Knee

Question 1

Classification: Modified hinge joint
Degrees of freedom: Flexion, extension, internal rotation, external rotation
Function: Weight-bearing joint, susceptible to degenerative changes

Answer 1

Tibiofemoral Joint:

Question 2

Angle between ASIS-patella line and patella-tibial tuberosity line
Normal range: Males: 13 degrees, Females: 18 degrees
Altered Q-angle: Affects patellar position, leading to genu varum or genu valgum

Answer 2

Q-Angle:

Question 3

Abnormal angulation observed during sitting
Characteristics: Anteverted hip, laterally dislocated patella, externally rotated tibia

Answer 3

Bayonet’s Sign

Question 4

Angle between femur and tibia axes
Normal range: 180-185 degrees
Altered angle: Indicates genu varum (decreased) or genu valgum (increased)

Answer 4

Medial Tibiofemoral Angle/Knee Angle

Question 5

Genu Valgum vs. Genu Varum

Answer 5

Genu valgum: Knees close together, tibia outward
Genu varum: Knees apart, tibia inward

Question 6

Features: Largest sesamoid bone, contains five facets
Function: Incongruent joint, contact during extension only at inferior pole

Answer 6

Patellofemoral Joint:

Question 7

Softening of cartilage underneath the patella
Cause of knee pain, especially over full flexion
Most affected area: Odd facet
Cinema Sign: Knee pain upon standing after prolonged sitting

Answer 7

Chondromalacia Patellae

Question 8

Umbrella term for anterior knee pain
Associated with patellar malalignment and tracking issues
Symptoms: Pain during stairs, prolonged sitting (movie sign), squatting, etc.

Answer 8

Patellofemoral Pain Syndrome (PFPS):

Question 9

Procedure: Patient supine with knee flexed at 30 degrees, examiner laterally deviates patella
Positive test: Quads contraction or apprehension, indicating possible patellar subluxation or dislocation

Answer 9

Special Test: Fairbank’s Apprehension Test:

Question 9

Inflammation of synovial fold causing snapping or catching sensation

Answer 9

Plica syndrome

Question 9

Inflammation or impingement of infrapatellar fat pad causing anterior knee pain

Answer 9

Fat pad syndrome

Question 10

Inflammation of patellar or quadriceps tendon, common in jumping sports

Answer 10

Tendonitis/jumper’s knee:

Question 11

Irritation of IT band against lateral femoral condyle, seen in runners or cyclists

Answer 11

IT band friction syndrome:

Question 11

Inflammation of bursa between skin and patella, causing swelling and tenderness

Answer 11

Inflammation of bursa between skin and patella, causing swelling and tenderness

Question 12

Bone tissue death leading to retropatellar pain, most common in medial knee

Answer 12

Osteochondritis dissecans

Question 13

Where is the pain felt in these cnditions
Sinding-Larsen Johansson syndrome:
Osgood-Schlatter disease:

Answer 13

Sinding-Larsen Johansson syndrome: Pain over inferior pole of patella
Osgood-Schlatter disease: Pain over tibial tuberosity

Question 14

Special Tests for PFPS:

Answer 14

Clarke’s Sign: Tests for patellar maltracking; patient in supine, examiner applies pressure on superior patella while patient contracts quadriceps.
Eccentric Step Test: Assesses patellar tracking during eccentric loading of quadriceps; patient descends a step with control.
Noble Compression Test: Evaluates for IT band friction syndrome; patient in supine with knee flexed, examiner applies pressure over lateral femoral condyle.

Question 14

Encloses patellofemoral and tibiofemoral joints; reinforced by structures like subcrureus.
Two layers: Synovial (inner), Fibrous (outer); patellar plica are remnants of synovial membrane and can cause pain if not reabsorbed.

Answer 14

Joint Capsule

Question 15

Most commonly affected in plica syndrome is infrapatellar; medial plica is most symptomatic.

Answer 15

Patellar Plica:

Question 15

housemaid’s knee (),
vicar’s knee (),
clergy’s knee (),
Baker’s cyst ().

Answer 15

housemaid’s knee (prepatellar),
vicar’s knee (infrapatellar),
clergy’s knee (infrapatellar), and
Baker’s cyst (popliteal).

Question 16

Fibrocartilaginous discs shaped like “MCLO”; functions include enhancing joint congruency, distributing weight-bearing forces, reducing friction, and absorbing shock.
More mobile: Lateral meniscus; Susceptible to injury: Medial meniscus.

Answer 16

Menisci

Question 17

Meniscal Attachments:

Answer 17

Transverse ligament, patellomeniscal ligaments, coronary ligaments, meniscofemoral ligament, Ligament of Humphry (Anterior PCL), Ligament of Wrisberg.

Question 17

Triad of the Knee:

Answer 17

Consists of PCL, MCL, and ACL.

Question 18

Nutrition: Only outer portion has blood supply; inner portion receives nutrition via diffusion.
Innervation: Central position is avascular.

Answer 18

Meniscal Characteristics:

Question 19

Signs and Symptoms of Meniscal Injury:

Answer 19

Joint line pain, loss of flexion (>10 degrees) and extension (>5 degrees), swelling, crepitus, positive special tests for meniscal integrity.

Question 19

Effect of Tibial Rotation on Cruciate and Collateral Ligaments:

Answer 19

Lateral rotation of tibia (ERCOLTA): Medial and lateral collateral ligaments become taut, while medial and lateral cruciate ligaments become lax. Medial rotation of tibia (IRCRUTA): Cruciate ligaments become taut, while collateral ligaments become lax.

Question 19

Primary rotatory stabilizers of the knee, restraining antero-posterior tibial motion and internal rotation of the tibia. Intracapsular and extrasynovial (ICES); no intrinsic source of depression, necessitating replacement if damaged.

Answer 19

Cruciate Ligaments:

Question 20

Special Test for ACL Injury:

Answer 20

Anterior Drawer Test: Knee flexed to 90 degrees. Lachman Test: Knee flexed to 25 degrees (20-30 degrees); considered better than Anterior Drawer Test due to hamstring contraction.

Question 21

MOI Tibia anteriorly displaced, externally rotated, with a valgus force.

Answer 21

Anteromedial Instability:

Question 22

MOI Tibia anteriorly displaced, internally rotated, with a varus force.

Answer 22

Anterolateral Instability:

Question 23

MOI Tibia posteriorly displaced, internally rotated, with a valgus force.

Answer 23

Posteromedial Instability:

Question 23

MOI Tibia posteriorly displaced, externally rotated, with a varus force.

Answer 23

Posterolateral Instability:

Question 24

Screw Home Mechanism/Locking of the Knee

Answer 24

Open Kinetic Chain (OKC): External rotation of the tibia in the last degrees of knee extension. Closed Kinetic Chain (CKC): Femur internally rotates on the fixed tibia.

Question 25

Mechanism of Injury: Vulnerable as it passes the fibula, injuries over the fibula can lead to foot drop or steppage gait due to loss of dorsiflexion.

Answer 25

Common Peroneal Nerve:

Question 26

Mechanism of Injury and Manifestation: Injury directed over the vastus medialis or adductor longus can lead to medial knee pain and loss of sensation in the medial aspect, known as Turner’s sign.

Answer 26

Saphenous Nerve: