Thigh/Knee Anatomy Flashcards Preview

Orthopaedic Anatomy > Thigh/Knee Anatomy > Flashcards

Flashcards in Thigh/Knee Anatomy Deck (258):
1

what is the intertrochanteric line?

anterior, between LT and GT

2

what is the intertrochanteric crest?

posterior, line between LT and GT

3

where is the adductor tubercle?

medial aspect of the distal femur (essentially the medial epicondyle)

4

where is the gluteal tuberosity?

the lateral continuation of the linea aspera superiorly to the GT

5

what is the linea aspera?

the ridge on the posterior aspect of the femur created inferiorly by the supracondylar lines and superiorly by the lateral (gluteal tuberosity), intermediate (pectineal line) and medial ridges.

6

anteversion of the hip

15°

7

head-neck angle of the femur

127° coxa vara if < 120 coxa valga inf > 135

8

anterior radius of curvature of the femur

120 cm

9

when does the tri-radiate cartilage fuse?

14-16

10

3 functions of the labrum

1. seal with hydrostatic pressure 2. lubrication 3. deepens the acetabulum

11

name the ligaments of the hip

iliofemoral (ASIS to intertrochanteric line - strongest)

pubofemoral

ischiofemoral

ligamentum teres

12

what are the longitudinal retinacular fibres?

travel along the neck carrying blood vessels

13

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adductor longus

14

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femoral artery and vein

15

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sartorius

16

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medial intermuscular septum

17

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vastus medialis

18

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vastus intermedius

19

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rectus femoris

20

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vastus lateralis

21

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sciatic nerve

22

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lateral intermuscular septum

23

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biceps femoris - short head

24

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biceps femoris - long head

25

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semitendinosus

26

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semimembranosus

27

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adductor magnus

28

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gracillis

29

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adductor brevis

30

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vastus lateralis

31

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vastus medialis and intermeius

32

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rectus femoris

33

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sartorius

34

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adductor longus

35

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adductor brevis

36

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gracillis

37

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semitendinosis

38

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gluteus maximus

39

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vastus lateralis

40

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tensor fascia lata

41

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rectus femoris

42

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sartorius

43

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adductor longus

44

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adductor brevis

45

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pectineus

46

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iliopsoas

47

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vastus intermedius

48

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adductor magnus

49

origin of glut max

dorsal ilium

50

insertion of glut max

fascia lata and gluteal tuberosity

51

origin glut med

dorsal ilium inferior to iliac crest

52

insertion of glut med

superolateral GT

53

origin of glut min

dorsal ilium between inferior and anterior gluteal lines

54

insertion of glut min

anterior GT

55

origin of iliacus

upper 2/3 of iliac fossa

56

insertion of iliacus

LT

57

TFL origin

ASIS

58

TFL insertion

IT band

59

origin sartorius

ASIS

60

insertion sartorius

superior part of the pes on the proximal, medial tibia

61

origin rectus femoris

AIIS - straight head

groove above acetabulum - reflected head

62

insertion rectus femoris

base of patella

63

origin vastus lateralis

intertrochanteric line

anterior-inferior GT

64

insertion vastus lateralis

lateral base and border of patella

65

origin vastus medialis

intertrochanteric line

medial lip of linea aspera

66

insertion vastus medialis

medial base and border of patella

67

origin vastus intermedialis

superior 2/3 anterolateral surface of femur and lateral intermuscular septum

68

insertion of vastus intermedialis

lateral border of patella

69

what is the articularis genu?

a small muscle that originates from the distal anterior surface of the femur to insert on the superior synovial membrane of the knee. It pulls the suprapatellar bursa superiorly during extension of the knee to prevent impingement

70

adductor brevis origin

anterior inferior pubic ramus

71

insertion adductor brevis

pectineal line

medial lip of linea aspera

72

origin adductor longus

anterior surface of body of pubis

73

insertion adductor longus

middle third of linea aspera

74

origin adductor magnus

inferior pubic ramus

ischial ramus

inferolateral area of ischial tuberosity

75

insertion adductor magnus

gluteal tuberosity

medial lip of linea aspera

medial supracondylar ridge

adductor tubercle

76

innervation of adductor magnus

posterior obturator

sciatic for hamstring portion*

77

origin pectineus

pecten pubis

78

insertion pectineus

pectineal line on femur

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79

innervation of pectineus

femoral nerve

AND

obturator nerve

80

origin gracillis

inferior margin of pubic symphysis and ischial ramus

81

insertion of gracillus

second on pes (just posterior to sartorius)

82

biceps femoris long head origin

ischial tuberosity

83

insertion of biceps femoris long head

fibular head

LCL

lateral tibial condyle

84

origin of biceps femoris short head

lateral lip of linea aspera

lateral supracondylar ridge

lateral intramuscular septum

85

insertion of biceps femoris short head

fibular head

LCL

lateral tibial condyle

86

innervation of biceps femoris short head

common peroneal nerve

87

origin semitendinosis

ischial tuberosity with long head biceps femoris

88

insertion of semitendinosis

top of the pes

89

semimembranosus origin

ischial tuberosity with long head of biceps and semiT

90

insertion semimembranosus

posterior surface of the medial tibial condyle

91

name the 5 insertions of semimembranosus

posterior medial tibial condyle

oblique popliteal ligament

posterior capsule and posterior horn of medial meniscus

posterior oblique ligament

aponeurosis of popliteal muscle

92

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iliacus

93

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sartorius

94

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rectus femoris

95

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obturator internus and gemeli

96

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piriformis

97

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glut min

98

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vastus lateralis

99

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vastus intermedius

100

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vastus medialis

101

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iliopsoas

102

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quadratus

103

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adductor magnus

104

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obturator externus

105

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adductor brevis

106

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gracillis

107

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pectineus

108

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obturator internus

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109

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adductor magnus

110

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semitendinosis

biceps femoris

111

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semimembranosus

112

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Gemeli

113

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adductor brevis

114

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adductor magnus

115

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glut max

116

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pectineus

117

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vastus lateralis

118

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iliopsoas

119

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quadratus femoris

120

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glut med

121

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obturator externus

122

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rectus femoris

123

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sartorius

124

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glut min

125

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glut med

126

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glut max

127

what are the boundaries of the femoral triangle?

inguinal ligament - sartorius - adductor longus - pectineus

floor: iliopsoas, pectineus, adductors

contents: NAVEL

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128

what are the boundaries of the adductor canal?

anteriolateral = vastus medialis

posterior = adductor longus and magnus

contents = FA, FV, FN, saphenous nerve, nerve to vastus medialis

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129

course of the superficial femoral artery

under sartorius between the adductors and vastus medialis, then exits the adductor hiatus posterior to the medial femoral condyle

130

components of the cruciate anastomosis

medial circumflex

lateral circumflex

inferior gluteal

1st perforator

131

course of the medial circumflex artery

between pectineus and iliopsoas

then obturator externus and adductor brevis

then adductor magnus and brevis

then along cranial edge of quadratus femoris

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132

course of the lateral circumflex

deep to rectus and sartorius

133

origin of the saphenous nerve

a terminal branch of femoral nerve providing sensation to medial lower leg

134

origin of the sural nerve

medial cutaneous branch from tibial nerve and lateral cutaneous branch from common peroneal that combine

135

normal degree of knee valgus

5-7°

136

normal rotation of the knee

3° internal

137

normal posterior tibial slope

8-10°

138

main motion of the medial plateau

pivot

139

main motion of the lateral plateau

glide

140

average thickness of the patella

23-25 mm

141

thickness of the patella you must maintain in arthroplasty

12 mm

142

how does the contact point of the knee joint change with dynamic movement?

in extension the contact point is anterior to the coronal slice through middle

in flexion the contact is much more posterior

143

what inserts at Gerdy's tubercle?

IT band

144

describe the surface of the tibial plateau

lateral and medial condyles

lateral and medial intercondylar tubercles

posterior intercondylar surface

145

what is the typical deformity in a proximal tibia fracture?

valgus

procurvatum

146

how many facets on the patella?

7:

3 medial

3 lateral

odd (extra medial)

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147

what is fractured?

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nothing.

this is a bipartite patella (2% of the population)

148

what attaches to the fibular head?

biceps

LCL

149

how does the fibula move during plantarflexion?

externally rotates and distalizes

150

difference between verticle and mechanical axis of femur

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151

difference between mechanical and anatomical axis of the femur

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152

what is Q angle?

ASIS to patella

patella to tibial tubercle

normal is 14 for males, 17 for females

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153

ligaments from the fibula to to tibia

anterior ligament

posterior ligament

interosseous membrane

154

12 ligaments of the knee

ACL

PCL

MCL

LCL

MPFL

Retinacular

arcuate

oblique popliteal

coronary

wrisberg

humphrey

transverse

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155

what is the retinacular ligament?

 

both lateral and medial transverse and longitudinal components

156

describe the 3 layers of the medial knee

superficial:

anterior - medial patellar retinaculum

medial - deep fascia enclosing sartorius

posterior - deep fascia enclosing gastrocs and roof of popliteal fascia

Middle:

anterior - MPFL

medial - superficial MCL

posterior - tendon of semimembranosus

Deep:

joint capsule, deep MCL

157

5 structures that converge at the posteromedial corner of the knee

1. MPFL

2. Adductor magnus tendon

3. Medial gastrocs tendon

4. Superficial MCL

5. Posterior oblique ligament

*all insert on the adductor tubercle

158

how many insertions does the superficial MCL have?

2 on tibia

1 on medial condyle of femur

159

what is schottle's point?

where the MPFL inserts

draw a line along the posterior femoral cortex then square it with the line along the anterior femoral joint surface

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160

2 main structures of the posterior knee capsule

oblique popliteal ligament - medial tibia to lateral femur

arcuate popliteal ligament - fibular head to lateral femur

*also popliteus from posteriomedial tibia to lateral knee joint

161

describe the layers of the posterolateral corner of the knee

superficial: anterior - ITB, posterior - biceps femoris

middle: lateral retinaculum, popliteal fibular ligament

deep: joint capsule, popliteus, LCL, arcuate ligament

162

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oblique popliteal ligament

163

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arcuate popliteal ligament

164

what is the dial test?

flex the knee to 30°

if there is a greater than 10° difference in external rotation of the knee then you have a posterolateral corner injury

 

*if this is also true at 90° knee flexion then you have a PCL injury too

165

innervation of ACL

tibial nerve

166

blood supply to ACL

middle geniculate artery

167

describe the anatomy of the ACL

medial surface of the lateral femoral condyle to the anteromedial tibia

*has 2 bundles - AM (tight in flexion), PL (tight in extension, stronger)

168

what is the anterolateral ligament?

anterior bundle of the LCL - remember segond #

169

where in space does the PCL exist?

extrasynovial, intraarticular

from posterolateral tibia to lateral aspect of medial femoral condyle

*2 bundles, AL (tight in flexion) and PM (tight in extension

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170

from which meniscus do wrisberg and humphrey arise?

posterolateral

171

how do the menisci absorb load?

lateral takes 70% of lateral compartment

medial takes 50% of medial compartment

*more load is experienced in flexion

172

describe the structure of the menisci

mostly type 1 collagen

most fibres are oriented circumferentially to resist compression

some fibres radially resist longitudinal force

surface meshwork resists shear

173

blood supply to meniscus

from medial and lateral genicular arteries to the outer third

174

4 bursa of the anterior knee

suprapatellar

prepatellar

superficial infrapatellar

deep infrapatellar

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175

boundaries of the popliteal fossa

semi M / semi T medially

biceps laterally

two heads of gastrocs inferomedial and lateral

176

contents of the popliteal fossa

vessels

tibial and common peroneal nerves

177

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anterior tibial artery

anterior tibial vein

deep peroneal nerve

178

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tibia

179

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interosseous membrane

180

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great saphenous vein

saphenous nerve

181

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tibialis posterior

182

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flexor digitorum longus

183

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fibular artery and veins

184

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posterior tibial artery

posterior tibial vein

tibial nerve

185

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flexor hallicus longus

186

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deep fascia of leg

187

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plantaris tendon

188

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medial head of gastrocs

189

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medial sural cutaneous nerve

190

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small saphenous vein

191

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sural communicating branch of the lateral sural cutaneous nerve

192

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lateral head of gastrocs

193

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soleus

194

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transverse intermuscular septum

195

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lateral sural cutaneous nerve

196

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fibula

197

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posterior intermuscular septum

198

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peroneus brevis

199

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peroneus longus

200

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deep fascia of the leg

201

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anterior intermuscular septum

202

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superficial peroneal nerve

203

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extensor digitorum longus

204

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extensor hallicus longus

205

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tibialis anterior

 

206

where is peroneus tertius?

anterior compartment!

207

order of contents of the anterior compartment from medial to lateral

tib ant

EHL

anterior tibial artery

deep peroneal nerve

EDL

tertius

208

origin of peroneus tertius

low anterior fibula

209

origin of EDL

proximal anterior fibula

210

origin of EHL

mid fibula and interosseous membrane

211

order of muscles in lateral compartment

longus is superficial to brevis

212

origin of FDL

posterior tibia

213

origin of FHL

posterior fibula

214

origin of tib post

posterior interosseous membrane

215

insertion of tibialis anterior

medial cuneiform and base of 1st metatarsal

216

insertion of EHL

base of distal phalanx

217

insertion of EDL

base of middle and distal phalanges

218

insertion of peroneus tertius

base of 5th metatarsal

219

insertion of peroneus longus

plantar surface of the medial cuneiform and base of the 1st metatarsal

220

insertion of peroneus brevis

base of the 5th metatarsal

221

origin of plantaris

lateral femoral supracondylar line

222

3 origins of popliteus

lateral condyle just anteroinferior to LCL

fibular head

posterior horn of lateral meniscus

223

how does the knee lock in extension?

tibia externally rotates in last few degrees of extension - the popliteus counters this by medially rotating the tibia and therefore, unlocking the knee

224

when is the knee most stable?

in full extension

225

insertion of FHL

plantar base of distal phalanx

226

insertion of FDL

plantar surface of base of distal phalanges 2-5

227

insertion of tib post

navicular tuberosity and medial cuneiform (plantar surface)

228

course of the tibial nerve

arises from sciatic split above popliteal fossa

gives off medial sural cutaneous nerve

crosses on top of plantaris

dives deep to soleus and enters the deep compartment

runs just anterior to transverse intermuscular septum

runs between FDL and FHL

229

course of the common peroneal nerve

arises from split of sciatic above popliteal fossa

runs medial to biceps

crosses superficial to lateral head of gastrocs

gives off lateral sural cutaneous nerve

stays lateral to soleus

winds around fibular neck deep to peroneus longus 3-4 cm below tip of fibula

penetrates posterior intermuscular septum

divides into superficial and deep branches

230

course of deep peroneal nerve

sharp turn after split to enter anterior compartment

runs along anterior surface of interosseous membrane

231

where does the superficial peroneal nerve give off its muscular branches?

upper 1/3 of leg only

232

course of superficial peroneal nerve

lateral surface of fibula for first 1/3

then under longus, on brevis

runs between brevis and EDL

233

what is the orientation of the femoral/saphenous nerve as it runs distally?

starts lateral to vessels in the femoral triangle

crosses anterior to vessels in the adductor canal

emerges medial to vessels from the adductor canal

pierces fascia at medial knee between gracillis and sartorius to become subcutaneous

234

medial to lateral structures in the popliteal fossa

artery

vein

nerve

235

where is the popliteal artery during TKA?

9mm posterior to the tibial plateau in 90° flexion

superficial to popliteus

deep to soleus

236

course of branches of popliteal artery

divides to tibioperoneal trunk and anterior tibial artery just below fossa

runs superficial to tib post

tibioperoneal trunk divides again 2.5 cm below fossa to peroneal and posterior tibial arteries

the anterior tibial quickly pierces the interosseous membrane to run down the anterior aspect of the membrane, just medial to deep peroneal nerve, between TA and EHL

at extensor retinaculum anterior tibial artery passes under EHL and then runs lateral

237

order of structures posterior to the medial malleolus

tib post

FDL

artery

vein

nerve

FHL

238

termination of the posterior tibial artery

medial and lateral plantar arteries

239

where is the peroneal artery?

deep to FHL in the deep posterior compartment!

terminates as calcaneal branch and anterior perforating artery

240

course of the great saphenous vein

arises from the dorsal vein of 1st digit

anterior to medial mal

medial leg with saphenous nerve

posterior to medial condyle at knee

medial thigh

through fossa ovalis

241

During a posterior apporach to the hip, what
muscle is your landmark so that you don’t
de-vascularize the head?

quadratus femoris

242

What is the only muscle in the thigh innervated by the
peroneal branch of the sciatic nerve?

short head of biceps

243

Which bands of ACL and PCL are tight in flexion?

anterior bands

244

A patient undergoes meniscal suturing of the medial
meniscus. Which of the following structures is most at
risk posteriorly?

saphenous nerve

245

A patient has disruption of the superficial branch of
the peroneal nerve. Which of the following is correct
with regards to findings:

decreased sensation in second web space

246

2

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saphenous vein

247

3

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sartorius

248

4

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semitendinosis tendon

249

5

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medial head of gastrocs

250

6

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popliteal artery

251

7

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biceps femoris

252

boundaries of the adductor canal

anterior - sartorius

posteromedial - magnus and longus

medial - vastus medialis

253

contents of adductor canal

superficial femoral artery

femoral vein

saphenous nerve

motor branch to vastus medialis

254

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double PCL sign = incarcerated bucket handle meniscal tear

255

Where does the medial patello-femoral ligament insert on the
patella:

superomedial aspect

256

average radius of curvature of the femur

120 cm anterior

257

if someone is dial + at 30 and 90, what other exam abnormality will you find?

increased varus opening at 0 flexion

-PCL

-LCL

-popliteus tendon

*all torn

258

pathology?

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this is a segond # - disruption of the anterior oblique band of the LCL

meaning ALL is avulsed and likely ACL is also torn