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OMS Peripheral > Knee > Flashcards

Knee Flashcards

(96 cards)

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1
Q

Where does the lateral collateral ligament originate?

A

The lateral epicondyle of the femur

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2
Q

Where does the medial collateral ligament originate?

A

The medial epicondyle of the femur

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3
Q

Where does the gastrocnemius originate?

A

The femoral condyles

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4
Q

What inserts onto the tibial tuberosity?

A

The infrapatellar tendon (ligamentum patellae)

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5
Q

What inserts onto Gerdy’s tubercle and where does it lie?

A
  • ITB

- Anterolaterally to the tibial tiberosity (2/3 of the way between tib tuberosity and fibula)

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6
Q

What attaches onto the fibular head? (2)

A

1- LCL
2- Biceps femoris

The common peroneal nerve wraps around the fibular head posteriorly

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7
Q

What are all the joints in the knee? (3)

Within how many capsules?

A

1- Superior tibiofibular joint
2- Patellofemoral joint: the extensor mechanism of the knee
3- Tibiofemoral joint: weight bearing activities

2&3 are in the same capsule

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8
Q

What are the four main patellar bursae?

A

1- Prepatellar bursa (subcutaneous)
2- Subcutaneous superficial infrapatellar bursa
3- Deep infrapatellar bursa (no communication with the joint, best felt with the knee in extension and it is just proximal to the tibial tuberosity)
4- Suprapatellar bursa (

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9
Q

Where does the infrapatellar fat pad of Hoffa lie?

A

It lies between the infrapatellar tendon and knee joint.

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10
Q

What is the quadriceps expansion/patella retinacula?

A

The tendons of vastus medialis and lateralis insert onto the medial and lateral borders of the patella.

Along with the ITB, it is responsible for transverse stability of the patella.

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11
Q

What does the medial aspect of the quadriceps expansion blend with?

A

The MCL

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12
Q

What type of joint is the tibiofemoral joint?

A

Hinge joint

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13
Q

What do the menisci of the knee do? (4)

A

1- Shock absorption
2- Load transmission
3- Lubrification
4- Stability

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14
Q

What are the coronary ligaments?

A

The ligaments that attach the menisci to the tibial condyles (“eyelashes of the menisci”)

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15
Q

Which coronary ligaments are longer between the medial and lateral?

A

Lateral due to the greater excursion of the lateral meniscus

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16
Q

What are the orientations of the knee’s menisci collagen fibres?

A

Superficial fibres - radial

Deep fibres - circumferential

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17
Q

What do the radial fibres of the knee’s menisci do?

A

Resistance to longitudinal stresses

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18
Q

What do the circumferential fibres of the knee’s menisci do?

A

Facilitates dispersion of compressive loads

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19
Q

What are the two types of injury to the menisci?

A

1- Longitudinal or transverse splitting of the fibrocartilage
2- Separation of the thinner inner part of the meniscus from the thicker outer portion (“bucket handle”)

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20
Q

What is the medial meniscus attached to?

A

The MCL

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21
Q

What is the lateral meniscus attached to?

A

It is separated from the capsule by the tendon of the popliteus. Posteriorly, the lateral meniscus contributes a ligamentous slip to the PCL –> Posterior meniscofemoral ligament

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22
Q

What are the three plicae of the knee?

A

1- Superior plica
2- Inferior plica
3- Medial plica –> alongside the medial border of the patella

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23
Q

What are the tendons that compromise pes anserinus (anteriorly to posteriorly)?
“Say Grace before Tea”

A

Sartorius
Gracilis
semiTendinosus

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24
Q

What is the size of the MCL and what are its attachments?

A

It originates from the medial femoral epicondyle, is 2.5 fingers wide and runs down approx 5 cm past the joint line (8-10cm in total length). It inserts into the tibia, posteriorly to pes anserus

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25
What are the two parts of the MCL?
1- Superficial layer: 80% of the resistance to valgus forces, these are the strongest part of the ligament 2- Deep layer: attaches to the capsule and medial meniscus, these are more prone to injury
26
What does the MCL stabilise?
1- The medial side of the knee, preventing excessive valgus forces Preventing... 2- lateral rotation of the tibia 3- anterior translation of the tibia 4- hyperextension of the knee
27
What is the size of the LCL and what are its attachments?
- 5cm long and the width of half a pencil - It originates at the lateral epicondyle of the femur and inserts into the head of the fibula where it blends with the tendon of biceps femoris
28
What does the LCL stabilise?
1- Restrains varus movement Controls... 2- posterior translation of the tibia 3- Lateral rotation of the tibia
29
Are the cruciate ligaments intracapsular?
Yes
30
Are the cruciate ligaments intrasynovial?
No
31
What is the size of the cruciate ligaments?
As thick as a pencil
32
Which fibres are taut in extension and flexion between the ACL's anteromedial and posterolateral bands?
Anteromedial - taut in flexion | Posterolateral - taut in extension
33
Does the ACL stabilise throughout movement?
True
34
What are the ACL's stabilising roles?
Resists... 1- anterior translation of the tibia 2- medial translation of the tibia 3- Valgus, varus and hyperextension stresses
35
What is the most common mechanism of injury to the ACL?
Lateral rotation combined with a valgus force applied to the fixed tibia It may also be injured in hyperextension, medial rotation in full extension or anterior translation caused by direct injury to the calf
36
Which is stronger between the ACL and PCL?
The PCL is twice as strong as the ACL and less oblique.
37
Is the PCL a principle stabiliser?
Yes
38
What does the PCL stabilise?
Controls... 1- posterior translation of the tibia 2- produces and restrains rotation of the tibia because posterior translation of the tibia occurs with concomitant lateral rotation of the tibia
39
What is the most common mechanism of injury for the PCL?
Forced posterior translation of the tibia on the flexed knee ("Dashboard injury") May also be injured in hyperextension
40
What forces go through the tibiofemoral joint in walking?
2-5 times body weight
41
What forces go through the tibiofemoral joint in running/jumping?
24 times body weight
42
What are the ranges of movement to the knee?
Extension - 0 degrees Flexion - 140 degrees Approx 5-10 degrees of passive extension Approx 160 degrees of passive flexion
43
When are active and passive axial rotations possible?
With the knee at 90 degrees in order to relax the coronary ligaments
44
What are the ranges for active axial rotation?
Lateral - 45 degrees | Medial - 35 degrees
45
When does automatic, involuntary rotation occur at the knee to achieve locked and unlocked positions of the knee?
It occurs around 20 degrees extension, the tibia rotates laterally to produce the 'locking' phase of the knee. The knee 'unlocks' with the popliteus medially rotating the tibia
46
What are the two main function of the patellofemoral joint?
1- Produces anterior displacement of the quadriceps tendon during movement, assists knee expansion by increasing the lever arm of the quads 2- Increases the contact area between the patellar tendon and the femur --> distributing compressive forces over a wider area
47
What can patellofemoral symptoms arise from?
``` 1- Instability 2- Maltracking 3- Malalignment 4- Biomechanical causes 5- Subluxation 6- Dislocation --> may lead to chondromalacia pattellae and OA of the joint ```
48
Which direction does the patella tend to migrate on full extension:
Laterally
49
What counteracts the natural displacement of the patella? | 3
1- High lateral border of the patellar groove on the femur 2- Active pull from the oblique fibres of vastus medialis 3- Medial quadriceps expansion
50
What type of joint is the superior tibiofibular joint?
Synovial plane joint
51
What is vastus medialis obliquus (VMO) made out of?
1- Vastus medialis distal fibres | 2- Adductor magnus
52
Where does the apex of the patella lie with the knee in extension and flexion?
Extension - 1 finger's breadth above the joint line | Flexion - Joint line
53
What is the best position of the leg to palpate the LCL?
Have the leg in the FABER position
54
What are possible conditions for knee pain in children?
- Knee pain in children is often referred from the hip - Meniscal lesions don't start until adolescence - Gradual onset of knee pain in adolescents: patellofemoral joint syndromes or Osgood-Schlatter's disease - Males --> traumatic meniscal tears from sport - Females --> instability, subluxation, episodes of dislocation of the patella
55
When does RA in the knee begin?
Between 30-40 yrs
56
Where can the knee refer pain to?
- Distally | - Occasionally proximally to the thigh
57
What is the most common site for anterior knee pain?
Superolateral corner at the insertion of vastus lateralis
58
What are the knee menisci and ligaments more prone to?
Acute lesions
59
What is likely injured after a direct injury?
Muscular contusion - likely quadriceps
60
What is likely injured after a direct blow to the patella (fall on bent knee)?
- Fracture - Contusion of the periosteum - Prepatella bursa involvement - PCL injury
61
What is likely injured after lateral side of the knee impact (rugby/football/etc)?
Results in excessive valgus: | - MCL
62
What is likely injured after excessive force applied to a flexed knee while the foot is planted e.g. skiing?
MCL/ACL/Medial meniscus
63
What is likely injured after a rotational injury?
Coronary ligaments
64
What is likely injured after a hyperextension injury?
Any of the ligaments as they are all taut in extension but the MCL and ACL are more likely to be injured
65
What would recurrent pain and swelling episodes be caused by?
Instability and derangement of the joint
66
Whats does being able to continue with the activity after knee injury signify?
Indicates a minor ligamentous sprain
67
If the patient is completely incapacitated after knee injury what does this indicate?
Major lesions: - ligament disruption and muscle tears - meniscal lesions or cruciate rupture
68
What pain does partial ligament tear produce?
Severe pain on movement
69
What does a pseudo locking of the knee after long period of sitting indicate?
Patellofemoral joint
70
What are typical aggravating factors for patellofemoral joint pain?
- Walking - Squatting - Using stairs (especially going down) When the forces going through the knee increase to 3x body weight
71
What is the most common structure in the knee to cause haemarthrosis?
ACL
72
What does swelling over 6-24hrs after injury indicate?
Slower swelling = synovial in origin as less blood supply e.g. MCL, meniscus, subluxation of the patella
73
What does swelling 2-6 hours after injury indicate?
Faster swelling = haemarthrosis e.g. ACL
74
What is a Baker's cyst?
Synovial effusion into the gastrocnemius or semimembranosus bursa due to effusion in the knee joint
75
What does true locking of the knee indicate?
A meniscal tear, this has a tendency to repeat itself
76
What is the treatment for traumatic arthritis of the knee
Direct treatment based on the cause
77
What is the treatment for OA and inflammatory arthritis?
Injection
78
What differential diagnosis needs to be made with a potential loose body in the knee?
ACL tear has similar symptoms, this needs to be considered if the symptoms have arisen post trauma
79
What age group does osteochondritis dissecans affect?
15-20 year olds
80
What are the characteristics of a Grade 1 MCL sprain?
- Pain, tenderness, swelling at site of injury - Mild capsular pattern - No notable instability - Normal valgus laxity
81
What are the characteristics of a Grade 2 MCL sprain?
- Moderate-major tearing of the ligament fibres - Pain and tenderness at site - Moderate to severe swelling - Capsular pattern - Minor degree of laxity - Firm elastic end feel
82
What are the characteristics of a Grade 3 MCL sprain?
- Macrofailure or complete rupture of the ligament - Swelling - Possible haemaerthrosis - Full capsular pattern - Severe pain at time of injury but relatively little since - Definite ligament laxity - Soft end-feel
83
What is the treatment for a MCL sprain?
- Occasionally surgery - Conservative management for functional recovery from ligamentous laxity: strengthening the dynamic knee stabilisers of the knee (hamstrings and quadriceps) while maintaining control with appropriate braces - Aspirate haemarthrosis
84
What is the treatment for an acute MCL sprain?
- POLICE | - Gentle transverse frictions as early as possible + 6 deep sweeps (2 -3 fingers) --> followed by a Grade A
85
What is the treatment for a chronic MCL sprain?
This is only if pt has end-range pain and/or limitation of movement (passive flexion or extension), pain on valgus stress 1- Friction for analgesic effect 2- Grade C mobilisation either in extension or flexion based on the limitations 3- Vigorous mobilisation post Grade C
86
What are the main findings for coronary ligament sprain?
- Pain on lateral rotation of the tibia if medial meniscus injured or medial rotation if lateral meniscus injured (less likely) - Pain on passive extension - Tender on palpation
87
What is the treatment for coronary ligament sprains?
- Friction | - Injection
88
What is the presentation of a knee bursitis?
- Localised pain | - Local swelling
89
Which two bursae of the knee are most commonly injured?
1- Prepatellar bursa | 2- Infrapatellar bursa
90
What is the treatment for knee bursitis?
- Injection
91
What is the treatment for quadriceps lesions?
- Friction with knee extended | - Grade A exercises
92
What is the presentation for tendinopathy of the medial and lateral quadriceps expansion?
- Gradual onset of pain - Felt locally - Pain on resisted knee extension - Tenderness over the medial, lateral or both sides of the patella
93
What is the treatment for tendinopathy of the quadriceps expansion?
- Friction to either or both sides ('up' and under) of the patellar borders
94
Where are two sites of patellar tendinopathy?
1- Apex of the patella (infrapatellar tendon) --> MOST COMMON, linked with repetitive jumping 2- Base of the patella (suprapatellar tendon)
95
What is the treatment for patellar tendinopathy?
- Friction | - Injection
96
What differential diagnosis can you make for patellar tendinopathy?
Infrapatellar fat pad (Hoffa's disease) causes similar symptoms but produces pain when gently squeezed at either side of the lower patella

OMS Peripheral (8 decks)

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