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MSK 2 > Clinical Biomechanics Of Knee > Flashcards

Clinical Biomechanics Of Knee Flashcards

1
Q

What joints make up the knee joint?

A

Tibiofemoral

Patellofemoral

Superior tibiofibular (ankle movement over knee movement)

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2
Q

What plane does the Tibiofemoral joint prevent motion in?

A

Frontal plane

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3
Q

What are the 2 degrees of freedom of the Tibiofemoral joint?

A

Flexion/Extension

Medial and lateral rotation

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4
Q

What are the convex/concave parts in the Tibiofemoral joint?

A

Tibia- concave

Femur- convex

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5
Q

What is the difference between the medial and lateral tibial Condyle?

A

Medial Condyle is 50% larger with articular cartilage 3x thicker

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6
Q

Where does the menisci attach?

A

Tibial plateau (between lateral and medial tibial Condyles)

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7
Q

What is the function of the menisci?

A

Increases stability

Increases contact area

Decreases friction

Enhances proprioception

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8
Q

What does the menisci provide to the joint?

A

Lubrication and nutrients

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9
Q

What does the menisci transmit?

A

50-60% of all forces placed on the knee

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10
Q

What is the shape of the medial and lateral meniscus?

A

Medial- C shaped

Lateral- O shaped

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11
Q

What is the attachment of the medial and lateral meniscus?

A

Medial- firm attachment to deep layers of MCL

Lateral- loose attachment to lateral capsule

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12
Q

What is the thickness of the medial and lateral meniscus?

A

Medial- thick posteriorly

Lateral- uniform thickness

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13
Q

What do the medial and lateral meniscus have in common with thickness?

A

Thicker on periphery, thinner along inner margin

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14
Q

What are the implications if you lose your menisci?

A

Shock absorption reduced by 20%

Increases load on femur by 2x and on tibial Condyles by 6-7x

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15
Q

How long is the menisci well vascularized?

A

Age 11

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16
Q

What is the periphery of the menisci well vascularized by?

A

Joint capsules and synovial membranes

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17
Q

What is the periphery of the menisci known as?

A

Red-Red zone (more blood flow, heals better)

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18
Q

What is the middle of the menisci known as?

A

Red-white (pink) zone (some blood flow)

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19
Q

What is the inner of the menisci known as?

A

White-White zone (poor blood flow, heals worse)

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20
Q

What is another factor that relates to healing of the meniscus besides vascularization?

A

Complexity of the tear

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21
Q

What does the Tibiofemoral ligaments control?

A

Hyperextension

Varus/valgus

Anterior/posterior displacement

Medial/lateral rotation

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22
Q

What does the MCL prevent?

A

Abduction (valgus) stress

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23
Q

What is the superficial layer of the MCL?

A

Thick, flat band (attaches 6 cm from joint line)

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24
Q

What is the deep layer of the MCL?

A

Continuation of capsule (attached to medial meniscus)

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25
Q

What does the MCL assist in?

A

Assists ACL to prevent anterior translation of tibia

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26
Q

What is injured more between the MCL and LCL?

A

MCL

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27
Q

Where is the LCL located?

A

Outside joint capsule (heals easier)

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28
Q

What does the LCL prevent?

A

Adduction (varus) stress

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29
Q

Where does the LCL attach?

A

Head of fibula

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30
Q

What has greater laxity between MCL and LCL?

A

LCL

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31
Q

What could an injury to the ACL also injure?

A

Medial meniscus

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32
Q

When are both the anteromedial and posterolateral major bundles of the ACL under tension?

A

Full extension

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33
Q

When is the posterolateral major bundle of the ACL under maximum tension?

A

0-30° of flexion

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34
Q

When is the anteromedial major bundle of the ACL under maximum tension?

A

45-60° of flexion

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35
Q

Where is most rotation available in the anteromedial and posterolateral major bundles of the ACL?

A

60-90° of flexion

36
Q

Where does the ACL attach?

A

Lateral femoral Condyle to

Anterior intercondylar surface and anterior horn of medial meniscus

37
Q

What does the ACL prevent in open chain?

A

Anterior tibial translation

38
Q

What does the ACL prevent in closed chain?

A

Posterior femoral translation

39
Q

What does the ACL assist to limit?

A

Hyperextension

Valgus forces

IR/ER

40
Q

What could an injury to the PCL also injure?

A

Lateral and medial meniscus

41
Q

Where does the PCL attach?

A

Medial femoral Condyle to

Posterior horns of medial and lateral meniscus

42
Q

How much stronger is the PCL when compared to the ACL?

A

50% thicker and 2x stronger

43
Q

What does the PCL prevent in open chain?

A

Posterior translation of tibia

44
Q

What does the PCL prevent in closed chain?

A

Anterior translation of femur

45
Q

What does the PCL assist to prevent?

A

Varus/valgus forces

IR/ER

46
Q

When is the anterolateral bundle of the PCL under most tension?

A

Flexion

47
Q

When is the posteromedial bundle of the PCL under most tension?

A

Extension

48
Q

What type of joint is the Tibiofemoral joint?

A

Modified hinge synovial

49
Q

How is the shaft of the femur aligned?

A

Slightly medially (creates normal valgus of 5-10°)

50
Q

Why does the medial femoral Condyle extend distally further?

A

To accommodate and distribute weight bearing evenly

51
Q

What is the Q angle?

A

Angle formed by line drawn from ASIS to mid patella and line from mid patella to tibial tuberosity

52
Q

What is the normal Q angle for males?

A

10-14°

53
Q

What is the normal Q angle for females?

A

15-17°

54
Q

What does it mean if you are over the average Q angle?

A

Valgum

55
Q

What does it mean if you are under the average Q angle?

A

Varum

56
Q

What is the contact pressure of Patellofemoral joint in full knee extension?

A

0

57
Q

When is there the most contact pressure in the Patellofemoral joint?

A

90° of flexion

58
Q

What is the normal ROM for knee extension?

A

5-10°

59
Q

What is the normal ROM for knee flexion?

A

130-140°

60
Q

What is an angle of >15° of knee extension considered?

A

Genu recurvatum

61
Q

What is the screw home mechanism in open chain extension?

A

Tibia externally rotates on fixed femur

62
Q

What is the screw home mechanism in closed chain extension?

A

Femur internally rotates on fixed tibia

63
Q

What unlocks the knee from the screw home mechanism?

A

Contraction of politeus

64
Q

How does the knee move in open chain?

A

Concave moving on convex (roll and glide in same direction)

65
Q

What is extension accompanied by in open chain?

A

Anterior tibial glide

66
Q

What is flexion accompanied by in open chain?

A

Posterior tibial glide

67
Q

How does the knee move in closed chain?

A

Convex on concave (roll and glide in opposite directions)

68
Q

What is extension accompanied by in closed chain?

A

Posterior femoral glide

69
Q

What is flexion accompanied by in closed chain?

A

Anterior femoral glide

70
Q

What is closed packed?

A

Maximum area of surface contact occurs (perfect fit)

Joint is compressed

71
Q

What is open (loose) packed?

A

Where you can assess best amount of movement

72
Q

What is the significance in closed packed position?

A

Load on static stabilizers

73
Q

What is the significance in open packed position?

A

Load of dynamic stabilizers (decreases friction)

74
Q

When is the knee in closed packed?

A

Full extension and ER

75
Q

When is the knee in an open packed position?

A

25° flexion

76
Q

What is flexion needed for gait?

A

60-70°

77
Q

What is flexion needed for on/off toilet?

A

75°

78
Q

What is flexion needed for stair climbing?

A

70-80°

79
Q

What is flexion needed for sit/rise from chair?

A

90°

80
Q

What is flexion needed for in/out of bath?

A

90°

81
Q

What is flexion needed for advanced function?

A

115°

82
Q

What percentage of knee osteoarthritis contributes to genetic factors?

A

40-65%

83
Q

What is clinical classification for OA of knee?

A

Knee pain plus 3 of following 6

Age > 50

Morning stiffness < 30 min

Crepitus

Tenderness

Bony enlargement

No palpable warmth

84
Q

What does replacing the patella during a TKA result in?

A

Longer healing time

85
Q

What is rehab for a TKA 1-2 weeks post?

A

0-90° flexion (don’t open incision)

86
Q

What is rehab for a TKA 3-6 weeks post?

A

115° of flexion

Increase strengthening

87
Q

What is the Wells criteria?

A

Risk factors for DVT post surgery

MSK 2 (21 decks)

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