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631: Clinical Management of the Musculoskeletal System I > Knee > Flashcards

Knee Flashcards

1
Q

What are the 2 joints of the knee?

A
  • Tibiofemoral joint

- Patellafemoral joint

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2
Q

What are the 3 most common types of knee injuries seen clinically?

A
  • Unspecified sprains, strains or overuse injuries
  • Contusions
  • Meniscal or ligamentous injuries
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3
Q

Which knee joint is the largest joint in the body?

A

the tibiofemoral joint

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4
Q

The tibiofemoral joint has _ degrees of freedom, what are they?

A

3:
Flexion/Extension
Internal Rotation/External Rotation
Abduction/Adduction

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5
Q

The lateral condyle serves as the origin of what 3 structures?

A
  • Popliteus
  • Lateral head of the gastrocnemius
  • Lateral collateral ligament (LCL)
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6
Q

The medial condyle serves as the origin of what 3 structures?

A
  • Adductor magnus
  • Medial head of the gastrocnemius
  • Medial collateral ligament (MCL)
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7
Q

Tibial plateaus are con___ in the mediolateral direction

A

concave

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8
Q

The medial tibial plateau is con___ in the A/P direction

A

concave

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9
Q

The lateral tibial plateau is con___ in the A/P direction

A

convex

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10
Q

Does the medial or lateral tibial plateau have a larger surface area? How much larger is it?

A

The medial plateau has a surface area that is approximately 50% greater than that of the lateral plateau

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11
Q

Medial plateau’s articular surface is __ times thicker than the lateral plateau’s

A

3

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12
Q

The presence of what accentuates the concavity of the tibial plateaus?

A

the menisci

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13
Q

What is the resting position of the tibiofemoral joint?

A

25 degrees of flexion

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14
Q

What is the closed-packed position of the tibiofemoral joint?

A

Full Extension and External Rotation of the Tibia

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15
Q

What is the capsular pattern for the tibiofemoral joint?

A

Flexion > Extension

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16
Q

What type of joint is the patellofemoral joint?

A

Modified plane joint

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17
Q

The patella has _ facets. What are they?

A 
5:
   Odd
   Superior
   Inferior
   Medial
   Lateral
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18
Q

Which patellar facet is most frequently affected with chondromalacia patella?

A

the odd facet

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19
Q

What are the 5 functions of the patellofemoral joint?

A
  • Provide the articulation with low friction
  • Protect the distal aspect of the femur from trauma and the quadriceps from attritional wear
  • Improve the cosmetic appearance of the knee
  • Improve the moment arm (distance between the center of gravity and the center of rotation) of the quadriceps
  • Decrease the amount of A/P tibiofemoral shear stress placed on the joint
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20
Q

Describe the positioning of the knee joint capsule in reference to the patella. What does it form?

A

The capsule ascends superiorly/anteriorly above the patella to form the suprapatellar pouch

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21
Q

What lines the inner portion of the knee joint capsule?

A

synovial membrane

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22
Q

What does the synovial membrane exclude from the interior portion of the knee joint?

A

the cruciate ligaments

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23
Q

The cruciate ligaments are ___-synovial and ___-articular

A

extrasynovial and intra-articular

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24
Q

What type of the joint is the proximal tibiofemoral joint?

A

Plane synovial joint between the Tibia and the Fibular Head

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25
Q

Which aspects of the proximal tibiofibular joint are convex and which are concave?

A

There is a slight convexity on the oval tibial facet and a slight concavity of the fibular head

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26
Q

In what direction does the tibial facet at the proximal tibiofemoral joint face?

A

laterally, posteriorly, and inferiorly

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27
Q

Does the proximal or distal tibiofemoral joint have more motion?

A

proximal

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28
Q

What are the 2 glides that can occur at the proximal tibiofemoral joint?

A
  • Superoinferior direction

- Anteroposterior direction

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29
Q

The ACL is the primary restraint for which motions?

A

Anterior translation and medial rotation of the tibia on the femur

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30
Q

The PCL is the primary restraint for which motions?

A

Posterior translation and medial rotation of the tibia on the femur

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31
Q

Both the ACL and PCL are the secondary restraints for which motions?

A

Valgus and varus rotation of the tibia

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32
Q

The MCL is the primary restraint for which motions?

A

Valgus and lateral rotation of the tibia

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33
Q

The LCL is the primary restraint for which motions?

A

Varus and lateral rotation of the tibia

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34
Q

Both the MCL and LCL are the secondary restraints for which motions?

A

anterior and posterior translation of the tibia on the femur

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35
Q

The ACL and PCL contain mechanoreceptors, so if there is disruption of these ligaments what happens?

A

There can be an interruption or elimination of sensory nerve fibers in the joint

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36
Q

The ACL’s ability to adjust to internal stress influences what 3 things?

A
  • laxity of the joint
  • stresses of the joint
  • kinematics of the joint
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37
Q

Which knee ligament is the strongest?

A

the PCL

It is twice as strong as the ACL, MCL, and LCL

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38
Q

Forcing the ACL more than _% beyond its resting length may result in rupture.

A

5

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39
Q

The PCL provides __-__% of the total restraint to posterior translation of the tibia on the femur

A

90 - 95%

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40
Q

Are the MCL and LCL extra- or intra-articular ligaments

A

extra-articular ligaments

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41
Q

Describe the structure of the MCL

A

It develops as a thickening of the medial joint capsule and is subdivided into a superficial band and a deep band

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42
Q

Describe the superficial band of the MCL

A

It is a thick, flat band that has a fan-like attachment proximally on the medial femoral condyle and blends with the posteromedial corner of the capsule

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43
Q

Describe the deep band of the MCL

A

It is a continuation of the capsule that blends with the Medial Meniscus

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44
Q

Which part of which ligament is the first to be injured when a valgus stress is applied

A

Superficial band of the MCL

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45
Q

Where does the LCL originate and insert at?

A

It arises from the lateral femoral condyle and runs distally and posteriorly to insert onto the head of the fibula

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46
Q

Does the LCL blend with the lateral meniscus?

A

No it develops independently, and remains completely free from the joint capsule and the lateral meniscus

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47
Q

The secondary knee restraints include structures in what aspects of the knee?

A

the posterolateral and posteromedial corners of the knee

48
Q

What do secondary knee restraints serve to control?

A

anterior tibial translation relative to the femur

49
Q

What provides dynamic stability to the knee?

A

Unopposed contraction of the quadriceps complex

50
Q

What does the unopposed contraction of the quadriceps complex increase? And what is it synergistic to?

A

anterior tibial translation and is synergistic to the PCL

51
Q

What does the unopposed contraction of the hamstrings complex increase? And what is it synergistic to?

A

posterior tibial translation and is synergistic to the ACL

52
Q

What are 4 other structures that provide support to the knee?

A
  • Popliteus
  • Patellar Tendon
  • Oblique popliteal ligament
  • Fabella
53
Q

What aspect of the menisci are more prone to tear with trauma?

A

the inner (thinner) regions

54
Q

The outer __% of the lateral meniscus is vascularized

A

25%

55
Q

The outer __% of the medial meniscus is vascularized

A

30%

56
Q

What shape is the medial meniscus? What does this result in?

A

Semilunar (half circle)

Results in a wider separation of its anterior and posterior horns

57
Q

How does the medial meniscus attach to the tibial plateau?

A

by coronary ligaments

58
Q

What does the MCL also attach to?

A

to the deeper portion of the MCL and the knee joint capsule

59
Q

What shape is the medial meniscus?

A

C-shaped

60
Q

The lateral meniscus has an excursion of approximately __ mm, whereas the medial meniscus has an excursion of approximately __ mm.

A

10

2

61
Q

Which menisci is larger and thicker?

A

medial

62
Q

What are the 6 functions of the menisci?

A
  • Load Transmission
  • Shock Absorption
  • Joint Lubrication
  • Nutrition
  • Secondary Mechanical Stability
  • Guiding of Movements
63
Q

List the 8 bursae of the knee

A
  • Superficial Infrapatellar Bursa
  • Deep Infrapatellar Bursa
  • Prepatellar Bursa
  • Tibiofemoral Bursa
  • LCL Bursa
  • Inferior Subtenindous Bursa (Biceps Femoris Tendon)
  • Anserine Bursa
  • Semimembranosus Bursa
64
Q

What is a plica?

A

a remnant of the 3 cavities in the synovial mesenchyme of the developing knee

65
Q

What is the retinacula formed from?

A

structures in the first and second layers of the knee joint

66
Q

In summary, because the bony surfaces of the knee lend little to inherent stability, what is joint stability reliant on?

A

The restraints of:

- joint capsule
- ligaments
- menisci
- musculature
67
Q

During flexion of the knee, the femur rolls ____ and glides ______.

A

posteriorly

anteriorly

68
Q

During extension of the knee, the femur rolls ____ and glides ______.

A

anteriorly

posteriorly

69
Q

When are the lateral condyle of the femur and the lateral meniscus congruent?

A

From 30 - 5 degrees of WB knee extension

70
Q

What does the lateral shift of the axis of movement during weight-bearing knee extension produce?

A

Internal rotation of the femur

71
Q

What movement is the only one to accompany extension in the last 5 degrees of extension? What is this referred to as?

A

rotation

The “screw home mechanism”

72
Q

During the “screw home mechanism” the tibia ______ rotates and the femur _______ rotates as the knee approaches full extension

A

externally

internally

73
Q

Knee hyperextension is usually available from _ - _ degrees

A

0 - 15

74
Q

During knee hyperextension, the femur tilts _____. What does this create?

A

forward

This creates anterior compression between the femur and the tibia

75
Q

The Q angle is an angle formed by the bisection of what 2 lines?

A
  • ASIS to the center of the patella

- Center of the patella to the tibial tubercle

76
Q

What is the Q angle a measure of?

A

The tendency of the patella to move laterally when the quadriceps muscles are contracted

77
Q

What is the normal Q angle for males? Females?

A
  • 8–14 degrees for males

- 15–17 degrees for females

78
Q

A Q angle greater than __ degrees is considered abnormal. What is this indicative of?

A

20

potential displacement of the patella

79
Q

The Patellofemoral Joint Reaction Force is a function of what 2 things?

A
  • Quadriceps and patellar tendon tension

- Angle formed between the quadriceps and patellar tendon

80
Q

During OKC exercises, maximum patellofemoral joint reaction force in the quad/patellar tendon is generated when?

A

going from 90 degrees to full extension

81
Q

During OKC exercises, the lowest patellofemoral joint reaction force in the quad/patellar tendon is generated when?

A

at 90 - 40 degrees

82
Q

During CKC exercises, maximum patellofemoral joint reaction force in the quad/patellar tendon is generated when?

A

at 60 degrees

83
Q

CKC exercises should initially be prescribe at _ - _ degrees and then can progress to _ - _ degrees

A

0 - 16

0 - 30

84
Q

Describe patellar tracking in the normal knee

A

the patella glides inferiorly and superiorly during flexion and extension

85
Q

The patella tracks _ - _ cm with respect to the femur during flexion and extension

A

5 - 7cm

86
Q

The patella moves in a ____ C-shaped curve from 20 to 30 degrees of motion

A

lateral

87
Q

Between 45 to 15 degrees the lateral curvature produces what 2 things?

A
  • Gradual medial glide of the patella

- Medial tilt of the patella

88
Q

Between 15 to 0 degrees the lateral curvature produces what 2 things?

A
  • Lateral glide of the patella

- Lateral tile of the patella

89
Q

What are 4 abnormal patellar tracking patterns?

A
  • Medial tracking patella
  • Lateral tracking patella
  • Patella Alta
  • Patella Baja
90
Q

What is the Waldron test used to assess?

A

patellofemoral function

91
Q

A posterior glide of the tibia on the femur increase _____.

A

flexion

92
Q

An anterior glide of the tibia on the femur increase _____.

A

extension

93
Q

Describe the 3 grades of a valgus and varus stress test

A
  • Grade I: The joint space opening is within 2mm of the contralateral side
  • Grade II: The joint space opens 3-5mm more than the contralateral side in 20 degrees of knee flexion and less than 2mm more than the normal knee in full extension
  • Grade III: The joint space opens 5-10mm more than that of the normal knee in 20 degrees of flexion and full extension
94
Q

What 2 tests assess for ACL tear?

A
  • Lachman’s Test

- Anterior Drawer Test

95
Q

How is Lachman’s test graded?

A

o 1+ (mild): 5mm or less
o 2+ (moderate): 5-10mm
o 3+ (serious): more than 10mm

96
Q

What 2 tests assess for PCL tear?

A
  • Posterior Sag (Godfrey) Sign

- Posterior Drawer Test

97
Q

What is the pivot shift?

A

The anterior subluxation of the lateral tibial plateau that occurs when the lower leg is stabilized in (almost) full extension, whereby further flexion produces a palpable spring-like reduction

98
Q

What 2 tests assess for the pivot shift?

A
  • Subluxation Test

- Reduction Test

99
Q

What patient position must patellar stability tests be assessed in?

A

90 degrees of flexion

100
Q

What does a patellar glide determine?

A

the amount of lateral deviation of the patella in the frontal plane

101
Q

A 5mm lateral displacement of the patella causes a __% decrease in VMO tension

A

50%

102
Q

Patella can be passively displaced medially and laterally approximately _ cm, which is 1/_ the width of the patella

A

1 cm

1/3

103
Q

What is considered abnormal patellar displacement?

A

more than 1/2 the patella over the medial or lateral aspect

104
Q

What may cause a decrease in the medial glide of the patella?

A

IT Band and/or lateral retinaculum tightness

105
Q

A slight ____ tilt of the patella is normal.

A

lateral

106
Q

What does a medial tilt result from?

A

a tight lateral retinaculum

107
Q

If the inferior pole of the patella is sitting lateral to the long axis of the femur, the patient has an _______ rotated patella

A

externally

108
Q

If the inferior pole of the patella is sitting medial to the long axis of the femur, the patient has an _______ rotated patella

A

internally

109
Q

What are the 6 meniscal tear tests?

A
  • McMurray’s Test
  • Apley’s Test
  • Anderson Mediolateral Grind Test
  • Bounce Home Test
  • Figure-4 Test
  • Payr Sign
110
Q

When performing McMurray’s test how does the clinician test the integrity of the medial meniscus?

A

ER the tibia while slowly extending the knee

111
Q

When performing McMurray’s test how does the clinician test the integrity of the lateral meniscus?

A

ER the tibia while slowly extending the knee

112
Q

What is indicative of a positive test for a rotation sprain of the soft tissue when performing Apley’s test?

A

Pain upon distraction and IR and ER rotation of the tibia

113
Q

What is indicative of a positive test for a meniscal tear when performing Apley’s test?

A

Pain upon compression while IR and IR the tibia

114
Q

When performing the Anderson mediolateral grind test a ____ stress should be applied while the knee is flexed and a ____ stress should be applied while the knee is flexed

A

valgus

varus

115
Q

Which meniscus test assess for a lateral meniscus tear? Medial meniscus tear?

A

Figure-4 Test

Payr Sign

116
Q

What are the 4 characteristics of plical irritation?

A
  • Anterior pain in the knee
  • Painful clicking
  • Giving way
  • Catching
117
Q

What are the 2 tests that assess for patellar chondromalacia?

A
  • Zohler’s Sign

- Clarke’s Test

631: Clinical Management of the Musculoskeletal System I (19 decks)

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