The Knee joint Flashcards Preview

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Flashcards in The Knee joint Deck (89):
1

What are acute injuries to the knee caused by and where do they usually present to?

- sports
- falls
- elderly
- fracture
- tear/sprain of ligaments
- soft tissues
- cartilage

2

What causes acute swelling/ pain?

- atraumatic causes
-acute gout
- flare of Osteo-arthritis
- flare of RA

3

What causes chronic knee pain/ swelling?

- osteoarthritis
- bursitis

4

What can severe knee pain result in?

reduced mobility

poor sleep

reduced quality of life

5

How does chronic knee pain/swelling have to last for in order for it to be classified as chronic?

3-4 months to 1 year

6

What is not associated with the knee joint?

fibula

7

What type of joint is the knee joint?

hinge joint

synovial

8

What 3 bones are involved in the knee joint?

1. distal femur
2. proximal tibia
3. patella

9

How many articulations do the 3 bones involved in the knee joint form?

3 articulations

10

What are the 3 articulations formed in the knee joint?

- 2 femorotibial - medial and lateral
- 1 femoropatellar

11

What is the most proximal part of the tibia like?

flat

12

What are the movements of the knee joint?

- extension/ flexion
- medial/lateral rotation - only a very small amount of rotation

13

Why do you lose knee flexion when the hip is extended?

due to the loss of tension on hamstrings

14

When can rotation occur?

when knee is flexed and collateral ligaments are relaxed

15

What happens when the knee joint approaches full extension?

the femur undergoes a few degrees of medial rotation on the tibia

this is also known as locking

16

What is locking?

joint approaching full extension and causing the femur to undergo a few degrees of medial rotation on the tibia

17

Is locking the knee stable or unstable and why is it so?

it is stable - as thigh muscles can relax

18

How is the knee unlocked?

By the popliteus muscle

19

What does the popliteus muscle do to the femur?

it laterally rotates the femur

20

Where and what is the popliteal fossa?

The space at the back of the knee

21

What runs through the popliteal fossa?

the popliteal artery

22

What are the medial and lateral femoral condyles?

expanded ends of the femur

23

What are the slight expansions of the proximal tibia?

medial and lateral tibial condyles

24

What is the flat surface of the tibia above the condyles known as?

tibial plateau - medial and lateral

25

What is the fit like of the tibial plateau with the rounded femoral condyles and what is the joint described as?

poor fit

incongruent

26

What is the tibial plateaux deepened by?

- 2 plates of fibrocartilage
- the menisci

27

What is stability and congruency like in extension?

most stable

very congruent

28

What is stability and congruency like in flexion?

unstable

least congruent

29

What are the menisci?

2 c shaped wedges of fibrocartilage

30

Where are the menisci thicker?

at the external margins

31

What are the functions of the menisci?

- increase joint congruency
- distribute weight evenly
- shock absorption
- assist in locking mechanism

32

What do the external edges of the menisci attach to?

fibrous capsule of the joint

33

What is the medial meniscus firmly attached to?

the tibial collateral ligament

34

What can cause meniscal tears?

sports or degenerative changes

35

What can cause pain or locking in meniscal tears?

displaced cartilage becoming trapped during knee movements

36

What is the treatment of meniscal tears?

repair or resection

37

What arthritis is damage of the meniscus associated with?

osetoarthritis

38

Why is the meniscus not very good at repairing itself?

as there is decreased blood supply

39

What are the different types of meniscal tears? (6)

1. vertical
2. transverse
3. peripheral
4. bucket handle
5. parrot beak
6. flap

40

What contribute to the stability of the knee?

ligaments

muscles - surrounding (most important part of the knee)

41

What are the ligaments inside the joint/ intra-articular ligaments?

anterior and posterior cruciate ligaments

42

What are the ligaments outside the joint/ extra articular ligaments?

fibular and tibial collateral ligaments

they work down on each side of joint

43

Where are the cruciate ligaments?

inside the joint capsule

44

how do the cruciate ligaments cross each in the centre of the knee?

obliquely

45

What does the posterior cruciate ligament attach to?

posterior intercondylar region of the tibia

46

Where does the posterior cruciate ligament travel?

supero-anteriorly to insert onto the medial femoral condyle

47

What does the anterior cruciate ligament attach to?

anterior intercondyle region of the tibia

48

How does the anterior cruciate ligament travel?

supero-posteriorly to attach to the lateral femoral condyle

49

Which is the stronger cruciate ligament?

Posterior cruciate ligament

50

What does the posterior cruciate ligament prevent?

posterior displacement of the tibia of the femur

hyperflexion

51

Which cruciate ligament is the main stabiliser of the flexed knee when weigh bearing?

posterior cruciate ligament

52

How can the posterior cruciate ligament be damaged?

When landing on the tibial tuberosity with the knee flexed - tibia slides backwards

53

What does the anterior cruciate ligament prevent?

anterior displacement of the tibia on the femur

hyperextension

54

How can the anterior cruciate ligament be damaged? (2)

when knee is hyperextended to force is applied anteriorly

55

Which cruciate ligament is more commonly injured?

anterior cruciate ligament

56

What is the tibial/medial collateral ligament?

a flat band attached to the medial meniscus

57

What does the tibial/medial collateral ligament prevent?

prevents abduction of the at the knee

58

What is the fibular/ lateral collateral ligament?

cord like band not attached to the lateral meniscus

59

What does the fibular/ lateral collateral ligament prevent?

prevents adduction of the leg at the knee

60

How does the lateral and medial collateral ligaments provide stability to the knee?

they prevent rotation during extension

61

What is a combined knee injury also known as?

the unhappy triad

62

What is a combined knee injury caused by?

excessive lateral twisting of the flexed knee

blow to the lateral side of the extended knee

63

What is torn in a combined knee injury?

tibial collateral ligament which is attached to the medial meniscus - which also tears

anterior cruciate ligament may also tear as it is taut during flexion (common when flexed knees are twisted)

64

What muscles are important in relation to the knee joint and act as the main stabilisers of the knee? (5)

1. quadriceps
2. hamstrings - posterior thigh
3. sartorius
4. gracillis
5. illiotibial tract

65

What can compensate for ligament damage and avoid surgery?

building up quads through physio and exercise - cycling

66

What are two bursae you need to be aware of?

prepatellar bursa

suprapatellar bursa

67

What problems can occur with the bursae and who is more prone to getting them?

1. prepatellar bursitis
2. suprapatellar effusion

people who spend a lot of time on their knees

68

What are common bony fractures to the knee? (3)

Fractures to:

1. patella
2. tibia
3. distal femur

69

What and where are the causes of the common bony fractures to the knee?

- trauma
- osteoporotic bone - low energy fractures
- peri-prosthetic - fractures around joint replacements

70

What are common meniscal tear causes?

1. acute injury/ trauma
2. wear and tear

71

What are causes of ligamentous injuries to the knee?

- trauma

72

What injuries usually happen to the ligaments of the knee?

- tears and rupture

73

What are common dislocations?

- patella - more common in females
- whole knee joint - very uncommon
- acute injury/ trauma

74

What direction do patella dislocations occur?

laterally due to placement and alignment of the knee

75

What direction does the rectus femurs, vastus intermedius and vast us lateralis pull?

superolaterally

76

What are the rectus femurs, vast us intermedius and vastus lateralis counteracted by?

the horizontal pull of the vast us medial is

77

Why is patella dislocation more common in females?

ankle of the neck of the femur is different and therefore the angle of placement is bigger (Q angle)

78

What is the dislocation of the patella related to?

the alignment of the femur in relation to the tibia

79

What are examples of abnormal alignment of the femur in relation to the tibia?

1. genu varum
2. genu algum

80

What is genu varum?

tibia is adducted wither respect to femur - bow leg

81

What is genu valgum?

Tibia abducted with respect to femur

82

What changes are apparent in osteoarthritis?

- osetophytes
-scleorosis - abnormal density of bone
- reduced joint space - very little meniscus

83

What does abnormal alignment of the knee lead to?

abnormal loading around the knee

84

What is a characteristic feature of a patellar fracture?

rough jagged ends

85

What shouldn't you confuse a patellar fracture with?

bi-partite patellar - no jagged ends

86

What is a characteristic of a femoral fracture?

painful - shards of bone

87

How much force is required for a tibial plateau fracture?

- a lot
- can be subtle and can be easily missed

88

What tears in a complete knee dislocation?

cruciate ligaments - connecting the tibia to the femur

89

What would you worry about in complete knee dislocation?

damage to blood supply and nerve supply (popliteal artery and nerve)