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COM MSK > Hip and Knee Joint > Flashcards

Hip and Knee Joint Flashcards

1
Q

Acetabulum formed by fusion of

A

Ilium, ischium and pubis

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2
Q

Which artery supplies the hip joint

A

Obturator artery to head of femur
Medial circumflex femoral- retinacular arteries
Ascending/transverse branches of lateral femoral circumflex artery (lateral pierces IF ligament)

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3
Q

Iliofemoral ligament

A

AIIS to IT line of femur
Y shaped
Strongest ligament in the body
Prevents hyperextension

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4
Q

Pubofemoral ligament

A

Obturator crest to IT line
Blends laterally with iliofemoral ligament
Prevents hyperextension
Primarily limits abduction

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5
Q

Ischiofemoral ligament

A

Ischial part of acetabular rim to femoral neck
Weakest ligament in hip
Hip externally rotates better than it internally rotates

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6
Q

Ligament of head of femur

A

Intra-articular ligament
Acetabular notch/transverse acetabular ligament to fovea of femur
Synovial fold conducting artery to head of femur (this artery contributes at birth but diminishes by age 4)
Minimal contribution to stability

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7
Q

Labrum

A

Fibrocartilaginous rim to margin of acetabulum

Increases acetabular articular area by 10%

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8
Q

Transverse acetabular ligament

A

Continuation of labrum inferiorly

Coursing over acetabular notch

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9
Q

Hiltons law

A

Nerves supplying muscles directly overlying and acting at joint also innervate that joint

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10
Q

Anterior hip muscles (flexors) innervated by

A

Femoral nerve

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11
Q

Inf/posterior muscles (external rotators) innervated by

A

Nerve to obturator externus and Nerve to quadratus femoris

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12
Q

Superior muscles (abductors) innervated by

A

Superior gluteal nerve

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13
Q

Strongest hip flexor

A

Iliopsoas

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14
Q

Flexors/adductors of hip

A

Pectineus
Gracilis
Adductor magnus/longus/brevis

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15
Q

Primary extensor from sitting to standing and then what muscle takes over

A 
Gluteus maximus from sitting to standing
Then hamstrings (semitendinosus, semimembranosus, long head biceps femoris)
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16
Q

Internal rotators of hip

A

Gluteus minimus/medius

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17
Q

What happens with weak/non-functional gluteus medius/minimus

A

Trendelenberg gait
Opposite side of pelvis sags, lean to weak side to raise opposite pelvis
Swing leg

18
Q

Log roll test

A

Patient supine, internally/externally rotate leg
Positive with pain
Helps with indeterminate radiographs in possible hip fracture

19
Q

Hip dislocation

A

Orthopedic emergency, especially in young children
Severe morbidity in elderly
Complex dislocation involves acetabular/femur fracture
Flexed hip is more susceptible to dislocation because of capsular laxity

20
Q

Resting position after posterior hip dislocation

A

Slight flexion, adduction, internal rotation

21
Q

Hip fracture position

A

Shortened and externally rotated

22
Q

Bipartite patella

A

Failure of superolateral portion to fuse
Commonly mistaken for fracture
8% of population

23
Q

Lateral collateral ligament

A

Extracapsular
Lateral femoral epicondyle to fibular head
Popliteus tendon passes deep

24
Q

Anterolateral ligament

A

Rotational stability to knee

From lateral epicondyle of femur to tibia posterior to Gerdys tubercle

25
Q

Segond fracture

A

Avulsion of anterolateral ligament from tibial insertion

Pathognomonic for ACL rupture

26
Q

Medial collateral ligament

A

Capsular
Medial epicondyle of femur to proximal tibia
Weaker than LCL
Meniscal attachment

27
Q

Meniscus

A 
Optimize force transmission across knee
Shock absorption
Secondary stabilizer of knee
Lateral meniscus has 2x more excursion than medial
Primary stabilizer in ACL deficiency
Medial is C-shaped
Lateral is circular shaped
Inter-meniscal ligament connects the two
Meniscofemoral ligaments
28
Q

Anterior cruciate ligament

A

85% stability to anterior tibial translation
Lateral intercondylar ridge to anterior tibia between intercondylar eminences
Anteromedial bundle is tightest during flexion
Posterolateral bundle is tightest during extension

29
Q

Posterior cruciate ligament

A

95% stability to posterior tibial translation
Posterior tibial sulcus below articulating surface to anterolateral medial femoral condyle
Anterolateral bundle tight in flexion
Posteromedial bundle tight in extension

30
Q

Blood supply to knee

A

Genicular anastomosis

  • Femoral
  • Popliteal
  • Anterior/posterior recurrent of anterior tibial
  • Circumflex fibular
31
Q

Middle genicular supplies

A

Cruciates, synovium, and posterior horns of meniscus

32
Q

Medial inferior genicular supplies

A

Peripheral 25% to medial meniscus

33
Q

Lateral inferior genicular supplies

A

Peripheral 25% to lateral meniscus

34
Q

Knee innervation

A

Femoral- anterior
Common fibular- lateral
Tibial- posterior
Obturator/saphenous- medial

35
Q

“Screw home”

A

Tibia externally rotates 5 degrees in last 15 degrees of extension
Allows cruciates to tighten and decrease quadriceps work while standing
Popliteus “unlocks” tibia via internally rotating to initiate flexion

36
Q

Genu recurvatum

A

Hyperextended knee

37
Q

MCL/LCL exam

A

Test at both 0 and 30 degrees (to isolate superficial MCL/LCL)
Instability at 0 degrees is capsular disruption or cruciate involvement

38
Q

MCL injuries

A

Most commonly associated with ACL
Most common multi-ligament injury
Intimately associated with medial meniscus as well

39
Q

Thessaly test

A

Patient stands on affected leg at 20 degrees knee flexion
Rotates on leg
+ is pain or click
Meniscus injury

40
Q

Meniscal tear

A

Most common indication for knee surgery
Usually caused by twisting of knee and you hear “pop”
Medial more common than lateral

41
Q

PCL injury causes

A

Fall onto flexed knee with foot in plantarflexion
Hyperextension injury
Dashboard injury/direct blow to anterior tibia

COM MSK (35 decks)

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