral condyles posteriorly

A

intercondylar notch/fossa

119
Q

posterior boundary of the intercondylar notch

A

intercondylar line

- forms base of popliteal surface of femur

120
Q

attachments to the intercondylar notch (3)

A
  • ACL (medial surface of lateral condyle - posterior attachment on femur)
  • PCL (lateral surface of medial condyle - anterior attachment of femur)
  • meniscofemoral ligament
121
Q

where are the medial and lateral epicondyles

A

lie above the respective condyles

122
Q

larger epicodyle

A

medial

- locaetd just below the adductor tubercle

123
Q

what attaches to the adductor tubercle

A

adductor magnus tendon

124
Q

what attachments are there to the medial epicondyle

A
  • tibial (medial) collateral ligament

- medial head of gastrocnemius m (just post to adductor tubercle)

125
Q

what attaches to the lateral epicondyle?

A

fibular/lateral collateral ligament

126
Q

what two grooves are one the lateral epicondyle

A
  • oblique groove (flexed knee)
  • vertical groove (extended knee)
  • located on lower portion of epicondyle for the popliteus tendon which shifts with knee movement
127
Q

proximal extremity feeders to femur

A
  • obturator (supplies femoral head)
  • medial femoral circumflex (branch of profunda femoris)
  • lateral femoral circumflex (enters at neck)
  • inferior gluteal (enters at neck)
  • first perforating (enters at neck)
128
Q

what blood supply is especially important ininfants, children, teens during ossification of femur

A

obturator a

  • supplies femoral head
  • unimportant in adults
129
Q

major supply to femoral head in adults

A

medial femoral circumflex

- enters at neck of femur

130
Q

what a courses within ligament of head of femur

A

branch of obturator to supply the femoral head

131
Q

femoral shaft arterial feeder

A

nutrient a (branch of second perforating artery)

132
Q

where is the nutrient canal of femur located?

A
  • posterior, upper end of linea aspera

- directed away from growing end of bone during development (obliquely upward)

133
Q

*** for all long bones, the nutrient canal is directed …

A

obliquely away from the growing end of bone

134
Q

distal extremity feeder areteries for femur

A
  • superior lateral genicular a
  • superior medial genicular a
  • descending genicular a
  • descending branch of lateral femoral circumflex a
135
Q

how many centers of ossification in femur

A

5
1 primary (shaft)
4 secondary

136
Q

the femur is the first bone to begin with this type of ossification

A

endochondral ossification

137
Q

the femur is the ______ bone to ossify

A
second earliest
(clavicle is first via intramembranous method)
138
Q

femur primary ossification

A

shaft starting at 7th fetal week and ending at puberty

139
Q

femur secondary ossification (4)

A
  • distal extremity near birth to 16-18
  • head 6mo to 17
  • greater trochanter 4 y to 16
  • lesser trochanter 12-14 y to 15 yo
140
Q

largest sesamoid in body

A

patella (forms in quadratus femorus tendon)

141
Q

the patella articulates with

A

femur (part of knee joint(

142
Q

shape of patella

A

triangular (apex directed inferiorly)

143
Q

borders of patella

A

superior (thick base(
medial
lateral

144
Q

attachments to superior border of patella

A
  • rectus femoris
  • vastus intermedius
  • vastus lateralis (lateral superior portion)
145
Q

attachements to medial border of patella

A
  • vastus medialis

- vastus lateralis

146
Q

how is the anterior surface of patella shaped

A

convex with longitudinal stria and small nutrient foramina

147
Q

what attaches to the longitudinal stria of patella

A

quadratus tendon

148
Q

describe the upper 4/5th of posterior surface of patella

A

smooth, oval shaped

149
Q

what separates the two patellar facets

A

vertical ridge

150
Q

what does the vertical ridge of the patella articulate with…

A

intercondylar groove of femur

151
Q

which of the patellar facets is larger

A

lateral facet

also deeper and more concave than medial

152
Q

what attaches at the lower 1/5th of posterior surface of patella

A

patellar ligament

- nutrient foramen are also located on this surface

153
Q

what is the blood supply to the patella

A

branches of gneicular arteries (by supplying the quadriceps tendon)

154
Q

when does the patella ossify?

A

variable # centers
appear 3-6 yrs; additonal later in childhood
ossifies by puberty