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Anatomy: Knee Flashcards

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1
Q

Frontal Plane Analysis: Normal Alignment

A
  • Alignment described in “varus” or “valgus”
  • Measurements using Anatomical or Mechanical axis
  • Anatomical Axis
    • Femur: oblique
    • TIbia: Vertical
    • Valgus (~ 5 degrees)
  • Varus: knees out: joint opens laterally; compresses forces on medial side
  • Valgus: knees in: joint opens medially; compresses forces on lateral side.
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2
Q

Abnormal LE Alignment: Frontal Plane: Genu Valgum

A
  • Defined as medial TF angle > 195 degrees
  • Consequences:
    • Increased compressive forces lateral condyles
    • Increased tensile forces medial structures
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3
Q

Abnormal LE Alignment: Frontal Plane: Genu Varum

A
  • Defined as medial TF angle <180 degrees
  • Consequences:
    • Increased compressive forces on medial condyles
    • Increased tensile forces on lateral structures
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4
Q

Sagittal Plane Analysis: Normal Anatomical Position

A
  • LOG passes slightly anterior to knee joint
  • Normal TF angle= 180 degrees
  • Little to no muscle activity required in static posture
  • Support provided by posterior structures.
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5
Q

Abnormal LE Alignment: Sagittal Plane: Genu Recurvatum

A
  • LOG falls substantially anterior to knee joint
  • Posterior joint capsule and related structures under considerable stress
  • May result in adaptive lengthening
  • Increased compressive forces anterior aspect of femoral condyles and tibial plateaus
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6
Q

Proximal TIbia: Osteology

A
  • Medial condyle
  • Lateral Condyle
  • Intercondylar eminence: ACL, PCL, and menisci attach here
  • TIbial plateau
  • Tibial Tuberosity
  • Tibial Crest: bony prominence down the anterior femur
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7
Q

Proximal Fibula: Osteology

A

Fibular Head: biceps femoris, lateral collateral ligament

Neck of the Fibula: Common peroneal n.

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8
Q

Distal Femur: Anterior View

A
  • Medial Condyle
    • medial epicondyle
  • Lateral Condyle
    • lateral epicondyle
  • Adductor tubercle: where you the adductor Magnus attaches
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9
Q

Femoral Condyles: Tibiofemoral Articular Surfaces

A
  • Medial condyle is larger and projects farther distally
  • Covered w/ articular cartilage
  • Intercondylar (trochlear) groove: where the patella lies
  • Intercondylar fossa: where the cruciate ligaments go through
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10
Q

Distal Femur: Posterior View

A
  • Linea Aspera

- Supracondylar Lines

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11
Q

TIbiofemoral Joint Classification

A
  • Diarthrodial (synovial)
  • Bicondylar
  • Biaxial
  • Compound: multiple articulations meaning that there is a medial and lateral surface
  • Complex: disc Fibrocartilage
  • Functions primarily as a hinge joint (flexion and extension)
  • Some rotation in the transverse plane
  • Closed packed position is also called the screw-home position
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12
Q

Members of Knee Joint

A
  • Femoral condyles
  • Intervening menisci
  • Tibial plateaus and condyles
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13
Q

Tibial Condyles: Proximal Tibia

A
  • Medial Tibial condyle or plateau
    • Is longer in the anteroposterior direction
    • The oval-shaped medial tibial plateau is larger (~50%)
  • Lateral tibial condyle or plateau
    • Is shorter (smaller) in the anteroposterior direction
    • More circular in shape
    • The articular cartilage is thicker than that of the medial tibial plateau
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14
Q

Tibiofemoral Osteokinematics

A
  • Normal knee flexion= 140 degrees
  • Normal knee extension= 0 degrees
  • Impact of 2 joint muscles:
    • with hip extended, knee flexion ROM may be limited to 120 degrees
    • with hip flexed, knee flexion ROM may be increased to 150-160 degrees
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15
Q

Tibiofemoral Osteokinematics: Functional ROM (Sagittal Plane)

A
  • Gait requires 60 degrees knee flexion
  • Stair climbing requires 80 degrees knee flexion
  • Sitting in a chair requires at least 90 degrees knee flexion
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16
Q

Tibiofemoral Arthrokinematics

A
  • Tibial articular surfaces are concave
  • Femoral articular surfaces are convex
  • Open chain: concave on convex
    • Tibia on femur; anterior roll and anterior glide
  • Closed chain: Convex on concave
    • Femur on Tibia; posterior roll and anterior glide
  • 0-25 degrees of CC flexion causes posterior roll of femur on a fixed tibia
  • After 25 degrees posterior roll is accompanied by an anterior glide of femur
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17
Q

Locking Mechanism of the Knee (Screw-Home Mechanism) OKC

A
  • Open Kinetic Chain (OKC) in a non-weight bearing position
    • 30 degrees from full extension
    • Lateral tibial condyle completes arthrokinematics first
    • As extension continues the medial tibial condyle arthrokinematics continues
    • Results in external rotation of the tibia
    • Brings joint into CPP
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18
Q

Locking Mechanism of the Knee (Screw-Home Mechanism) CKC

A
  • Closed Kinetic Chain (CKC) in a weight-bearing position
    • 30 degrees from full extension
    • LFC completes arthrokinematics first because it is smaller than the MFC
    • As extension continues the MFC arthrokinematics continues
    • This results in internal rotation of the femur
    • Brings joint into the CPP (majority of the supporting ligaments to become taut)
    • Coming out of CC the femur will externally rotate as the knee flexes
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19
Q

Unlocking the Knee: TIbiofemoral Arthrokinematics

A

Open Chain

  • First 30 degrees of flexion
  • Medial tibial condyle moves first
  • Followed by lateral condyle which causes IR of tibia
  • Brings knee into OPP

Closed Chain

- First 30 degrees of flexion
- Medial femoral condyle moves first
- Followed by lateral condyle which causes ER of femur
- Brings knee into OPP
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20
Q

Capsular Kinesiology: Tibiofemoral Joint

A
  • Closed Packed Position: full knee ext with full ER
  • Open Packed Position: 20-30 degrees of knee flexion
  • Capsular pattern: greater limitation in flexion than extension
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21
Q

Patella

A
  • Sesamoid bone (largest in body)
  • Triangular with apex at inferior pole
  • Posteriorly its surface should be smooth
  • By holding the quadriceps further forward, adds a great deal to effectiveness of quadriceps pull
  • proximal aspect: base
  • Distal aspect: apex or inferior pole
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22
Q

Patellofemoral Joint Classification

A
  • Diarthrodial
  • Planar
  • Defined by the shape of the patellar surface of the femoral condyles
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23
Q

Members of Patellofemoral Joint

A
  • Posterior surface of patella and anterior surface of femoral condyles
  • Least congruent joint of the body
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24
Q

Patellar articular surfaces on the femoral condyles

Study These Flashcards
A
  • Intercondylar (trochlear groove)
  • The lateral patellar surface is larger
  • The medial patellar surface is smaller
25
Patella: Articulating (posterior) Surface
- A vertical ridge corresponds to trochlear groove and divides posterior surface into 2 facets - In general has asymmetrical facets - Lateral articular facet - Medial articular facet - Odd facet is located medial to the medial facet
26
Patella Tracking: Tilt
Axis is superior/inferior - With knee extended, patella rests in slight lateral tilt - medial tilt occurs from 0-30 degrees of flexion and > 100 degrees - Lateral tilt occurs between 30-100 degrees of flexion
27
Patella Tracking: Rotation
Axis is anterior/posterior - Medial rotation occurs when inferior pole moves medially with tibial IR - Lateral rotation occurs when inferior pole moves laterally with tibial ER
28
Patella Tracking: Patella Glide
- Medial glide occurs with knee flexion - Lateral glide occurs with extension -This is a translation instead of rotation so movement doesn't occur along an axis.
29
Importance of the Patella
- Considered an anatomic pulley - Alters angle of pull for patella tendon (quadriceps muscle) JRF increase as knee flexion increases: -Ex: stair climbing: PF JRF = 3.3 x body weight; squats PF JRF= 7.8 x body weight
30
Capsular Kinesiology: Patellofemoral Joint
- CPP- full flexion - OPP- full extension - Capsular pattern - n/a due to being a planar joint
31
Non-muscular support of Knee Joint Complex
- Tibiofemoral and patellofemoral joints are highly incongruent - Tibiofemoral- shallow articular of tibia on convex femur - Patellofemoral-shallow articular facets of patella
32
Knee Joint Capsule
Encloses the tibiofemoral and patellofemoral joints - In general it is large and lax - It is grossly composed of an external or superficial fibrous layer and a thinner internal synovial membrane
33
Fibrous Capsule
- Attaches to posterior aspects of femoral and tibial condyles, and runs across the intercondylar notch - Attaches medially and laterally along border of femur and tibia - Anteriorly blends with tendons of VL and VM (aka medial and lateral patellar retinaculi), and attaches to edges of patella. - Cruciate ligaments are in the capsule but outside the synovial
34
Fibrous Capsule: Retinaculum
- Lateral retinaculum reinforced by ITB - Retinaculi further reinforced by patellofemoral & patellotibial ligaments - MPFL: medial patella femoral ligament. An important stabilizer of the patella
35
Synovial Capsule
- Posteriorly attaches to condyles of tibia and femur - Posteriorly reflects off the fibrous capsule and loops forward following the contours of the condyles - So, intercondylar notch and eminence enclosed by fibrous layer but outside synovial space
36
Synovial Membrane:
- Posteriorly-invaginates anteriorly to - Follow femoral intercondylar notch between the femoral condyles. - Adheres to the anterior and sides of the ACL and PCL ligaments - ACL and PCL are intracapsular and extrasynovial - Posterolaterally the synovial lining passes between the popliteus muscle and the lateral femoral condyle
37
Synovial Capsule-Anteriorly
- Continues w/ fibrous layer attaching to patellar borders. - Again differentiates from fibrous layer proximal to patella. - Forms a large pocket that extends proximally a few cm between femur and quadriceps muscle - This is known as the suprapatellar pouch and essential for full movement of patella and knee
38
Patella Tendon (Ligament)
- Characteristics - Continuous with quadriceps tendon - Strong and thick - Merges with fibrous capsule via retinaculum - Attachments: inferior/anterior patella to tibial tuberosity - Associated structures - infrapatellar fat pad - Bursa
39
Medial Collateral Ligament
- Attachments: medial femoral condyle to medial tibial condyle and medial meniscus - Superficial - Deep - Function: Checks against valgus force and taut in extension - Taut in ER of tibia in OC - Taut in IR of femur and tibia in CC - Taut in Extension - Blends in with capsule not really able to isolate and palpate like LCL
40
Lateral Collateral Ligament
- Extracapsular and extrasynovial - Attachment: lateral femoral condyle to lateral fibular head - Checks against varus force - Taut in extension - Taut in IR of tibia in OC - Taut in ER of femur and tibia in CC
41
Anterior Cruciate Ligament
- Intracapsular and Extrasynovial - Attachments: intercondylar region of tibia to posteromedial lateral femoral condyle - Mainly prevents anterior translation of tibia on femur - Anteromedial bundle-taut in full flexion and extension - Posterolateral bundle-taut in full extension - All taut in tibial and femoral internal rotation in CC
42
Posterior Cruciate Ligament
- Attachments: posterior tibia intercondylar region to anteromedial aspect of medial femoral condyle - Shorter, thicker and stronger than ACL - Mainly checks against posterior displacement of tibia on femur - Taut in full flexion, full extension and IR of femur.
43
Accessory Ligaments of the Knee
Oblique Popliteal Ligament -Located b/t semimembranosus tendon and LFC -Taut in full extension Arcuate Popliteal Ligament -Originates from Fibular head then divides ("Y") Reinforcements of the Posterior Capsule
44
Menisci
-Fibrocartilage -Located on articular surface of tibia -lateral covers more than medial Attachments: -Centrally: small ligaments attaching to horns -Peripherally: coronary ligament Deepens the tibial plateaus -In sagittal section they are wedge-shaped such that they are thicker on the periphery and thinner centrally
45
Menisci-Function
1. Protect against compressive and rotational forces (shock absorption) 2. Increase contact area between tibia and femur 3. Stabilization - Innervation-aneural - Vascularity: - red zone: good blood zone good potential to heal - Red/white zone: ok potential to heal - White zone: nope no healing
46
Medial Meniscus
- "C" shaped - Broader posteriorly than anteriorly - More anchored than lateral - Increased risk of injury - Attaches to deep portion of MCL - Less (tibial) coverage area leads to increased contact area between femur and tibia. - Medial tears are more common than lateral
47
Lateral Meniscus:
- More crescent shaped - Smaller and more mobile than medial meniscus - Separated from LCL by popliteus tendon - Covers more tibial area, which decreases contact area between tibia and femur
48
Anterior and Posterior Horns
- Each horn is firmly attached to the tibia plateau below - Meniscal motion on the tibia is limited by multiple attachments to surrounding structures - The medial meniscus has greater ligamentous and capsular restraints, limiting translation to a greater extent than the lateral meniscus
49
Common Meniscal Attachments
- Coronary Ligaments: Attaches periphery of meniscus to tibial plateau - Transverse Tibial Ligaments: attaches anterior horns of medial and lateral meniscus
50
Unique Medial Meniscal attachments
- The deep fibers of the medial collateral ligament (MCL) - The anterior horn of the medial meniscus is attached to the anterior cruciate ligament (ACL) - The posterior horn of the medial meniscus is attached to the posterior cruciate ligament (PCL) - Through capsular connections the semimembranosus
51
Unique Lateral Meniscal Attachments
- The meniscofemoral ligament connects lateral meniscus to the PCL and the medial femoral condyle - The tendon of the popliteus muscle through capsular attachments - helps to control the mobility - separates the lateral meniscus from the lateral collateral ligament (LCL)
52
Bursae of the Knee
- General functions of bursa-lubrication, nutrition - Communicating bursa are invaginations of the synovial membrane of the joint - the suprapatellar bursa - popliteus bursa
53
Bursae of the Knee: Non-Communicating bursa
- Prepatellar Bursa-located b/t skin and anterior aspect of patella - Subcutaneous Infrapatellar bursa located b/t skin and tibial tuberosity - Deep infrapatellar bursa located between patellar tendon and anterior aspect of infra patellar fat pad (superficial to tibial tuberosity) - Pes Anserine Bursa - Gastrocnemius Bursa - Communicating means that it's a continuum of the synovial.
54
Fat Pad
- Deep Infrapatella Fat Pad - Highly Innervated - Good Vasculartization
55
Retinaculum
- Extension of fibrous layer of knee joint - Retinaculum - Medial - Lateral
56
Plica
- Superior Band - Medial band - Most prominent - Inferior Band - Can be small or large and can become thickened and a source of pain
57
Iliotibial Band (ITB)
- Tendon of TFl - Thickening of fascia lata - Attaches to lateral tibia at Gerdy's tubercle - Also has fibers blending to lateral retinaculum and patella, therefore fibrous layer of joint - Function - >30 degrees flexion - < 30 degrees flexion
58
Popliteal Artery
Continuation of Femoral artery passes through the adductor hiatus distally
59
Popliteal Fossa
- Borders - Posteriorly-gastrocnemius (2 heads) - Floor- popliteus m. and femur - Superolateral- biceps femoris m. - Superomedial- semimembranosus and semitendinosus mm. - Contents: popliteal artery and vein, tibial and common peroneal nerve

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