MSK - The Knee Joint Flashcards by Gianluca Tosney

What type of joint is the knee joint?

Hinge Type Synovial joint

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What type of movements does the type of joint that the knee joint is allow?

Flexion and Extension (and to a degree, lateral and medial rotation)

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Wat articultions is the knee joint formed by?

Articulations between the Patella, Femur and Tibia

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What does the shape of the knee joint mean in relation to its strength?

What does it rely on to ensure stability?

Relatively weak

Relies on muscles and ligaments

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Label this diagram of a knee joint

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Name the articulatons of the knee joint and describe what is articulating in each one

Tibiofemoral – The medial and lateral condyles of the femur articulating with the tibia

Patellofemoral – The anterior and distal part of the femur articulating with the patella

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What articulation is the green highlighted area?

What articulation is the pink highlighted area?

Green - Tibiofemoral

Pink - Patellofemoral

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What is the function of the tibiofemoral joint?

It is the weightbearing joint

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What is the function of the patellofemoral joint and how does it do this?

Increases the efficiency of the quadriceps femoris muscle

Allows the tendon to be inserted directly over the knee

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What are both joints lined by?

What are both joints enclosed by?

Both lined by hyaline cartilage

Both enclosed by a single joint cavity

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In relation to the quadratus femoris tendon, what does the patella do?

Minimises wear and tear

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Name the menisci of the knee joint

What type of structure are they?

Medial and Lateral

Fibocartilage

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What are the functions of the menisci?

1 - To deepen the articular surface of the tibia, thus increasing stability of the joint

2 - To act as shock absorpers

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What shape are the menisci and where do they attach?

C shaped

Attach at both ends to the intercondylar area of the tibia

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Where else does the medial menisci attach?

What clinical relevance does this have?

Also attaches to the tibial collateral ligament and the joint capsule

Any damage to the tibial collateral ligament results in tearing of the medial meniscus

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What is the structure highighted in green?

What is the structure highighted in red?

What is the structure highighted in blue?

Green - Tibial Collateral Ligament

Red - Lateral Meniscus

Blue - Medial Meniscus

What is a bursa and what is it’s function?

A bursa is synovial fluid filled sac, found between moving structures in a joint with the aim of reducing wear and tear on those structures

Name the bursae located in the knee joint and where they can be found

Suprapatella bursa – This is an extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur

Prepatella bursa – Found between the apex of the patella and the skin

Infrapatella bursa – Split into deep and superficial. The deep bursa lies between the tibia and the patella liagment. The superficia lies between the patella ligament and the skin

Semimembranosus bursa – Located posteriorly in the knee joint, between the the semimembranosus muscle and the medial head of the gastrocnemius

Name the major ligaments in the knee

1 - Patellar Ligament

2 - Collateral Ligaments

2a - Tibial (medial) collateral ligament

2b - Fibular (lateral) collateral ligament

3 - Cruciate Ligaments

3a - Anterior cruciate ligament

3b - Posterior cruciate ligament

Where are the attachments of the patellar ligament?

A continuation of the quadriceps femoris tendon distal to the patella, it attaches to the tibial tuberosity

What are the shape of the collateral ligaments?

What is their function?

Strap-Like

Stabilise the hinge motion of the knee and prevent any lateral or medial rotation

What shape is the Tibial (medial) collateral ligament?

Where are its attachments?

A wide and flat ligament

Proximally - Medial epicondyle of the femur

Distally - Medial surface of the tibia

What shape is the Fibular (lateral) collateral ligament?

Where are its attachments?

What is its function?

Thinner and rounder than the tibial collateral

Proximally - Intercondylar fossa of the femur

Distally - Posterior intercondylar region of the tibia

Prevents posterior dislocation of the tibia onto the femur

What are the four main movements of the knee joint?

Extension

Flexion

Medial Rotation

Lateral Rotation

What muscle(s) allow knee joint **extension**?

**Quadriceps Femoris**

What muscle(s) allow knee joint **flexion**?

**Hamstrings, gracilis, sartorius** and **popliteus**

What muscle(s) allow knee joint **Lateral Rotation**?

**Biceps Femoris**

What muscle(s) allow knee joint **Medial Rotation**?

**Semimembranosus, Semitendinosus, Gracilis, Sartorius** and **Popliteus**

How do injuries to the collateral ligaments occur?

Force being applied to the side of the knee when the foot is placed on the ground

How can damage to the collateral ligaments be assessed?

Asking the patient to medially rotate and laterally rotate the leg **Pain on medial rotation -** Damage to the medial ligament **Pain on lateral -** Damage to the lateral ligament

If the tibial collateral ligament is damaged, what else is more than likely torn?

The **medial meniscus**

How can damage to the anterior cruciate ligament (**ACL**) occur?

**Hyperextension** of the knee joint Application of a large force the back of the knee with the joint partly flexed

How can you test for injury to the anterior cruciate ligament?

Peform an **anterior drawer test** where you attempt to pull the tibia forwards, if it moves, the ligament has been torn

What is the triad of injuries that damage to the anterior cruciate ligament displays known as? What is the triad?

The **Unhappy Triad** ## Footnote **1 - Rupture of the medial collateral ligament** **2 - Damage to the medial meniscus** **3 - Rupture of the anterior cruciate ligament**

What is the most common mechanism of posterior cruciate ligament damage? What is it known as? How else can it be damaged?

"**Dashboard Injury**" - This occurs when the knee is **flexed** and a large force is applied to the shins, pushing the tibia posteriorly. Often seen in car accidents Can also be torn by **hyperextension** of the knee joint or damage to the upper part of the tibial tuberosity

How do you test for Posterior Cruciate Ligament damage? How is it performed?

**Posterior Drawer Test** Hold the knee in flexed position and pushed the shin posteriorly. If there is movement, the ligament has been torn

What can friction between the skin and the patella cause? How does this clinically present?

Can cause the prepatella bursa to become inflammed Produces a swelling on the anterior side of the knee known as **housemaids knee**

What can friction between the skin and tibia cause? What is this known as?

Cause the **infrapatella bursa** to become inflamed ## Footnote **Clergyman's Knee**