Knee Flashcards
(151 cards)
1
Q
Medial femoral condyle
A
Extends further distantly
This creates a 10° valgus angle
2
Q
Lateral femoral condyle
A
Extends further anteriorly
This prevents lateral patellar dislocation from horizontal forces of the quadriceps
3
Q
Gerdy’s tubercle
A
On lateral tubercle of the tibia.
Attachment site for the ITB
4
Q
Patella
A
Triangular sesamoid bone
Attachment site foe muscles and improves extension of quads.
Apex (bottom), base (top)
Lateral, medial and odd facet
5
Q
Rectus femoris
A
AIIS –> tibial tuberosity
Knee extension, hip flexion, APT
Femoral nerve
Femoral and deep femoral artery
6
Q
Vastus lateralis
A
Linea aspera (lateral lip) –> tibial tuberosity.
Knee extension, some external rotation
Femoral nerve
Femoral, deep femoral and popliteal artery.
- because the fibres run more vertical than the VMO, it exerts more pull on the patella *
7
Q
Vastus medialis
A
Linea aspera (medial lip) --> tibial tuberosity
Knee extension, some medial rotation
Femoral nerve
Femoral artery
oblique fibre direction
8
Q
Sartorius
A
ASIS –> pes anserine
Hip Flexion, abduction, lateral rotation
Knee flexion
APT
Femoral nerve
Femoral artery
9
Q
Biceps femoris
A
Long head: Ischial tuberosity
Short head: linea aspera
Insertion: head of fibula and lateral tibial condyle
Knee flexion
Long head also extends hip, PPT
Sciatic nerve
Inferior gluteal, obturator and deep femoral arteries
10
Q
Semitendinosis
A
Ischial tuberosity –> pes anserine
Knee flexion
Hip extension, PPT
Sciatic nerve
Inferior gluteal, obturator and deep femoral arteries
11
Q
Semimembranosus
A
Ischial tuberosity –> medial tibial condyle
Knee flexion
Hip extension, ppt
Sciatic nerve
Obturator, deep femoral arteries.
12
Q
Popliteus
A
Lateral aspect of lateral femoral condyle –> medial proximal tibia
Medial rotation of tibia
Knee flexion
Tibial nerve
Popliteal artery
13
Q
Plantaris
A
“Palmaris longus of the leg”
Posterior lateral femoral condyle and distal lateral supracondylar line of the femur –> posterior calcaneus
(Runs between Gastrocs and soleus)
Plantar flexion
Knee flexion
Tibial nerve
Popliteal artery
14
Q
Closed chain movements of the knee
A
Flexion and extension –> raising and lowering body from ground
Rotation –> twisting body when foot planted.
15
Q
Knee flexion is controlled mostly by what nerve?
A
Tibial
16
Q
Knee extension is controlled mostly by what nerve?
A
Femoral
17
Q
The Vastus lateralis fibres are more vertical than the VMOs, therefore
A
The vastus lat has greater pull on the patella
18
Q
What two muscles feed into the patellar retinaculum?
A
VMO and vastus lateralis
19
Q
The sciatic nerve splits into:
A
The fibular which splits into superficial (lateral) and deep (anterior), and tibial (which innervates the posterior compartment)
20
Q
The lateral distal leg is innervated by the:
A
Superficial fibular nerve
21
Q
The anterior distal leg is innervated by the:
A
Deep fibular nerve
22
Q
The posterior distal leg is innervated by the:
A
Tibial nerve
23
Q
Medial collateral ligament
A
Flat band
Medial epicondyle of the femur –> proximal shaft of the tibia, and medial meniscus
Resists: valgus stress, hyperextension, anterior displacement of tibia on femur
24
Q
Adductor magnus tendon is fascially connected to
A
The VMO
25
Lateral collateral ligament
Lateral epicondyle of the femur --> head of the fibula
Resists: varus stress and hyperextension
Runs between the popliteus (medial) and biceps femoris (lateral)
26
LCL is different from the MCL in that:
It is shorter and rounder and hence more stable (and thus gets injured less often)
It does not attach to the meniscus
27
The collateral ligaments become _________ with lateral rotation of the tibia, and ________ with medial rotation.
Taut
| Lax
28
Anterior Cruciate Ligament
Intercapsular but Extrasynovial
Anterior intercondylar area of tiba, upward and lateral to the post-medial intercondylar notch of the lateral femoral condyle
Resists anterior glide and internal rotation of the tibia on the femur, and knee extension.
Fibres oblique, with multiple twisty bundles
29
Posterior Cruciate Ligament
Intercapsular but Extrasynovial
Posterior intercondylar area of the tibia, upward and medially to the ant-lateral intercondylar notch of the the medial femoral condyle
Fibres have medial twist, and run more vertically than ACL
30
PCL: Open chain
Resists posterior glide and internal rotation of tibia on femur, and knee extension
31
PCL: Closed chain
Resists anterior glide of femur on tibia (squatting) -- ant/med fibres become taut.
32
Oblique Popliteal Ligament
AKA short capsular fibres of the MCL
Post-med tibial condyle --> attaches to meniscus --> blends with semimem tendon --> medial side of lateral femoral condyle.
With MCL and semiMem, controlls ant-medial rotary instability
33
Arcuate popliteal ligament
Thickening of posterior lateral capsule
Attaches on the apex of the fibula --> fans in a Y-shape over the posterior joint capsule --> attaches to fascia of the popliteus and posterior horn of lateral meniscus
With LCL , ITB, popliteus and biceps femoris, reinfoces posterior joint capsule
34
Arcuate complex
popliteus + arcuate popliteal ligament
35
Posterior Meniscofemoral ligament
(Not always present)
Posterior side of lateral meniscus --> ant-lat surface of medial aspect of intercondylar fossa of the femur (beside PCL)
36
Anterior Meniscofemoral ligament
(Not always present)
Anterior: tracks on anterior surface of PCL
37
Transverse ligament
Runs between menisci and anchors them together
38
Coronary ligaments
Run the perimeter of the tibial plateaus
Anchor menisci to their tibial articular surfaces
Prevent displacement of the menisci
39
Which fibres of the coronary ligaments are longer?
Lateral -- thus more movement allowed
40
Menisci: Functions
1. shock absorber
2. spreads stress over a larger surface area
3. lubricates joint, decreases friction
4. improves joint congruency by evening out weight distribution
5. prevents hyperflexion
6. prevents joint capsule from entering joint space; participates in screw home mechanism
7. plays crucial role in degeneration
41
Medial Meniscus
Semilunar (C-shaped)
Anterior horn attaches to intercondylar area of tibia: anterior to ACL insertion
Posterior horn attaches anterior to PCL insertion
Coronary ligaments attach it to joint capsule, MCL, and medial tibial condyle
42
Lateral Meniscus
Semilunar (O-shaped)
Anterior and Posterior horns attach close to each other, just anterior and posterior to the intercondylar eminence
Coronary ligaments attach it to joint capsule and lateral tibial condyle but NOT the LCL.
Also attached to popliteus tendon
43
Which meniscus is more mobile?
Lateral, because:
- longer coronary ligaments,
- not attached to LCL, and
- popliteus connection increases its posterior movement during flexion
44
Fat Pads
Intracapsular but extrasynovial
- fill up dead spaces, thereby increasing stability
- assist joint lubrication
- abundant with free nerve endings --> impingement can lead to pain, the sensation of "giving out"
Densely packed fat cells containing elastic tissue --> change shape with joint movement
45
Movement of infrapatellar fat pad during flexion/extension
Deep to patellar tendon, superficial to femoral condyles
In flexion, fills intercondylar notch
In extension, occupies patellar groove and covers trochlear surface
46
The thickest layer of cartilage in the body is contained within ..
The patellofemoral joint
47
Patellofemoral joint
Synovial, modified plane
Patellar facets (convex) on femoral groove for the patella
48
Patellar ligament
Apex of patella to tibial tuberosity
49
Patellar retinaculum
Supplied partly by VMO and vastus lat fascia
Stabilizes patella against excess lateral and medial deviation
50
Superior TibFib Joint
Synovial, plane
Facet of head of the fibula (convex) on lateral tibia
Moderate capsular strength
Ligaments: ant, post ligaments of the head of the fibula
51
Tibial-Femoral: degrees of freedom
Two.
Flex/ext
IR/ER
52
Tibial-Femoral: resting
25º flexion
53
Tibial-Femoral: closed pack
Full extension and IR
54
Tibial Femoral: Capsular Pattern
Flexion>Extension
55
Tibial Femoral: ROM and End Feel
Flex: 135º
Ext: 15º
Med Rot: 20-30º
Lat Rot: 30-40º
Firm end feel
56
Patellofemoral: Degrees of freedom
Two
Flex/extend
Med/Lat glide
57
During which movements is the patella concave?
Superior-inferior
58
During which movements is the patella covex?
Medial-lateral
59
Patellofemoral: resting
Full extension
60
Patellofemoral: closed packed
Full flexion
61
Patellofemoral: capsular pattern
Flexion > Extension
62
The knee is anteriorly reinforced by:
Patellar tendon
| Quadriceps tendon
63
The knee is reinforced anterolaterally by:
Lateral patellar retinaculum (vast lat)
ITB
ACL
PCL
64
The knee is reinforced anteromedially by:
Medial patellar retinaculum (VMO)
65
The knee is reinforced medially and posteromedially by:
Pes anserine tendons (sartorius, gracillis, semiten)
Semimembranosus tendon
MCL
ACL
66
The knee is reinforced posterolaterally by:
Biceps femoris
ACL
PCL
LCL
67
The knee is reinforced posteriorly by
Gastrocs
Popliteus
(check ER and posterior displacement of tibia on femur)
68
Glide during knee flexion
Posterior glide of the tibia
69
Glide during knee extension
Anterior glide of the tibia
70
Tibial rotation during knee flexion:
First 15-20º internal rotation
71
Tibial rotation during knee extension
Last 15-20º external rotation
72
How is knee movement during flex/extension affected by the medial femoral condyle?
Because it projects more distally, is more curved and is obliquely oriented, and has a longer articular surface, during extension as the tibia glides forward the movement at the lateral condyle ends sooner. The tibia continues to move at the medial condyle, thus external rotating into valgus angulation.
73
What happens to the ACL and PCL during rotation?
They check IR
During ER they become lax, allowing more ER.
74
Popliteus: open and closed chain
Open: medial rotation of the tibia
Closed: lateral rotation of the femur
75
During knee extension, the menisci ...
move anteriorly
76
During knee flexion, the menisci ...
move posteriorly (allows them to maintain congruency)
77
Mobility of anterior and posterior horns of the menisci
Anterior: somewhat mobile
Posterior: fixed
78
Normal valgus angulation
6º
79
Excessive genu valgus, weight bearing forces shift
to lateral knee, stressing MCL
80
Excessive genu varus, weight bearing forces shift
to medial knee, stressing LCL
81
Patellar movement during knee flexion
S shaped -- superior-laterally
82
Patellar movement during knee extension
S shaped-- inferior-medially
83
The odd facet comes in contact with femoral condyles
at 135º knee flexion
84
Q angle is obtain by comparing
Axis of femur and axis of tibial tuberosity (centre of patella midpoint)
85
Normal Q angles
Males 13º
| Females 18º
86
During knee flexion:
Popliteus medial rotates tibia
Tibia medially rotates during first 15-20º
Tibia glides posteriorly on femur (restricted by PCL)
Menisci move posteriorly
The patella moves in an superior-lateral s-shaped direction
At 135º the patellar odd facet comes into contact with the femoral condyles.
Flexion restricted by tissue-on-tissue restriction
Medial rotation controlled by ACL, PCL, oblique popliteal ligament
87
During knee extension
Tibial glides anteriorly on femur (restricted by ACL)
Menisci move anteriorly
The patella moves in an inferior-medial S-shaped direction
Tibia externally rotates during the final 15-20º of extension
Hyperextension is checked by the MCL, LCL, ACL, PCL
88
Suprapatellar pain may indicate
rectus femoris tendonitis
89
Infrapatellar pain may indicate
Osgood Schlatter disease
90
Medial pain may indicate
ACL, PCL or meniscus injury
| OA
91
Lateral pain may indicate
ACL, PCL or meniscus injury
OA
ITB friction syndrom
92
Posterior pain may indicate
Baker's cyst
93
Prepatellar pain may indicate
OA
chondromalacia patella
tracking disorder
bursitis
94
Excess valgus force may lead to
injury to the MCL, medial meniscus, ACL (terrible triad)
95
Hyperextension may lead to
ACL injury, meniscal tears
96
Flexion with posterior translation may lead to
PCL injury
97
Excess varus force may lead to
LCL, PCL, posterolateral capsule injuries
98
The knee is most like to become injured from force directed in what direction?
Antero-valgus/ antero-medial
99
Decreased Q angle will cause the patella to
track medially
| --> chrondromalacia patella
100
Increased Q angle will cause the patella to
track laterally
| --> sublux, tracking disorder, chrondromalacia
101
Patella alta
Patella rides high
102
Patella baja
patella rides low
103
Camel sign
One hump from patella alta, the other from exposed fat pad
104
L4 reflex
Knee Jerk
105
L5 reflex
Medial Hamstrings
106
S1 reflex
Achilles
107
L3 dermatome
Lateral leg just above and below knee, toward anterior shin
108
L4 dermatome
Post-medial leg, heel, medial plantar foot to big toe
109
L5 dermatome
Anterolateral leg, dorsum of foot
110
S1 dermatome
Lateral lower leg, lateral edge of foot
111
At 90º flexion, the femur is in contact with what part of the patella?
Superior
112
At 45º flexion, the femur is in contact with which part of the patella?
Middle
113
At 20º flexion, the femur is in contact with what part of the patella?
Inferior
114
MCL Spain: MOI
excessive valgus or lateral rotational stress; blow to lateral knee
(usually occurs with damage to other structures)
115
MCL Sprain: Sx
ADL: problem with lateral change of direction.
| Pain, instability with push off
116
MCL Sprain: effusion
A Grade 3 rupture will also tear through the joint capsule, so there will be minimal edema
117
MCL Sprain: Special Tests
Acute: brush/stroke
| SubA/Chronic: Valgus Ligamentous Stress Test, Apley's Distraction
118
LCL Sprain: MOI
Excessive varus and rotational stress; blow to medial knee
| rarely damaged in isolation
119
LCL Sprain: Sx
ADL: problem with lateral change of direction; pain/instability with decel
120
MCL sprain will also often involve
ACL
| medial meniscus
121
LCL sprain will also often involve
bicep femoris
popliteus
ITB
gastrocs
122
LCL Sprain: Special test
Acute: brush/stroke
| SubA/Chronic: Varus ligamentous stress test, Apley's distraction
123
ACL Sprain: MOI
Excessive IR, valgus or varus stress
Forced hyperextension
Direct blow with foot planted; indirect twisting
124
ACL Sprain: ADLs
Unable to run forward
125
ACL Sprain: Which muscle needs strengthening?
Hamstrings (resist anterior glide); emphasis on closed chain exercises until able to do MOI
126
ACL Sprain: Special Tests
Acute: brush/stroke
| SubA/Chronic: Lachman's, Anterior Drawer
127
PCL Sprain: MOI
Direct injury to flexed knee
Hyperextension
Dashboard injury
128
PCL Sprain: ADLs
Can't squat, run backwards, descend stairs
129
PCL Sprain: Remex focus
Quadricep strength, closed chain exercises
130
Coronary Ligament Sprain: Sx
persistent, intermittent knee pain
| when chronic, painful PROM/POP flex/ext/ER due to scarring
131
Which coronary ligaments are most frequently sprained?
medial/anteromedial. Often accompany meniscal injuries
132
Meniscal Injuries: MOI
Forced opposite rotation during flex/ext; excessive knee flexion while weight bearing; poor (grinding) biomechanics
133
Which meniscus is more prone to injury?
Medial (less mobile)
134
Meniscal Injuries: Sx (Acute)
Acute: "something giving out"; bowel-liquifying pain
Joint effusion, palpable tenderness
Refusal to return to activity
135
Meniscal Injuries: Sx (Chronic)
Clicking and catching
| Locking of knee in flexion around 25º
136
Meniscal Injuries: Special Tests
The Twist
MacMurray's
Apley's Compression
137
Patellofemoral Syndrome
Painful degenerative changes to the patella
138
Patellofemoral Syndrome: predisposing factors
```
Biomechanics (pronation, tibial ER, anteversion, Q angle)
Structural issues (patella alta -- not blocked by lat condyle)
Posture (hyperlordosis)
Muscle Imbalances (Vast lat: VMO)
```
139
Patellofemoral Syndrome: Sx
```
Movie Theatre Sign
Pain with compression (Clarke Sign)
Crepitus
Edema
Peripatellar or subpatellar pain (ant/med)
```
140
Patellofemoral Syndrome: Special Tests
Grind Sign/Clarke/Patellofemoral Compression
| Patellofemoral Apprehension
141
Chondromalacia Patella
Softening of the articular cartilage of the patella
May lead to patellofemoral syndrome
** In H & K same as patellofemoral/patellar tracking **
142
Chondromalacia Patella: Sx
Grating, grinding sensation with knee flexion
Anterior knee pain when standing after sittings
Increased pain going up stairs, getting out of chair
Positive for Grind test
143
Plica Syndrome
Synovial fold in 55% of population which runs from superomedial medial condyle to infrapatellar fat pad.
May become fibrosed and cause pain, snapping and clicking similar to a meniscal or patellofemoral problem
144
Patellar Tendonitis
Jumpers knee
inflammation of the patellar tendon from repetitive strain, often in jumping sports
145
Patellar Tendonitis: Sx
Burning pain at superior pole, inferior pole, or tibial tuberosity.
Similar presentation to patellofemoral syndrome
Pain with RROM Flexion OR extension (depending on what book you read). Grrrrrrr.
146
Patellar Tendonitis: Special tests
Tendonitis differentiation test
Grind test
Ely's (pain with POP)
147
ITB Friction Syndrome
Inflammation and pain with ITB crosses at lateral femoral condyle
MOI: repeated hip/knee flexion, postural imbalances
148
ITB Friction Syndrome: Sx
Gradual onset, worse with activity (especially downhill running)
Pain along lateral thigh, into lateral knee
Decreased adduction, extension/flexion, rotation
149
ITB Friction Syndrome: Presentation
HT, TrPs at TFL, glutes, vast lat
150
ITB Friction Syndrome: Special Tests
Noble's Compression Test
Ober's
Thomas
151
Knee OA
Painful degenerative condition affecting articular cartilage of the joint and subchondral bone
Pain inside knee with (over)use; stiff with disuse
