Knee Flashcards
Why is the knee joint classified as a complex joint?
Because it involves more than 2 articular surfaces and it contains intracapsular menisci.
What are the 3 articulations of the knee joints?
- the 2 joints between the femur and tibia are classified as synovial, bi-condylar type;
- the joint between the femur and patella is classified as a synovial , sellar type.
Classsify the knee joint
- Synovial – possesses a capsule, synovium, hyaline cartilage, etc.
- Complex (also Compound if PFJ included) – intraarticular structures intervene between the bones
- Bicondylar – two areas of joint contact
- Modified Hinge Joint – not just sagittal plane movement
Why is the knee joint described as a ‘modified hinge joint’?
Movements are largely restricted to one plane, however some axial rotation is possible.
Where does the knee joint line correspond to?
The upper margin of the tibial condyles.
What are the 2 main functions of the knee joint?
- Mobility
- Weightbearing/stability
The bony architecture of the knee joint makes it
relatively unstable, therefore how is it adapted to its function of weightbearing?
Strong collateral ligaments (transverse stability)
Intracapsular ligaments, ie cruciate ligaments (antero-posterior stability)
Strong capsule
Arrangement of the muscles surrounding the joint
Rotational stability is provided by both the cruciate and collateral ligaments
Describe the position of the synovial membrane lining the knee joint
It lines the capsule posteriorly and is reflected onto the bone as far as the articular surfaces. At the sides the membrane lines the capsule as far as the attachment of the menisci. Anteriorly, commencing at the upper border of patella, it forms a large pouch (suprapatellar bursa) under the quadriceps tendon over the anterior surface of the femur. Each side of the patella the membrane extends beneath the expansions of the vasti muscles.
Why are numerous bursae associated with the knee joint?
-The arrangement of the anterior structures
-The closeness of tendons surrounding the joint.
Define ‘synovium’
Complex arrangement of folds and pouches.
Characterised by extensive presence of bursae (bursa) – either communicating or non-communicating with the joint synovium.
What are the main functions of bursae?
Bursae minimise friction between moving surfaces (typically tendons and bone)
Give the 4 principle bursae and their respective locations
- Subcutaneous prepatellar bursa [between the lower part of the patella and the skin]
- Deep infrapatellar bursa [between the upper part of the tibia and the ligamentum patellae]
- Subcutaneous (superficial) infrapatellar bursa [between the tibial tubercle and the skin]
- Suprapatellar bursa [extends 6 cm above the base of the patella between the femur and the
quadriceps femoris]
Describe the location of the subtendinous bursae
On the lateral side between the lateral collateral ligament and the tendons of biceps femoris and popliteus muscles.
On the medial side of the joint are a series of bursae separating the medial collateral ligament from
the tendons of the other hamstring muscles and gastrocnemius muscle.
Describe the articular surfaces of the fibrous joint capsule
- “True” capsular fibres of the knee are absent anteriorly
- Various structures crossing the knee joint blend with/provide expansions of fibrous tissue to form a patchwork of retinaculae
- Lateral – ITB, LCL
- Anteriorly – Quadriceps and tendons
- Medially – MCL, Sartorius, Gracilis
- Posteriorly – Hamstrings particularly Semimembranosus (OPL), Popliteus
Identify the bones in knee articulation
Femur
Tibia
Patella
Describe the shape of the femur
Femur: Convex femoral condyles, longer anteroposteriorly than transversely, diverge posteriorly, with the medial condyle being narrower and jutting out more than the lateral. The intercondylar notch continues the groove of the patella surface. Faint grooves separate condylar and patellar surfaces, with the patellar surface divided by a groove into smaller medial and larger lateral parts.
Describe the shape of the tibia
Tibia: Flat articular surfaces separated by intercondylar eminence with triangular areas anterior and posterior, the eminence lodging in the intercondylar notch of the femur, The oval concave medial articular surface is larger than the rounded lateral surface, concave transversely but concavo-convex anteroposteriorly.
Describe the shape of the patella
Patella: Oval articular surface divided into larger lateral and smaller medial areas by a vertical ridge. Another faint ridge separates a medial perpendicular facet from the main medial area.
Describe the attachments of the fibrous capsule and identify areas where the capsule may be thicker or deficient.
The knee is surrounded by a thick ligamentous sheath composed mainly of muscle tendons and their expansions; there’s no complete fibrous capsule.
Anteriorly, the fibrous capsule attachment to the femur is deficient, blending with the quadriceps tendons, its attachment to the tibia is more complete, being deficient only in the tibial tuberosity.
Posteriorly, true capsule fibres pass vertically from above the articular surface to the posterior border of the tibia, being strengthened by the oblique popliteal ligament.
At the sides capsular fibres pass from the femoral to tibial condyles, blending posteriorly with a ligamentous network and anteriorly with tendinous expansion of quadriceps femoris: the lower lateral capsule is strengthened by the arcuate popliteal ligament from the fibular head.
Define Q angle
A line representing the resultant line of force of the quadriceps, made by connecting a point near the ASIS to the mid-point of the Patella.
The Q angle can be measured in laying or standing. Standing is usually more suitable, due to the normal weight-bearing forces being applied to the knee joint as occurs during daily activity.
Define ‘Genu Valgus’
Decreasing of the femoraltibial angle (less than 170-175). A person with knock knees (genu valgum) has a large gap between their feet when they’re standing with their knees together. Many young children have knock knees, which tend to be most obvious at around the age of 4.
Define ‘Genu Varus’
Increasing of the femoraltibial angle (more than 170-175). 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. Sometimes, older kids do too. It’s rarely serious and usually goes away without treatment, often by the time a child is 3–4 years old
What are the 2 ligaments oustide the joint capsule called?
Medidal and lateral collateral ligaments.
What are the key roles of the collateral ligaments?
Movement
Weight bearing
Strengthens joint
Limits hyperextension of knee
Limit valgus and varus force respectively
Describe the structure of the MCL
MCL is broader
Strong band passing downward and forward from the medial epicondyle of femur to the medial condyle and shaft of tibia.
The most superficial fibres extend below the level of the tibial tuberosity, deeper fibres pass from femur to tibia, while the deepest spread out to attach to the head of the medial meniscus.
Describe the structure of the LCL
LCL is shorter – a rounded cord – and is independently of the capsule/lateral meniscus
5cm long.
Passes downward and backwards from the lateral epicondyle of the femur to the lateral surface of the fibular head anterior to the apex
Does not blend with the joint capsule
Give the 2 sets of intra-capsule structures found in the knee joint capsule
Cruciate ligaments (ACL and PCL)
Menisci (Medial and Lateral)
Describe the attachments of the menisci
The deep surface of the capsule is attached to the periphery of each meniscus connecting it to the adjacent margins of the tibia. The medial collateral ligament is blended into the fibrous capsule whereas the lateral ligament is free standing. Through this arrangement, the medial ligament is attached to the medial meniscus, and the 2 structures are often both involved in any injury process.
Describe the shape of the menisci
The menisci are intra-articular crescentic-shaped fibrocartilage structures triangular in cross-section interposed between femoral and tibial condyles. The periphery is attached to the joint capsule and the medial meniscus firmly anchored to medial collateral ligaments. The superior surface is smooth and concave, the inner free border is thin. The medial meniscus is broader posteriorly than anteriorly; the lateral meniscus is of uniform width. Anterior and posterior horns attach the menisci to the intercondylar eminence
Describe the attachments of the menisci
Posteriorly the medial meniscus is attached to the oblique popliteal ligament via the joint capsule and the lateral meniscus to the popliteus tendon: the lateral meniscus usually contributes a slip to the PCL (mensicofemoral ligament). From their outer margins thickenings of the joint capsule attach the menisci to the side of the patella (meniscopatellar fibres).
What is the transverse meniscomeniscal ligament?
The transverse or meniscomeniscal ligament is a ligament in the knee joint that connects the anterior margin of the lateral meniscus to the anterior end of the medial meniscus .
Identify the key roles of the mensici
- Improve congruence
- Weight bearing
- Shock absorption
- Lubrication
- Participate in locking mechanism
Describe the position of the Anterior Cruciate Ligament
Passes posteriorly, laterally and proximally from the anterior tibial spine to the medial surface of the lateral femoral condyle, spiralling medially through 110* as it does so. The anteromedial band limits flexion and posterolateral band limits extension.
Longer than PCL (5:3)