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KINES-LEC 3rd Shift > knee > Flashcards

knee Flashcards

1
Q

tibiofemoral joint - joint type

A

synovial double condyloid/modified hinge

t/n: this is because of voluntary control of movement is possible in 2 planes (saggital/transverse)

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2
Q

tibiofemoral joint (2) planes

A

(2) DOF:
1) sagittal - flex/ext.
2) transverse plane - tibial ER/IR

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3
Q

patellofemoral joint - joint type

A

non-synovial joint/false joint

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4
Q

tibiofemoral joint anatomy (femoral condyles)

A

FEMORAL CONDYLES

larger medial FEM condyle
- greater radius of curvature
- shifted a bit POSTERIROLY/projects more DISTALLY

lateral FEM condyle
- shifted ANTERIORLY (more directly in line with the shaft of femur)

t/n: there is some ROTATORY movement happening because of IMBALANCE when it comes to lat/med condyles SHAPE

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5
Q

tibiofemoral joint anatomy (tibial condyles & tibial plateaus)

A

TIBIAL CONDYLES

larger medial TIB condyle / smaller lateral TIB condyle (same w/ femoral)

TIBIAL PLATEAUS

larger medial TIB plateau / smaller lateral TIB plateau (in order to match two tibial condyles)

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6
Q

(3) tibiofemoral alignments

A

1) physiological valgus angle/anatomical longitudinal axis of femur
2) mechanical axis/weight-bearing line
3) q angle/quadriceps angle

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7
Q

physiologic valgus angle

A
  • anatomical/longitudinal axis of femur
  • normal values: 175-185 (180 ave)
  • crosses MIDLINE
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8
Q

genu valgum

A
  • knock knees
  • greater than 185 deg
  • MEDIAL COLL. ligament STRETCHED
  • LATERAL COLL. ligament COMPRESSED
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9
Q

genu varum

A
  • bow legs
  • lesser than 185 deg
  • MEDIAL COLL. ligament COMPRESSED
  • LATERAL COLL. ligament STRETCHED
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10
Q

mechanical axis/weight-bearing line

A
  • transmits weight DOWN TO LE / passes through MECHANICAL AXIS
  • passes CENTER OF
    1) hip joint
    2) knee joint
    3) ankle joint
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11
Q

mechanical axis during single-leg stance

A
  • shifts MEDIALLY
  • MEDIAL aspect COMPRESSIVE FORCE / LATERAL aspect MORE DESTRUCTIVE/TENSILE FORCE
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12
Q

Q angle

A
  • quadriceps angle
  • normal value: 10-15 deg
  • male ave: 14 deg / female ave: 17 deg (wider pelvis/short stature)
  • INTERSECTION lines FROM:
    1) ASIS to midpoint of patella
    2) tibial tubercle to midpoint of patella
  • represents vector for combined pull of quads fem & patellar tendon
  • will influence the amt. of force that quadriceps muscle & patellar tendon are generating
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13
Q

menisci of the knee characteristics

A
  • fibrocartilaginous discs (gel-like structure)
  • reduces frictional forces
  • increases concavity of tibial plateau > increases congruence of joint
  • wb function:
    1) shock absorber
    2) pressure distribution
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14
Q

medial vs lateral menisci (anatomical config.)

A

MEDIAL
- larger
- C shape
- thick on the outside (on periphery)/thinner on central area

LATERAL
- smaller (almost 4/5 of a circle)
- thick on outside (on periphery)/thinner on central area

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15
Q

(4) menisci attachments

A

1) transverse ligament
- connecting 2 anterior horns of lateral and medial meniscus
2) coronary ligaments
- stabilize meniscus between femur and tibia (imagine putting a coin in that space > absence of coronary lig. > meniscus unstable) / in place no matter what movement
3) joint capsules
4) tendons of some muscles

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16
Q

medial menisci vs lateral menisci (attachments)

A

MEDIAL
- MCL
- ACL (anterior horn)
- PCL (posterior horn)
- semimembranosus

LATERAL
- LCL
- ACL (common tibial attachment)
- popliteus

t/n: meniscal motion is influenced by these structures > will dictate stabilization of menisci

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17
Q

medial menisci vs lateral menisci (stability/mobility)

A

medial meniscus = more attachments = more stable
- medial meniscus being stable cannot go/move with knee joint = has greater risk for injuries

lateral meniscus = less attachments = more mobile
- since LE has many functional activities/involves lots of movements, it requires movement of menisci (lateral)

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18
Q

knee joint OPP/CPP

A

OPP
- slight knee flexion (25-30 deg)
- not stretched too much

CPP (bony/lig)
- full knee ext.
- tibial ER

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19
Q

knee joint capsule characteristics

A
  • very thick
  • has 2 layers
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20
Q

knee joint capsule (2) layers

A

1) fibrous capsule/layer
2) synovial membrane/sheath

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21
Q

knee joint capsule: fibrous capsule/layer (characteristics & function)

A
  • superficial
  • attached to distal femur/proximal tibia
  • attaches to patella/quadriceps tendon/patellar tendon
  • creates TIGHT seal
  • is part of EXTENSOR RETINACULUM
  • ENCLOSES synovial fluid
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22
Q

knee extensor retinaculum (3) contents

A

1) lateral patellar retinaculum
2) medial patellar retinaculum
3) fibrous capsule

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23
Q

knee joint capsule: synovial membrane/sheath (characteristics & function)

A
  • deeper
  • thinner
  • SECRETE and ABSORB synovial fluid
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24
Q

knee joint: synovial fluid

A
  • moves when we move tibiofemoral joint (extension = anteriorly / flexion = posteriorly)
  • semi-flexed position (usual position of comfort) = equal distribution of fluid / does not impinge any pain-sensitive structures being controlled on CENTRAL area

t/n: if knee joint is injured > inflammation > swelling > excessive fluid in synovial cavity > compression of structures in joint

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25
Q

knee fat pads

A
  • fatty soft tissues found in the knee joint
  • reduce frictional forces (between tendon and bone/muscle and bone)
  • acts as shock absorbers (when too much pressure is present in the joint, e.g. when you kneel)
  • very rich in nerve innervation > compressed too much > pain (fat pad impingement syndrome)
  • FOUND SUPERIOR on the PATELLA
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26
Q

(3) knee fat pads

A

1) anterior suprapatellar fat pad (anterior to quadriceps tendon)
2) posterior suprapatellar fat pad (posterior to quadriceps tendon)
3) infrapatellar (hoffa’s) fat pad

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27
Q

patellar plicae

A
  • joint synovial membrane
  • embryonic stage > septum > separate 2 lateral and medial compartments of knee
  • plicae stage > synovial septum resorbed > remnants of synovium > patellar plicae
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28
Q

patellar plicae syndrome

A
  • patellar plicae (pain-sensitive structures) irritated/inflamed
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29
Q

(4) patellar plicae locations

A

inferior (infrapatellar) > superior (suprapatellar) > medial > lateral

*commonly found inferiorly (infrapatellar)

30
Q

knee bursa

A
  • balloon-like structure
  • reduce fictional forces
31
Q

(5) bursa of the knee

A

1) prepatellar bursa (between patella & skin)
- if inflamed, popeye’s knee / injured, housemaid’s knee
2) suprapatellar bursa (between quadriceps tendon & femur)
3) infrapatellar bursa (superficial & deep)
- if inflamed, clergyman’s knee
4) pes anserinus (subsartoial bursa/pes anserinus muscles)
5) popliteal bursa (small bursa posteriorly)

32
Q

(4) knee joint ligament groups

A

1) collateral ligaments (LCL/MCL)
2) cruciate ligaments (anterior/posterior)
3) ligaments of posterior (joint) capsule
4) meniscofemoral ligament

33
Q

lateral collateral ligament (LCL)

A
  • fibular collarteral ligament
  • lateral side > controls varus forces
  • merges with biceps femoris (tendon) > CONJOINED TENDONS
  • provides SECONDARY RESTRAINT for TIBIAL ER
34
Q

medial collateral ligament (MCL)

A
  • controls valgus forces (PRIMARY)
  • RESTRAINT ANTERIOR tibial TRANSLATION (SECONDARY)
35
Q

anterior cruciate ligament (ACL)

A
  • from MEDIAL TIBIAL PLAT
  • moves upwards > superior > posterior > lateral
  • attached to MEDIAL SURFACE of LAT. FEM CONDYLE
36
Q

True/False:
Both ACL & PCL are intracapsular & extrasynovial.

A

true

t/n: intracapsular = inside capsule / extrasynovial = outside synovium

37
Q

ACL functions (unidirectional control)

A
  • prevent excessive ANTERIOR translation of the tibia on fixed femur
  • prevent excessive POSTERIOR translation of femur on fixed tibia
  • prevent hyperextension of the knee
38
Q

ACL functions (multidirectional control)

A
  • provides STABILIZATION (ANTEROLAT/ANTEROMED)
39
Q

(2) ACL bundles

A

1) anteromedial bundle (AMB)
- taut in knee flex. >90 degrees (maximal knee flexion)
- also taut in hyperEXT. (but PLB more taut)
2) posterolateral bundle (PLB)
- taut in hyperEXT.

40
Q

True/False:
Both bundles of ACL are taut in hyperextension.

A

true

t/n: that’s why if we have hyperext. injury, you can injure both bundles of ACL

41
Q

posterior cruciate ligament (PCL)

A
  • from LATERAL TIBIAL PLATEAU
  • moves up sup > bit forward ant > medial
  • attached to LATERAL SURFACE of MED. CONDYLE
42
Q

PCL functions (unidirectional)

A
  • prevent excessive posterior translation of tibia on fixed femur
  • prevent excessive anterior translation of femur on fixed tibia
43
Q

PCL functions (multidirectional)

A
  • provides STABILIZATION (POSTEROMED/POSTEROLAT)
  • secondarily RESISTS varus forces
  • prevent too much tibial IR
44
Q

True/False:
PCL cross-sectional area > ACL

A

true

t/n: that’s why ACL is more injured

45
Q

(3) ligaments of posterior capsule

A

1) oblique popliteal ligament
2) posterior oblique ligament
3) arcuate ligament

46
Q

oblique popliteal ligament (characteristics & functions)

A
  • expansion of semimemb. muscle
  • merges with (posterior) joint capsule > posteromedial tibial condyle
  • support joint posteromedially
47
Q

posterior oblique ligament

A
  • attached to adductor tubercle
  • attached to MCL > posteromedial tibia > medial meniscus
  • support joint posteromedially
48
Q

arcuate ligament

A
  • support joint posterolaterally
  • (2) branches: medial / lateral
49
Q

meniscofemoral ligament

A
  • not true ligament (misnomer)
  • attached from meniscus going to femur
  • from lateral meniscus > PCL > medial femoral condyle
50
Q

meniscofemoral ligament (2) fibers

A

1) anterior = ligament of Humphry
2) posterior = ligament of Wrisberg

51
Q

knee arthrokinematics (OKC)

A
  • concave tibia moving

extension
- tibia roll ANT. / glide ANT.

flexion
- tibia roll POST. / glide POST.

52
Q

knee arthrokinematics (CKC)

A
  • femur moving

extension
- condyle roll ANT. / glide POST.

flexion
- condyle roll POST. / glide ANT.

53
Q

everything about Screw Home Mechanism

A

EXTENSION
- also called “terminal knee rotation/extension” / “locking mechanism of the knee”
- very important FUNCTIONALLY (e.g. ambulation) so that knee doesn’t buckle
- last 20-30 degrees of extension
- tibial ER

FLEXION
- unlocking knee
- tibial IR
-

54
Q

(3) factors of Screw Home Mechanism

A

1) bone & joint (larger medial femoral condyles/medial plateau = GREATER ARC MOTION for knee flex/ext)
2) ligament (obliquity of ACL = generate SOME ROTATIONAL MOTION)
3) muscle (obliquity of Q-angle = lateral pull of quadriceps)

55
Q

True/False:
Muscle responsible for tibial IR during unlocking of the knee (flexion) is Popliteus.

A

true

t/n: no muscle is active during tibial ER, locking of the knee (extension) but rather supported by femoral condyles/tibial plateau/passive tension of ACL/Q-Angle

56
Q

(5) compressive forces on the knee (and their BW contribution)

A

1) gait (ambulation) = 2x BW
2) stair climbing = 2x BW
3) running = 3-4x BW
4) genu varum = medial compressed > lateral
5) genu valgum = lateral compressed > medial

57
Q

normal knee ROM (knee flexion/deep squats/normal gait/stair ascent/stair descent/sitting down/hyperext)

A

F: 130-140 (135)
DS: 160
G: 60-70
SA: 80
SD: 110-120
SIT: >=90
H: -5

58
Q

patella

A
  • largest sesamoid boin
  • inverted triangle (apex = inferior)
  • has (2) vertical ridges
  • contribute to anatomic pully of quadriceps
  • increased moment arm / increased torque generation capacity of quads fem.
59
Q

patella vertical ridge

A
  • posterior patella
  • divided to med. and lat. facets
60
Q

patella 2nd vertical ridge

A
  • separate med. and odd facets
61
Q

(5) facets of patella

A

1) sup
2) inf
3) med
4) lat
5) odd

62
Q

patellar contact

A

knee extended = inferior pole > femur
20 deg flexion = inferior facet compressive contact
45 deg flexion = middle portion compressive contact
90 deg flexion = superior facet compressive contact
> 90 degrees (135 deg) flexion = more contact > odd facet

63
Q

insall-salvati index

A
  • patellar height
  • ratio of length of patellar tendon to length of patella
  • normal ratio: 1:1 (equal)
64
Q

patella alta

A

> 1:1 / >1:2
- patella situated higher
- patellar tendon length increases

65
Q

patella baja

A

< 1:1 / <0.8
- patella situated lower
- patellar tendon length decreases

66
Q

(3) patellar motion

A

1) upwards
2) downwards
3) side to side

67
Q

patellar rotational movements (3) axis

A

(2) X axis
- patellar flexion (inf > backward)
- patellar ext. (inf > forward)

Y axis
- medial tilting
- lateral tilting

Z axis (spinning motion of patella)
- medial rotation
- lateral rotation

68
Q

patellofemoral joint stress

A

walking: 25-50% of bw
running: 5-6x of BW (from 25-50%)
***
- knee flexion increased > resultant force increased
- knee flexion decreased > resultant force decreased/lower

69
Q

True/False:
Too much bending (deep squats) on the knee can result to excessive compression of the patella.

A

true

t/n: this is called “patellofemoral joint syndrome/stress”

70
Q

patellar instability (frontal plane instability)

A
  • frontal plane/lateral patellar instability VERY COMMON (motions: IR & ER)
  • d/t: physiological valgus of the knee / high q angle (pulled lat. = displaced lat.)
  • imbalance of forces (weak VMO) > instable lat

KINES-LEC 3rd Shift (4 decks)

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