Anatomy of the Knee Flashcards
What is the popliteal fossa?
- diamond-shaped conduit behind the knee joint
- formed by muscles posteriorly
- major route for structures able to travel between thigh and leg
Label the components that make up the border of the popliteal fossa using the labels below:
Superomedial – Semimembranosus (semitendinosus)
Superolateral – Biceps femoris
Inferomedial – medial head Gastrocnemius
Inferolateral – lateral head Gastrocnemius
Floor – Popliteus muscle
Roof – Popliteal fascia
1 = Superomedial – Semimembranosus 2 = Inferomedial – medial head Gastrocnemius 3 = Floor – Popliteus muscle 4 = Superolateral – Biceps femoris 5 = Inferolateral – lateral head Gastrocnemius
Roof – Popliteal fascia - NOT SHOWN
The popliteal fossa is a conduit allowing neurovascular structures to pass between the thigh and leg. What is contained within the popliteal fossa using the mnemonic NAV moving medially to laterally?
1 - popliteal artery, popliteal vein, tibial and common fibular nerve
2 - popliteal vein and artery, tibial and sciatic nerve
3 - femoral vein and artery, tibial and common fibular nerve
4 - popliteal vein and artery, sciatic and common fibular nerve
1 - popliteal artery, popliteal vein, tibial and common fibular nerve
- deepest to superficial is the above order backwards
Which large nerve branches into the 2 nerves contained within the popliteal fossa, the tibial and common fibular nerve?
1 - femoral nerve
2 - obturator nerve
3 - sciatic nerve
4 - lateral cutaneous nerve
3 - sciatic nerve
The popliteal artery passes through the popliteal fossa inferiorly and then bifurcates into the tibial artery. What 2 branches does the tibial artery then bifurcate into?
1 - posterior fibula and anterior fibula artery
2 - posterior tibial and deep tibial artery
3 - deep tibial and superficial tibial artery
4 - posterior tibial and anterior tibial artery
4 - posterior tibial and anterior tibial artery
The popliteal artery passes through the popliteal fossa inferiorly. As its passing through the popliteal artery it lets off other branches that are able to supply blood to all the structures of the knee. What are these arteries called and what are they called collectively?
1 - geniculate artery with 1
2 - geniculate arteries with 5
3 - tibial artery with 4
4 - fibula artery with 2
- 2 - geniculate arteries with 5
The popliteal artery passes through the popliteal fossa inferiorly. As its passing through the popliteal artery it lets off other branches that are able to supply blood to all the structures of the knee. These arteries are called the geniculate arteries and there are 5 of them. Label them in the image below using the labels provided:
- medial superior genicular artery
- lateral superior genicular artery
- lateral inferior genicular artery
- middle genicular artery
- medial superior genicular artery
1 = lateral superior genicular artery 2 = medial superior genicular artery 3 = middle genicular artery 4 = lateral inferior genicular artery 5 = medial inferior genicular artery
Which pulse can be taken at the popliteal fossa as part of the peripheral vascular examination?
- popliteal pulse
The popliteal vein passes through the popliteal fossa inferiorly and then bifurcates into what 2 key veins?
1 - deep and superficial saphenous veins
2 - deep and superficial gastrocnemius veins
3 - deep and superficial tibial veins
4 -deep and superficial perforating veins
1 - deep and superficial saphenous veins
The adductor magnus possess a small opening between the adductor and hamstring regions of this muscle. This opening allows 2 key vessels to pass through and enter the popliteal fossa. What is this opening called and what 2 vessels pass through?
1 - adductor hiatus and femoral artery and vein
2 - abductor hiatus and popliteal artery and vein
3 - adductor hiatus and popliteal artery and vein
4 - external hiatus and popliteal artery and vein
3 - adductor hiatus and popliteal artery and vein
What is a bakers cyst?
- fluid filled swelling that develops behind the knee
- often develops over the popliteal fossa
The popliteal fossa has its own cutaneous nerve supply which covers the skin of the popliteal fossa on the back of the knee. Which nerve provides this?
1 - lateral femoral cutaneous nerve (L2-L3)
2 - obturator nerve (L2-L4)
3 - medial femoral cutaneous nerve (L2-L3)
4 - posterior femoral cutaneous nerve (S1- S3)
4 - posterior femoral cutaneous nerve (S1- S3)
- important when examining the patient
Which aspects of the femur articulate with the knee joint?
1 - condyles (medial and lateral)
2 - adductor tubercles
3 - epicondyles (medial and lateral)
4 - linea aspera
1 - condyles (medial and lateral)
Is the fibula medial or lateral?
- lateral
Which aspects of the tibia articulate with the knee joint?
1 - condyles (medial and lateral)
2 - fibular and tibial heads
3 - epicondyles (medial and lateral)
4 - tibial tuberosity
1 - condyles (medial and lateral)
What type of bone is the patella?
1 - sesamoid bone
2 - long bone
3 - short bone
4 - irregular bone
1 - sesamoid bone
The patella is a sesamoid bone. What is unique about sesamoid bones?
1 - only 1 in the body
2 - help alleviate compression forces and protect tendons
3 - rough surface for tendon attachment
4 - form of bursa
2 - help alleviate compression forces and protect tendons
- normally embedded within a muscle or tendon near joint surface
There are 2 menisci of the knee joint. What are the names of these?
- medial and lateral menisci
- in the form of wedges made of type I collagen
There are 2 menisci of the knee joint, the medial and lateral menisci. What type of cartilage is this?
1 - hyaline
2 - fibrocartilage
3 - elastic cartilage
2 - fibrocartilage
We have the medial and lateral menisci that sit on the surface of the tibia. The medial menisci is more fixed than the lateral menisci. Why is this?
1 - stronger collagen
2 - fixed to bone with no other attachments
3 - fixed by tibial collateral ligament
4 - held by shape of tibial condyle
3 - fixed by tibial collateral ligament
There is a ligament that attaches the medial and lateral menisci of the knee. What is this ligament called?
1 - anterior cruciate ligament
2 - collateral ligament
3 - transverse ligament
4 - annular ligament
3 - transverse ligament
There are 2 crucial ligaments that are contained within the centre of the joint capsule of the knee. What are these 2 ligaments called?
- posterior cruciate ligament
- anterior cruciate ligament
There are 2 crucial ligaments that are contained within the centre of the joint capsule of the knee called the posterior and anterior cruciate ligament. Are these contained within the synovial joint cavity?
- no
The knee joint has a large number of ligament that stabilise the knee. There are 2 collateral ligaments that help stabilise the knee. What are they called?
- medial (tibia) collateral ligament
- lateral (fibula) collateral ligament
The knee joint has a large number of ligament that stabilise the knee. There are 2 collateral ligaments called the medial (tibia) and lateral (fibula) ligaments. What is the attachment sites for the medial (tibial) collateral ligament?
- medial epicondyle of the femur to medial condyle of tibia
The knee joint has a large number of ligament that stabilise the knee. There are 2 collateral ligaments called the medial (tibia) and lateral (fibula) ligaments. What is the attachment sites for the lateral (fibula) collateral ligament?
- lateral epicondyle of the femur to fibula head
The knee joint has a large number of ligament that stabilise the knee. There is a ligament that connects the menisci called the transverse ligament. There is also a ligament that attaches the posterior lateral aspect of the menisci to the posterior cruciate ligament and eventually attaching to the medial condyle of the femur. What is this ligament called?
1 - posterior cruciate ligament
2 - oblique popliteal ligament
3 - arcuate popliteal ligament
4 - posterior meniscofemoral ligament
4 - posterior meniscofemoral ligament, also called the ligament of Wrisberg
There is a ligament that is an expansion of the semimembranosus tendon that helps reduce hyperextension of the knee. What is this ligament called?
1 - posterior cruciate ligament
2 - oblique popliteal ligament
3 - arcuate popliteal ligament
4 - medial (tibia) collateral ligament
2 - oblique popliteal ligament
There is a ligament that is arises on the posterior aspect of the fibular head and arches superiorly and medially to attach on the posterior side of the joint capsule of the knee. What is this ligament called?
1 - posterior cruciate ligament
2 - oblique popliteal ligament
3 - arcuate popliteal ligament
4 - medial (tibia) collateral ligament
3 - arcuate popliteal ligament
There are 2 ligaments that attach to the patella (one medial and one lateral) and to the medial and lateral epicondyles of the femur that are essentially areas of the joint capsule that are thickened. What are these ligaments called?
1 - medial and lateral patellofemoral ligaments
2 - lateral and medial collateral ligaments ligaments
3 - medial and lateral cruciate ligaments
4 - arcuate and oblique ligaments
1 - medial and lateral patellofemoral ligaments
There are 2 ligaments that attach to the patella (one medial and one lateral) and to the medial and lateral condyles of the tibia that are essentially areas of the joint capsule that are thickened. What are these ligaments called?
1 - medial and lateral patellofemoral ligaments
2 - lateral and medial collateral ligaments ligaments
3 - medial and lateral patellotibial ligaments
4 - arcuate and oblique ligaments
3 - medial and lateral patellotibial ligaments
There is a ligament that is often referred to as the patellar tendon, but based on the definition of bone to bone is called the patellar ligament. Where does this ligament attach?
- patellar apex and attaches to the tibial tuberosity
The word cruciate means cross as the anterior and posterior cruciate ligaments cross in the knee joint. Which ligament has the following trajectory and attachment sits:
- attaches onto anterior aspect of tibial plateau (where it articulates with the femur)
- moves superiorly (up), posteriorly (backwards) and laterally
- attaches onto the medial side of the lateral condyle of the femur
- anterior cruciate ligament
The word cruciate means cross as the anterior and posterior cruciate ligaments cross in the knee joint. Which ligament has the following trajectory and attachment sits:
- attaches onto posterior aspect of tibial plateau (where it articulates with the femur)
- moves superiorly (up), anteriorly (forwards) and medially
- attaches onto the lateral side of the medial condyle
- posterior ligament
The anterior and posterior cruciate ligaments are 2 of the strongest ligaments of the knee and are contained within the joint capsule (but not the synovial capsule). In addition to limiting rotation, what movements do the anterior and posterior ligaments limit to stabiles the knee?
- anterior = anterior displacement of the tibia in relation to the femur
- posterior = posterior displacement of the tibia in relation to the femur
The anterior and posterior cruciate ligaments are 2 of the strongest ligaments of the knee and are contained within the joint capsule (but not the synovial capsule). The mnemonic LAMP can help to remember attachment sites for these ligaments. What does LAMP refer to?
- LA = Lateral condyle of femur for Anterior cruciate ligament
- MP = Medial condyle of femur for Posterior cruciate ligament
What are the 3 key muscles that stabilise the knee joint?
1 - Pes anserinus, Popliteus, Hamstrings
2 - Pes anserinus, Adductors, Quadriceps
3 - Pes anserinus, Popliteus, Quadriceps
4 - Pes anserinus, Abductors, Quadriceps
3 - Pes anserinus, Popliteus, Quadriceps
Pes anserinus is the anatomical name given to 3 muscles that attach to the medial proximal aspect of the tibia and provide stability and support to the knee. Say Grace before SupperTime can help remember what these 3 muscles are?
1 - sartorius, gracilis, and semitendinosus
2 - semimembranosus, gracilis, and semitendinosus
3 - soleus, gracilis, and semitendinosus
4 - sartorius, gracilis, and semimembranosus
1 - Sartorius, Gracilis, and SemiTendinosus
There are a number to structures that stabilise the knee. One of these is the iliotibial band, which originates at the iliac crest and attaches where on the tibia?
1 - lateral condyle
2 - medial condyle
3 - gerdys tubercle
4 - tibial tuberosity
3 - gerdys tubercle
- medial border of knee
The popliteal muscle is a small muscle on the posterolateral corner of the knee. What is the origin and insertion of this muscle?
1 - O = lateral condyle of femur and I = posterior tibia superior to soleal line
2 - O = medial epicondyle of femur and I = posterior tibia superior to soleal line
3 - O = lateral condyle of femur and I = posterior fibula superior to soleal line
4 - O = lateral epicondyle of femur and I = soleal line of tibia
1 - O = lateral condyle of femur and I = posterior tibia superior to soleal line
The popliteal muscle is a small muscle on the posterolateral corner of the knee, with its origin at the lateral condyle of the femur, and inserts onto the superior soleal line of the tibia. What is the primary function of this muscle?
- unlocking of the knee, allowing you to walk
- laterally rotates the femur on the tibia by 5 degrees
- femur head turns outwards (laterally)
The iliotibial tract is a thickened band of deep fascia that runs down the lateral surface of the thigh, formed from the deep fascia of the thigh, the fascia lata. The tract acts as an aponeurosis for 2 muscles, what are these muscles?
1 - gluteus maximus and tensor fasciae latae
2 - gluteus minimus and tensor fasciae latae
3 - gluteus medius and tensor fasciae latae
4 - bicep femoris and tensor fasciae latae
1 - gluteus maximus and tensor fasciae latae
The iliotibial tract is a thickened band of deep fascia that runs down the lateral surface of the thigh, formed from the deep fascia of the thigh, the fascia lata. The tract acts as an aponeurosis for 2 muscles; gluteus maximus and tensor fascia latae. What is the primary function of the iliotibial tract?
- stabilise the hip and knee
- pulls at gerdys tubercle and aligns the knee
The iliotibial tract is a thickened band of deep fascia that runs down the lateral surface of the thigh, formed from the deep fascia of the thigh, the fascia lata. The tract acts as an aponeurosis for 2 muscles; gluteus maximus and tensor fasciae latae. What is the distal attachment for the iliotibila tract?
- gerdys tubercle on proximal tibia
There are 5 key muscles in the anterior compartment of the thigh. Which of these is involved in knee flexion?
1 - Vastus Medialis 2 - Vastus Lateralis 3 - Vastus Intermedius 4 - Rectus Femoris 5 - Sartorius
5 - Sartorius
Bursae are important to ensure tendons do not run on bones and allow friction free movement. How many bursae are located in the knee?
- > 12
Bursae are important to ensure tendons do not run on bones and allow friction free movement. There are >12 in the knee. Label the key brusae using the labels below:
Infra = above sub = below
suprapatellar bursae subcutaneous prepatellar bursae semimembranosus bursae popliteal bursae subcutaneous infrapatellar bursae medial gastrocnemius bursae anserine bursae deep infrapatellar bursae lateral gastrocnemius bursae subtendinous prepatellar bursae
1 = suprapatellar bursae 2 = subtendinous prepatellar bursae 3 = subcutaneous prepatellar bursae 4 = deep infrapatellar bursae 5 = subcutaneous infrapatellar bursae 6 = medial gastrocnemius bursae 7 = semimembranosus bursae 8 = anserine bursae 9 = lateral gastrocnemius bursae 10 = popliteal bursae
What is bursitis?
- inflamed bursae
Clergyman’s knee is due to too much kneeling on the bursae. Specifically which bursae is affected?
1 - suprapatellar bursae
2 - subcutaneous infrapatellar
3 - semimembranosus bursae
4 - popliteal bursae
- subcutaneous infrapatellar
Housemaids knee is due to too much kneeling on the bursae. Specifically which bursae is affected?
1 - prepatellar bursae
2 - subcutaneous infrapatellar
3 - semimembranosus bursae
4 - popliteal bursae
1 - prepatellar bursae
- prepatellar bursae which are the subtendinous prepatellar and the subcutaneous
What does valgus mean in relation to the knee?
- outward angulation of the distal segment of a bone or joint
- knees point inwards
- think G in valgus is like glue sticking the knees together
What does varus mean in relation to the knee?
- excessive inward angulation (medial angulation, that is, towards the body’s midline) of the distal segment of a bone or joint
- knees point outwards
In injuries of the ligaments of the knee, is valgus (knees pointing inwards) or varus (knees pointing outwards) more common?
- valgus
- during flexion or extension
The O’Donoghue unhappy triad comprises of three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. What are the 3 soft tissue injuries that generally occur at the same time?
1 - ACL, MCL, medial menisci
2 - PCL, MCL, medial menisci
3 - ACL, MLCL, lateral menisci
4 - ACL, LCL, medial menisci
ACL = anterior cruciate ligament PCL = posterior cruciate ligament MCL = medial collateral ligament LCL = lateral collateral ligament
1 - ACL, MCL, medial menisci
- MCL attaches to medial menisci so could pull it off
- ACL blends with medial menisci
What movements commonly cause damage to the anterior cruciate ligaments?
1 - rotation with foot planted
2 - hyperflexion with foot planted
3 - hyperextension with foot planed
4 - hyperflexion with foot twisted
3 - hyperextension with foot planed
- patients can hear a pop
What movements commonly cause damage to the posterior cruciate ligaments?
1 - direct blow to a knee that is flexed
2 - direct blow to a knee that is extended
3 - direct blow to a knee when planted
4 - hyperextended knee
1 - direct blow to a knee that is flexed
When we look at the white and red zones of the knee menisci in the image below. Is the whole menisci able to heal if damaged?
- no
- red zone indicates some can be repaired if blood flow is present
What is a knee extensor mechanism injury?
- an inability to extend the knee
- can occur above, on or below the patella
- muscle, tendon or bone can be damaged
What is patellar maltracking?
- movement of your kneecap that isn’t aligned
- patella can move sideways
- can be caused by injury or laxity of patellar tendon
What is knee dislocation?
- complete failure of the articulation between the tibia and femur
- very rare
A knee dislocation is a complete failure of the articulation between the tibia and femur and is very rare. Why is this classed as a medical emergency?
- blood vessels can be constricted
- can cause ischemia to tissue below the knee
