E2- Hip and knee Flashcards

1
Q

what can the shape of the femur be impacted by

A

growth of the ossification center
force of m activation
WB
circulation
trauma

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2
Q

what is coxa vara

A

less than 125-105 deg
hip bend inward
cause genu valga

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3
Q

what is coxa valga

A

greater than 125-140 deg
hip bend outward
cause genu vara

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4
Q

what is femoral torsion

A

relative RT between the shaft and neck

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5
Q

what is normal anteversion of femoral torsion

A

15 deg (8-20)

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6
Q

what is excessive anteversion

A

greater than 15-35

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7
Q

what is retroversion

A

less than 15 deg

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8
Q

what can excessive anteversion cause

A

hip dislocation
OA
increase contact stress
in toeing

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9
Q

how does increased anteversion affect motion

A

less ER more IR

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10
Q

how does retroversion affect motion

A

increase ER less IR

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11
Q

what is the normal for creg’s test

A

8-15 deg

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12
Q

where is the femoral head located

A

inferior to mid 1/3 of inguinal lig
posterior to center is fovea

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13
Q

what is the lig teres

A

tubular, synovial lined connective tissue
contains mechanoreceptors

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14
Q

what is housed in the lig teres

A

acetabular artery

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15
Q

what is the acetabulum

A

deep, cuplike socket

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16
Q

what is the acetabular notch

A

60-70 deg opening

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17
Q

what is in the acetabular fossa

A

fat, blood vessels, synovial membrane, ligaments

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18
Q

where is the normal contact of the femoral head

A

along the lunate surface

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19
Q

what is the lunate surface

A

covered in articular cartilage, sup-ant, where the femoral head contacts

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20
Q

when is the joint force highest for the lunate surface

A

walking

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21
Q

what happens to the acetabulum during midstance of the gait cycle

A

300% BW
notch widens
lunate deforms
increase contact area/decrease pressure

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22
Q

what is the acetabular labrum

A

strong, flexible ring of fibrocartilage rim of acetabulum

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23
Q

where is the transverse acetabular lig

A

spans the acetabular notch

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24
Q

where is the labro-chondral junction

A

internal labrum blends with the articular cartilage of acetabulum

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25
Q

where is the 13% of forces in the acetabulum coming from during the swing phase

A

muscles
passive structures

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26
Q

what is the function of the acetabulum labrum

A

mechanical stability “grip”
deepens socket
keeps negative pressure, fluid sealed

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27
Q

what is the acetabular alignment

A

projects laterally, inf/ant inclination

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28
Q

what is dysplastic acetabulum

A

malformed, does not fully cover the femoral head

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29
Q

what can dysplastic acetabulum cause

A

chronic dislocation
OA
pain

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30
Q

what is the center edge angle

A

degree acetabulum covers femoral head

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31
Q

what is acetabular anteversion angle

A

extent to which the acetabulum faces anteriorly

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32
Q

what is the difference between acetabulum anteversion and femoral version (ante/retro)

A

femoral- axis of femur and transcondylar axis of knee
acetabulum- acetabular morphology

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33
Q

what ligaments reinforce the external capsule of the hip

A

iliofemoral
pubofemoral
ischiofemoral

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34
Q

what elongates the iliofemoral lig

A

hip EXT and full ER

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35
Q

what elongates the pubofemoral lig

A

hip ABD/EXT and some ER

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36
Q

what elongates the ischiofemoral lig

A

taught in IR and hip ABD

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36
Q

what is the iliocapsularis

A

deep hip flexor
lateral to iliacus
deep to rectus femoris and sartorius

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37
Q

how could a person with parapelgia stand upright

A

by leaning on the iliofemoral lig to make them taut and hold their body weight

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38
Q

what is the closed pack position of the hip

A

full EXT
slight IR and hip ABD

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39
Q

what is the position of max joint congruity of the hip

A

90 flexion
moderate ABD and ER

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40
Q

true/false
max jt congruity of the hip is equivalent to the closed pack position of the hip

A

false
closed pack position is not associated with the position of max congruity

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41
Q

what is the osteokinematics of the femoral on pelvic

A

femur moves on fixed pelvis

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42
Q

what is the osteokinematics of the pelvic on femoral

A

RT of pelvis on fixed femurs

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43
Q

what is the deg of motion of femoral on pelvic hip flexion

A

120-140
results in posterior tilt and lumbar flexion

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44
Q

how does the deg of motion change for hip flexion with LE extended

A

70-80 deg
due to hamstring tension

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45
Q

what is the deg of motion of femoral on pelvic hip extension

A

18-30 deg

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46
Q

what is the deg of motion of femoral on pelvic hip ABD

A

40-55 deg

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47
Q

what can limit motion of hip ABD

A

pubofemoral lig
adductor muscles

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48
Q

what is the deg of motion of femoral on pelvic hip ADD

A

20-25 deg

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49
Q

what can limit motion of hip ADD

A

ABD muscles
piriformis
ITB

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50
Q

what is the deg of motion of femoral on pelvic hip RT

A

IR- 30-45
ER- 32-50

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51
Q

what is ipsidirectional lumbopelvic rhythm

A

lumbar and spine move in same direction

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52
Q

what is maximized in ipsidirectional lumbopelvic rhythm

A

angular displacement of trunk

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53
Q

what is contradirectional lumbopelvic rhythm

A

lumbar and pelvis move in opposite direction
above lumbar stays stationary
used in walking

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54
Q

when is the pelvis in contradirectional lumbopelvic rhythm

A

walking
sitting with ant/post tilts

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55
Q

what is the contradirectional rhythm of hip flexion in sitting

A

ant pelvic tilt
lumbar spine ext
sacrum nutates (flexes)

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56
Q

what is the contradirectional rhythm of hip extension in sitting

A

post pelvic tilt
lumbar spine flx
sacrum counternutate (extends)

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57
Q

what is the contradirectional rhythm of R hip ABD of support leg with walking

A

L iliac crest hip hikes
L lateral flexion

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58
Q

what is the contradirectional rhythm of R hip ADD of support leg with walking

A

L iliac crest drops
R lateral flexion

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59
Q

how does the hip roll/slide with open chain arthrokinematocs

A

convex femur rolls/slides in opposite directions

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60
Q

what is the arthrokinematics of open chain exercise of hip flx

A

roll ant
slide post/inf

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61
Q

what is the arthrokinematics of open chain exercise of hip ext

A

roll post
slide ant/sup

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62
Q

what is the arthrokinematics of open chain exercise of hip IR

A

roll ant
slide post

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63
Q

what is the arthrokinematics of open chain exercise of hip ER

A

roll post
slide ant

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64
Q

what is the arthrokinematics of open chain exercise of hip ABD

A

roll sup
slide inf

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65
Q

what is the arthrokinematics of open chain exercise of hip ADD

A

roll inf
slide sup

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66
Q

what is the path of the arthokinematics while the hip is doing IR/ER

A

transverse

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67
Q

what is the path of the arthokinematics while the hip is doing ABD/ADD

A

longitudinal

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68
Q

what m are the primary hip flexors

A

iliopsoas
sartorius
rectus femoris
adductor longus
pectineus

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69
Q

when is the iliopsoas best recruited

A

prominent femoral-hip flexor
trunk/pelvis flexor over fixed thighs
swing phase of walk
frontal plane stability

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70
Q

when is the psoas minor best recruited

A

stabilize the underlying position of psoas major

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71
Q

what are the primary action of sartorius

A

hip flex, abd, er

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72
Q

what is the TFL innervation

A

superior gluteal n L4-S1

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73
Q

what is the ITB innervation

A

superior gluteal n L4-S1
inferior gluteal n L5-S2

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74
Q

what innervates the sartorius

A

femoral n L2-4

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75
Q

what m do the obturator n innervate

A

hip adductors
obturator externus

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76
Q

what m has isometric torque at hip

A

rectus femoris

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77
Q

what innervates the rectus femoris

A

femoral L2-4

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78
Q

what are the primary hip add

A

pectineus
adductor longus
gracilis
adductor brevis
adductor magnus

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79
Q

what m are in the superficial layers of hip adductors

A

pectineus
adductor longus
gracilis

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80
Q

what m has the longest moment arm to promote hip flx

A

rectus femoris

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81
Q

what m are in the middle layer of hip adductors

A

adductor brevis

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82
Q

what m are in the deep layer of hip adductors

A

adductor magnus

83
Q

what m can be an extensor and flexor when close to full extension or flexion

A

adductor magnus

84
Q

when does IR m increase in torque

A

60-90 deg of hip flexion
piriformis becomes IR at 60 deg

85
Q

what is the function of the IR during gait

A

during stance they rotate the pelvis on the femur

86
Q

what are the primary m of hip extensors

A

glute max
hamstrings
post head of adductor magnus

87
Q

when do adductors recruit to become extensors

A

greater than 70 deg flexion

88
Q

what is the innervation of glute max

A

inferior gluteal n L5-S2

89
Q

what is the innervation of the hamstrings

A

sciatic L5-S2

90
Q

what is the innervation of the post head of adductor magnus

A

obturator L2-4

91
Q

what are the main 4 hip flexors

A

tensor fascia latte
rectus femoris
sartorius
iliopsoas

92
Q

if a patient is in a significant lean, what m has an increase of their moment arm

A

hamstrings
increase passive tension

93
Q

what is the m mechanics of femoral on pelvic hip extension with going up a hill

A

large extension torque
rectus femoris and glute max cooperation
rectus= flexion torque ant pelvic tilt, HS/gastoc/glutes/adductor= ext torque

94
Q

what are the primary hip abductors

A

glute max and medius
TFL

95
Q

what m has the largest percentage of hip abductors

A

glute medius

96
Q

what are the primary hip ER

A

glute maximus
quadratus femoris
gemellus sup and inf
obturator internus
piriformis

97
Q

what decelerates the drop of the hip when the other leg is kicking a soccer ball

A

glute medius

98
Q

what happens with pelvic on femoral RT during ER with R LE planted

A

R LE planted and ER contraction allows the body to rotate to the L

99
Q

what m is at work with planting and cutting in sports

A

glute max can ER and EXT for turn and push off

100
Q

what is m are decelerating the planting and cutting action in sports

A

adductors and IR

101
Q

what are symptoms of greater trochanter syndrome

A

lateral hip pain
common >40 yr F
achy, tender near GT

102
Q

what deviations are present with GTPS

A

weak hip ABD and gait deviations

103
Q

when is GTPS most painful

A

standing on one leg
climbing hills
prolong walking

104
Q

what is GTPS

A

tendinopathy of glute med/min and or bursas

105
Q

why is GTPS most panful in midstance

A

tension stress and compression

106
Q

what biomechanical problems can develop with hip abd weakness

A

postural instability
falls
patella-femoral pain
LBP
ankle pain
knee instability

107
Q

what are symptoms of OA in the hip

A

pain in groin, buttock, thigh, knee
crunching

108
Q

what is OA of the hip

A

narrowing of the joint space, deterioration of cartilage, thickened capsule leads to inability to move the hip to perform routine activities

109
Q

what is hip resurfacing

A

trim the natural bone and apply metal coverings to head and acetabulum

110
Q

what can be the biomechanical consequence of a positive coxa vara

A

increase moment arm of ABD
more joint stability

111
Q

what can be the biomechanical consequence of a negative coxa vara

A

increase shear of femoral neck
decrease moment arm of ABD

112
Q

what can be the biomechanical consequence of a positive coxa valga

A

decrease shear force on femoral neck
increase moment arm of ABD

113
Q

what can be the biomechanical consequence of a negative coxa vara

A

decrease moment arm of ABD
joint displacement

114
Q

what can cause a acetabular labrum tear

A

RT, repetitive and near end range motions
hip dislocation, deep squat, strenuous activities

115
Q

what can be secondary pain with an acetabulum labrum tear

A

obturator internus and pelvic floor pain

116
Q

what is dysplasia of the hip

A

poorly formed acetabulum during development due to intrauterine position or abnormal neuromuscular development

117
Q

what are complications of hip fx

A

reduced independence
shorten life
immobility
blood clots
bed sore
UTI

118
Q

why is usage of a cane important

A

reduces compressive forces if in opposite
reduces JRF by reducing activation of hip ABD

119
Q

what is the normal alignment of the knee angle

A

170-175 is normal genu valga

120
Q

what is excessive genu valga

A

<170 creates knock knee

121
Q

what is genu vara

A

> 180 creates bow leg

122
Q

what reinforces the anterior connective tissues in the knee

A

med/lat retinacular fibers extensions of ITB and vastus lat/med that connect to femur/tibia/patella/quads/ligs/mensci

123
Q

what are the anterior knee muscular reinforcements

A

quads

124
Q

what reinforces the lateral connective tissues in the knee

A

LCL
lat patellar retinacular fibers
ITB

125
Q

what are the lateral knee muscular reinforcements

A

biceps femoris
popliteus tendon
lat head of gastroc

126
Q

what reinforces the posterior connective tissues in the knee

A

oblique popliteal lig
arculate popliteal lig

127
Q

what are the posterior knee muscular reinforcements

A

popliteus
gastroc
hamstrings

128
Q

what reinforces the posterior-lateral connective tissues in the knee

A

arcuate popliteal lig
LCL
popliteofibular lig

129
Q

what are the posterior-lateral knee muscular reinforcements

A

tendon of popliteus

130
Q

what is the fabella

A

sesamoid bone in the posterolateral capsule of the knee joint

131
Q

what attaches to the fabella

A

fabellofibular lig
oblique popliteal lig
fabella to fibular head

132
Q

what reinforces the medial connective tissues in the knee

A

anterior- medial patella retinacular fibers
medial- medial patella retinacular fibers, MCL
posterior- SM tendon, posterior capsule, posterior oblique lig, pes anserine

133
Q

what are the medial knee muscular reinforcements

A

semimembranuous
SGT
pes anserine

134
Q

what are extensions of synovial membrane in the knee

A

14 bursae

135
Q

what are the fat pads of the knee

A

suprapatellar
deep infrapatellar

136
Q

what provides stability for the tibiofemoral jt

A

soft tissue

137
Q

what does the menisci do for the tibiofemoral jt

A

form seat for the femoral condyles

138
Q

where is the menisci anchored on the tibia

A

intercondylar region at ant/post horns

139
Q

what attaches to the external edge of meniscus attached to the tibia and what does it allow

A

coronary lig and pivoting

140
Q

what are the coronary ligs connected by

A

transverse lig anteriorly

141
Q

what m attach to the menisci

A

quads
semimebranosuous
popliteus

142
Q

what is the function of the m that attach to the menisci

A

stabilization

143
Q

what are the primary function of tibiofemoral jt

A

decrease compressive forces

144
Q

what is the secondary function of tibiofemoral jt

A

stabilize jt motion
lubricate articular cartilage
proprioception
arthokinematics

145
Q

what are common mechanisms of injury at tibiofemoral jt

A

axial RT with flexed knee - menisci
bucket handle
medial injury due to valgus force - MCL/post med capsule

146
Q

what can increase the risk of menisci tear

A

lig laxity (ACL)
malalignment

147
Q

which m has the most direct attachment to the mensci

A

popliteus

148
Q

what is the red zone of the menisci

A

peripheral 1/3 of menisci
good for healing

149
Q

what is the white zone of the menisci

A

inner 2/3 of menisci
nutrition from synovial fluid

150
Q

when does RT occur in the knee

A

slight flexion

151
Q

what is the range of flexion at the knee

A

130-150

152
Q

what is the range of extension at the knee

A

5-10 deg hyperextenion

153
Q

how is RT named for the tibiofemoral jt

A

position of tibial tuberosity relative to anterior femur

154
Q

at 90 deg of hip flx, what is the deg of axial RT of tibiofemoral jt

A

40-45 deg
2:1 ER exceeds IR

155
Q

what is the arthro of tibial on femoral ext

A

tibia rolls and slides anterior meniscus ant by quads

156
Q

what is the arhro of femoral on tibia ext

A

femoral condyles roll ant and slide post
quads direct rolls and stabilize menisci

157
Q

what “screw home” motion is required during full ext to increase jt congruence and stability

A

10 ER during last 30 deg ext

OC- tibia ER
CC- femur IR

158
Q

what drives the “screw home” concept for EXT

A

shape of the condyles
passive ACL tension
slight lateral pull of quads

159
Q

what m unlocks the knee for “screw home” for FLX

A

popliteus

160
Q

what m help stabilize axial RT in flexion at the knee

A

popliteus and semimembranosus

161
Q

What does the MCL blend into

A

medial meniscus

162
Q

what does the LCL blend into

A

bicep femoris tendon

163
Q

what is the primary function of MCL and LCL

A

limit motion in frontal plane

164
Q

when knee is extended what lig fights valgus forces

A

MCL

165
Q

when knee is extended what lig fights varus forces

A

LCL

166
Q

what are secondary functions of the LCL and MCL

A

general stabilizing tension
extreme RT

167
Q

what resist valgus forces

A

MCL
ACL
PCL
lateral meniscus comp
pes anserine
med gastroc

168
Q

what resist varus forces

A

LCL
posterior-lateral capsule
ITB
bicep femoris tendon
jt contact medial
ACL/PCL
lat gastroc

169
Q

what does MCL resist

A

valgus
knee ext
extreme ER at knee

170
Q

what does LCL resist

A

varus
knee ext
axial RT

171
Q

what does the posterior capsule of the knee resist

A

knee ext
OPL- resist ER
varus

172
Q

what does the ACL resist

A

resist ext - ant tibia or post femur
extreme varus, valgus, RT

173
Q

what does PCL resist

A

knee flexion- post tibia or ant femur
extreme varus, valgus, RT

174
Q

when is the ACL taut

A

some fibers in FLX
increase taut in EXT

175
Q

where does ACL attach in tibia

A

anterior runs posterior

176
Q

what happens to the tibia when the quad causes ext?
what becomes taut

A

tibia is pulled anterior
ACL limits the slide

177
Q

how do you perform anterior drawer test

A

90 deg knee flex
pull prox tibia ant
ACL prevents slide
hamstrings can activiate and limit slide

178
Q

what factors play into ACL tear

A

speed and direction
compressive and shear force
control and timing of m forces
integrity and strength of tissue
alignment

179
Q

how can strong quad activation cause ACL tear

A

valgus collapse
excessive ER, femur IR

180
Q

what is the posterior drawer test

A

knee 90 deg flx
prox end tibia post
limits femur ant

181
Q

what is the stabilizer of the patellafemoral jt

A

quad

182
Q

what moves when the it is tibia on femoral

A

tibia and patella on femoral condyles

183
Q

what moves on femoral on tibial

A

femur and femur condyles on patella

184
Q

true/false
the more flexion of the knee (60-90 deg) the more contact of the patella on the femoral condyles

A

true

185
Q

when is there the least amount of contact of the patella and femoral condyles

A

20 deg flexion and 135 deg flex

186
Q

what m does knee ext

A

quadriceps- femoral n

187
Q

what m does knee internal rotation

A

sartorius- femoral n
gracilis- obturator n
SM- sciatic (tibial) n
ST- sciatic (tibial) n
popliteus - tibial n

188
Q

what m does knee external rotation

A

bicep femoris- sciatic (tibial and fibular) n

189
Q

what m does knee flexion

A

SM - sciatic
ST- sciatic
bicep femoris- sciatic
sartorius/gracilis - femoral/obturator
gastroc/plantaris- tibial
popliteus- tibial

190
Q

what innervates the posterior capsule of knee

A

posterior tibial n

191
Q

what innervates the medial knee and post/post med capsule

A

obturator n

192
Q

what innervates the ant-medial and ant-lateral capsule

A

femoral n

193
Q

what group in the quads has the most extension torque

A

vastus group

194
Q

what vastus m has fibers in 2 directions

A

vastus medialis
VML and VMO

195
Q

what m has the greatest cross section in the quads

A

vastus lateralis

196
Q

what does the articularis genu do

A

pull the capsule proximal

197
Q

what is the knee extensor mechanism

A

forms the quadriceps tendon

198
Q

what is the quad to hamstring ratio

A

knee ext torque is 2/3 of knee flx

199
Q

how does the quads do eccentric functions

A

rate of descent
dampens impact/load on knee - walking

200
Q

what are the concentric functions of the quads

A

accelerates tibia/femur toward ext
jump, step up, running

201
Q

where is the longest moment arm during a long arc quad
a. 90 flx
b. 45 flx
c. 0 ext

A

0 ext due to the the most amount of weight to hold the leg straight

less patella contact on the femur

202
Q

where do you generate more force in a squat position
a. 90 flx
b. 45 flx
c. 0 ext

A

90 deg flx due to the amount of weight the patient has to force upward

203
Q

why does extensor lag happen

A

external torque is too great for internal torque (quads) to happen

204
Q

what impacts the length of the knee extension moment arm

A

shape/position of patella
shape of distal femur
evolute

205
Q

what factors associate with joint compression forces of the PF jt

A

quads force
knee flexion angle

206
Q

what is the functional role of the patella

A

acts as a spacer and increases the internal moment arm (pulley)