BLOCK 12 WEEK 4 Flashcards
The Knee
- The knee joint is a hinge joint
- Knee joint is where your femur meets your tibia
Knee Articulations
The places these bones meet are called articulations or articulating surfaces. There are two articulations in your knee:
- Patellofemoral: Where your patella meets your femur. Anterior aspect of the distal femur articulates with the patella. It allows the tendon of the quadriceps femoris (knee extensor) to be inserted directly over the knee – increasing the efficiency of the muscle.
- Tibiofemoral: Where your tibia meets your femur. Medial and lateral condyles of the femur articulate with the tibial condyles. It is the weight-bearing component of the knee joint.
Cartilage:
- hyaline/articular cartilage around the joints
- fibrocartilage is what the meniscus are made up of
Ligaments:
- collateral ligaments
- cruciate ligaments
Angular knee Joint Deformaties
Genu Valgum deformity (aka knocked knees)
- Genu valgum (knock-knees) is a common lower leg abnormality that is usually seen in the toddler, preschool and early school age child.
- In genu valgum, the lower extremities turn inward, causing the appearance of the knees to be touching while the ankles remain apart.
- Genu valgum is most severe by age 3 but then usually resolves on its own by age 7-8.
-Knock knees are slightly more common in girls than boys.
CAUSE:
- Physiological (most common cause)
- Pathological: rickets, previous fracture of tibia
Genum Varum (aka Bow legs)
- Bow legs (or genu varum) is when the legs curve outward at the knees while the feet and ankles touch.
- . Infants and toddlers often have bow legs. It’s rarely serious and usually goes away without treatment, often by the time a child is 3–4 years old.
- Bow legs don’t usually bother young children because the condition doesn’t cause pain or discomfort.
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Q angle
Q angle: This angle is created by the femur’s diagonal placement within the thigh and by the tibia’s vertical placement in the leg
- This angle is typically between 15 and 20 degrees and on average is higher in biologic females(women 17, men 14)
- a normal Q angle allows the weight supported by the knee joint to be centered through the middle of the knee, in the knee’s intercondylar region.
GENUM VALGUM:
- When the Q angle increases over the normal range
- weight bearing center to the lateral compartment of the knee
- which increases the quadriceps lateral pull
- causes the medial collateral ligament to overstretch
GENUM VARUM:
Medial Collateral Ligament
- Medial Collateral Ligament resists Valgus forces
- gives medial stability
Lateral Collateral Ligament
- Lateral Collateral Ligament resists Varus forces
- Lateral stability
Cruciate Ligaments
- gives STATIC stability
- ROTATIONAL stability
- is Intra-capsular but extra-synovial
ACL Rupture
ACL:
- Taut in EXTENSION
- Prevents posterior displacement of femur
- Axis for knee locking
- Anterior Cruciate Ligament Test is known as LACHMANS TEST
Posterior Cruiciate Ligament
- Taut in FLEXION
- Prevents Anterior Displacement of femur
- Stabilizes the flexed knee
Knee Arthroscopy
Knee arthroscopy:
- is a type of keyhole surgery used to diagnose and treat knee pain or other knee problems. It can be used for inflammation, damage, injury and infections.
- During a knee arthroscopy, your surgeon will use a camera to look inside your knee for damage to the cartilage (meniscus), joint lining and ligaments. Your surgeon may also:
- treat your knee – they may repair or remove any damaged tissue and cartilage (meniscus)
- take small tissue samples (biopsies), which may help to diagnose problems such as infections
- do some more complicated surgery, including surgery to repair torn knee ligaments or to treat an unstable kneecap
Menisci
Menisci have two main functions:
- Deepens the articular surface of the tibia – increasing the stability of the joint.
- Acts as shock absorbers– increasing surface area to further dissipate forces that are transmitted across the joint.
- They are attached at both ends to the intercondylar area of the tibia.
Medial Meniscus: In addition to this attachment, the medial meniscus is also fixed to the medial collateral ligament and the joint capsule. Damage to the medial collateral ligament is often associated with a medial meniscal tear.
Lateral Meniscus: The lateral meniscus is smaller and does not have any additional attachments, rendering it more mobile.
X RAYYYYY
Terrible Triad (BLOWN KNEE)
Unhappy / TERRIBLE Triad (Blown Knee)
As the medial collateral ligament is attached to the medial meniscus, damage to either can affect both structure’s functions.
A lateral force to an extended knee, such as a rugby tackle, can rupture the medial collateral ligament, damaging the medial meniscus in the process.
The ACL is also affected, which completes the ‘unhappy triad’.
- Medial meniscus, medial (tibial) collateral ligament, Anterior cruciate ligament
Terrible Triad MRI
- Torn ACL on pic
- Torn MCL on pic 2
The wavy like appearance on the first pic indicates a tear would normally be smooth
Knee Locking Mechanism
Quadriceps femoris
Nerve Supply: femoral nerve (L2-L4)
- Myotome which extend the knee: (L3-L4)
Quads and Q-angle
Iliotibial Band
- Your iliotibial band is a strong, thick band of tissue that runs down the outside of your thigh.
- iliac crest to the lateral tibial condyle
- ACTED ON BY: tensor fascia latae and the gluteus maximus
Job: pulls the knee into hyperextension
Hamstrings
PES ANSERINUS (GOOSE FOOT)
Pes Anserinus is the conjoined tendons of three muscles which insert into the anteromedial surface of tibia above the ACL:
- SARTORIUS
- GRACILLIS
- SEMITENDINIOUS