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Ortho Tx 700 > Knee > Flashcards

Knee Flashcards

1
Q

Medial femoral condyle

A

Extends further distantly

This creates a 10° valgus angle

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2
Q

Lateral femoral condyle

A

Extends further anteriorly

This prevents lateral patellar dislocation from horizontal forces of the quadriceps

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3
Q

Gerdy’s tubercle

A

On lateral tubercle of the tibia.

Attachment site for the ITB

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4
Q

Patella

A

Triangular sesamoid bone

Attachment site foe muscles and improves extension of quads.

Apex (bottom), base (top)
Lateral, medial and odd facet

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5
Q

Rectus femoris

A

AIIS –> tibial tuberosity

Knee extension, hip flexion, APT

Femoral nerve
Femoral and deep femoral artery

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6
Q

Vastus lateralis

A

Linea aspera (lateral lip) –> tibial tuberosity.

Knee extension, some external rotation

Femoral nerve
Femoral, deep femoral and popliteal artery.

  • because the fibres run more vertical than the VMO, it exerts more pull on the patella *
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7
Q

Vastus medialis

A 
Linea aspera (medial lip)
--> tibial tuberosity

Knee extension, some medial rotation

Femoral nerve
Femoral artery

oblique fibre direction

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8
Q

Sartorius

A

ASIS –> pes anserine

Hip Flexion, abduction, lateral rotation
Knee flexion
APT

Femoral nerve
Femoral artery

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9
Q

Biceps femoris

A

Long head: Ischial tuberosity
Short head: linea aspera

Insertion: head of fibula and lateral tibial condyle

Knee flexion
Long head also extends hip, PPT

Sciatic nerve
Inferior gluteal, obturator and deep femoral arteries

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10
Q

Semitendinosis

A

Ischial tuberosity –> pes anserine

Knee flexion
Hip extension, PPT

Sciatic nerve
Inferior gluteal, obturator and deep femoral arteries

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11
Q

Semimembranosus

A

Ischial tuberosity –> medial tibial condyle

Knee flexion
Hip extension, ppt

Sciatic nerve
Obturator, deep femoral arteries.

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12
Q

Popliteus

A

Lateral aspect of lateral femoral condyle –> medial proximal tibia

Medial rotation of tibia
Knee flexion

Tibial nerve
Popliteal artery

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13
Q

Plantaris

A

“Palmaris longus of the leg”

Posterior lateral femoral condyle and distal lateral supracondylar line of the femur –> posterior calcaneus
(Runs between Gastrocs and soleus)

Plantar flexion
Knee flexion

Tibial nerve
Popliteal artery

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14
Q

Closed chain movements of the knee

A

Flexion and extension –> raising and lowering body from ground

Rotation –> twisting body when foot planted.

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15
Q

Knee flexion is controlled mostly by what nerve?

A

Tibial

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16
Q

Knee extension is controlled mostly by what nerve?

A

Femoral

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17
Q

The Vastus lateralis fibres are more vertical than the VMOs, therefore

A

The vastus lat has greater pull on the patella

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18
Q

What two muscles feed into the patellar retinaculum?

A

VMO and vastus lateralis

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19
Q

The sciatic nerve splits into:

A

The fibular which splits into superficial (lateral) and deep (anterior), and tibial (which innervates the posterior compartment)

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20
Q

The lateral distal leg is innervated by the:

A

Superficial fibular nerve

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21
Q

The anterior distal leg is innervated by the:

A

Deep fibular nerve

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22
Q

The posterior distal leg is innervated by the:

A

Tibial nerve

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23
Q

Medial collateral ligament

A

Flat band
Medial epicondyle of the femur –> proximal shaft of the tibia, and medial meniscus

Resists: valgus stress, hyperextension, anterior displacement of tibia on femur

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24
Q

Adductor magnus tendon is fascially connected to

A

The VMO

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25
Q

Lateral collateral ligament

A

Lateral epicondyle of the femur –> head of the fibula

Resists: varus stress and hyperextension

Runs between the popliteus (medial) and biceps femoris (lateral)

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26
Q

LCL is different from the MCL in that:

A

It is shorter and rounder and hence more stable (and thus gets injured less often)

It does not attach to the meniscus

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27
Q

The collateral ligaments become _________ with lateral rotation of the tibia, and ________ with medial rotation.

A

Taut

Lax

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28
Q

Anterior Cruciate Ligament

A

Intercapsular but Extrasynovial

Anterior intercondylar area of tiba, upward and lateral to the post-medial intercondylar notch of the lateral femoral condyle

Resists anterior glide and internal rotation of the tibia on the femur, and knee extension.

Fibres oblique, with multiple twisty bundles

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29
Q

Posterior Cruciate Ligament

A

Intercapsular but Extrasynovial

Posterior intercondylar area of the tibia, upward and medially to the ant-lateral intercondylar notch of the the medial femoral condyle

Fibres have medial twist, and run more vertically than ACL

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30
Q

PCL: Open chain

A

Resists posterior glide and internal rotation of tibia on femur, and knee extension

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31
Q

PCL: Closed chain

A

Resists anterior glide of femur on tibia (squatting) – ant/med fibres become taut.

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32
Q

Oblique Popliteal Ligament

A

AKA short capsular fibres of the MCL

Post-med tibial condyle –> attaches to meniscus –> blends with semimem tendon –> medial side of lateral femoral condyle.

With MCL and semiMem, controlls ant-medial rotary instability

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33
Q

Arcuate popliteal ligament

A

Thickening of posterior lateral capsule

Attaches on the apex of the fibula –> fans in a Y-shape over the posterior joint capsule –> attaches to fascia of the popliteus and posterior horn of lateral meniscus

With LCL , ITB, popliteus and biceps femoris, reinfoces posterior joint capsule

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34
Q

Arcuate complex

A

popliteus + arcuate popliteal ligament

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35
Q

Posterior Meniscofemoral ligament

A

(Not always present)

Posterior side of lateral meniscus –> ant-lat surface of medial aspect of intercondylar fossa of the femur (beside PCL)

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36
Q

Anterior Meniscofemoral ligament

A

(Not always present)

Anterior: tracks on anterior surface of PCL

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37
Q

Transverse ligament

A

Runs between menisci and anchors them together

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38
Q

Coronary ligaments

A

Run the perimeter of the tibial plateaus
Anchor menisci to their tibial articular surfaces

Prevent displacement of the menisci

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39
Q

Which fibres of the coronary ligaments are longer?

A

Lateral – thus more movement allowed

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40
Q

Menisci: Functions

A
  1. shock absorber
  2. spreads stress over a larger surface area
  3. lubricates joint, decreases friction
  4. improves joint congruency by evening out weight distribution
  5. prevents hyperflexion
  6. prevents joint capsule from entering joint space; participates in screw home mechanism
  7. plays crucial role in degeneration
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41
Q

Medial Meniscus

A

Semilunar (C-shaped)

Anterior horn attaches to intercondylar area of tibia: anterior to ACL insertion

Posterior horn attaches anterior to PCL insertion

Coronary ligaments attach it to joint capsule, MCL, and medial tibial condyle

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42
Q

Lateral Meniscus

A

Semilunar (O-shaped)

Anterior and Posterior horns attach close to each other, just anterior and posterior to the intercondylar eminence

Coronary ligaments attach it to joint capsule and lateral tibial condyle but NOT the LCL.

Also attached to popliteus tendon

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43
Q

Which meniscus is more mobile?

A

Lateral, because:

  • longer coronary ligaments,
  • not attached to LCL, and
  • popliteus connection increases its posterior movement during flexion
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44
Q

Fat Pads

A

Intracapsular but extrasynovial

  • fill up dead spaces, thereby increasing stability
  • assist joint lubrication
  • abundant with free nerve endings –> impingement can lead to pain, the sensation of “giving out”

Densely packed fat cells containing elastic tissue –> change shape with joint movement

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45
Q

Movement of infrapatellar fat pad during flexion/extension

A

Deep to patellar tendon, superficial to femoral condyles

In flexion, fills intercondylar notch
In extension, occupies patellar groove and covers trochlear surface

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46
Q

The thickest layer of cartilage in the body is contained within ..

A

The patellofemoral joint

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47
Q

Patellofemoral joint

A

Synovial, modified plane

Patellar facets (convex) on femoral groove for the patella

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48
Q

Patellar ligament

A

Apex of patella to tibial tuberosity

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49
Q

Patellar retinaculum

A

Supplied partly by VMO and vastus lat fascia

Stabilizes patella against excess lateral and medial deviation

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50
Q

Superior TibFib Joint

A

Synovial, plane

Facet of head of the fibula (convex) on lateral tibia

Moderate capsular strength

Ligaments: ant, post ligaments of the head of the fibula

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51
Q

Tibial-Femoral: degrees of freedom

A

Two.
Flex/ext
IR/ER

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52
Q

Tibial-Femoral: resting

A

25º flexion

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53
Q

Tibial-Femoral: closed pack

A

Full extension and IR

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54
Q

Tibial Femoral: Capsular Pattern

A

Flexion>Extension

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55
Q

Tibial Femoral: ROM and End Feel

A

Flex: 135º
Ext: 15º
Med Rot: 20-30º
Lat Rot: 30-40º

Firm end feel

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56
Q

Patellofemoral: Degrees of freedom

A

Two
Flex/extend
Med/Lat glide

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57
Q

During which movements is the patella concave?

A

Superior-inferior

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58
Q

During which movements is the patella covex?

A

Medial-lateral

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59
Q

Patellofemoral: resting

A

Full extension

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60
Q

Patellofemoral: closed packed

A

Full flexion

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61
Q

Patellofemoral: capsular pattern

A

Flexion > Extension

62
Q

The knee is anteriorly reinforced by:

A

Patellar tendon

Quadriceps tendon

63
Q

The knee is reinforced anterolaterally by:

A

Lateral patellar retinaculum (vast lat)
ITB
ACL
PCL

64
Q

The knee is reinforced anteromedially by:

A

Medial patellar retinaculum (VMO)

65
Q

The knee is reinforced medially and posteromedially by:

A

Pes anserine tendons (sartorius, gracillis, semiten)
Semimembranosus tendon
MCL
ACL

66
Q

The knee is reinforced posterolaterally by:

A

Biceps femoris
ACL
PCL
LCL

67
Q

The knee is reinforced posteriorly by

A

Gastrocs
Popliteus
(check ER and posterior displacement of tibia on femur)

68
Q

Glide during knee flexion

A

Posterior glide of the tibia

69
Q

Glide during knee extension

A

Anterior glide of the tibia

70
Q

Tibial rotation during knee flexion:

A

First 15-20º internal rotation

71
Q

Tibial rotation during knee extension

A

Last 15-20º external rotation

72
Q

How is knee movement during flex/extension affected by the medial femoral condyle?

A

Because it projects more distally, is more curved and is obliquely oriented, and has a longer articular surface, during extension as the tibia glides forward the movement at the lateral condyle ends sooner. The tibia continues to move at the medial condyle, thus external rotating into valgus angulation.

73
Q

What happens to the ACL and PCL during rotation?

A

They check IR

During ER they become lax, allowing more ER.

74
Q

Popliteus: open and closed chain

A

Open: medial rotation of the tibia
Closed: lateral rotation of the femur

75
Q

During knee extension, the menisci …

A

move anteriorly

76
Q

During knee flexion, the menisci …

A

move posteriorly (allows them to maintain congruency)

77
Q

Mobility of anterior and posterior horns of the menisci

A

Anterior: somewhat mobile
Posterior: fixed

78
Q

Normal valgus angulation

A

6º

79
Q

Excessive genu valgus, weight bearing forces shift

A

to lateral knee, stressing MCL

80
Q

Excessive genu varus, weight bearing forces shift

A

to medial knee, stressing LCL

81
Q

Patellar movement during knee flexion

A

S shaped – superior-laterally

82
Q

Patellar movement during knee extension

A

S shaped– inferior-medially

83
Q

The odd facet comes in contact with femoral condyles

A

at 135º knee flexion

84
Q

Q angle is obtain by comparing

A

Axis of femur and axis of tibial tuberosity (centre of patella midpoint)

85
Q

Normal Q angles

A

Males 13º

Females 18º

86
Q

During knee flexion:

A

Popliteus medial rotates tibia
Tibia medially rotates during first 15-20º
Tibia glides posteriorly on femur (restricted by PCL)
Menisci move posteriorly
The patella moves in an superior-lateral s-shaped direction
At 135º the patellar odd facet comes into contact with the femoral condyles.

Flexion restricted by tissue-on-tissue restriction
Medial rotation controlled by ACL, PCL, oblique popliteal ligament

87
Q

During knee extension

A

Tibial glides anteriorly on femur (restricted by ACL)
Menisci move anteriorly
The patella moves in an inferior-medial S-shaped direction
Tibia externally rotates during the final 15-20º of extension

Hyperextension is checked by the MCL, LCL, ACL, PCL

88
Q

Suprapatellar pain may indicate

A

rectus femoris tendonitis

89
Q

Infrapatellar pain may indicate

A

Osgood Schlatter disease

90
Q

Medial pain may indicate

A

ACL, PCL or meniscus injury

OA

91
Q

Lateral pain may indicate

A

ACL, PCL or meniscus injury
OA
ITB friction syndrom

92
Q

Posterior pain may indicate

A

Baker’s cyst

93
Q

Prepatellar pain may indicate

A

OA
chondromalacia patella
tracking disorder
bursitis

94
Q

Excess valgus force may lead to

A

injury to the MCL, medial meniscus, ACL (terrible triad)

95
Q

Hyperextension may lead to

A

ACL injury, meniscal tears

96
Q

Flexion with posterior translation may lead to

A

PCL injury

97
Q

Excess varus force may lead to

A

LCL, PCL, posterolateral capsule injuries

98
Q

The knee is most like to become injured from force directed in what direction?

A

Antero-valgus/ antero-medial

99
Q

Decreased Q angle will cause the patella to

A

track medially

–> chrondromalacia patella

100
Q

Increased Q angle will cause the patella to

A

track laterally

–> sublux, tracking disorder, chrondromalacia

101
Q

Patella alta

A

Patella rides high

102
Q

Patella baja

A

patella rides low

103
Q

Camel sign

A

One hump from patella alta, the other from exposed fat pad

104
Q

L4 reflex

A

Knee Jerk

105
Q

L5 reflex

A

Medial Hamstrings

106
Q

S1 reflex

A

Achilles

107
Q

L3 dermatome

A

Lateral leg just above and below knee, toward anterior shin

108
Q

L4 dermatome

A

Post-medial leg, heel, medial plantar foot to big toe

109
Q

L5 dermatome

A

Anterolateral leg, dorsum of foot

110
Q

S1 dermatome

A

Lateral lower leg, lateral edge of foot

111
Q

At 90º flexion, the femur is in contact with what part of the patella?

A

Superior

112
Q

At 45º flexion, the femur is in contact with which part of the patella?

A

Middle

113
Q

At 20º flexion, the femur is in contact with what part of the patella?

A

Inferior

114
Q

MCL Spain: MOI

A

excessive valgus or lateral rotational stress; blow to lateral knee

(usually occurs with damage to other structures)

115
Q

MCL Sprain: Sx

A

ADL: problem with lateral change of direction.

Pain, instability with push off

116
Q

MCL Sprain: effusion

A

A Grade 3 rupture will also tear through the joint capsule, so there will be minimal edema

117
Q

MCL Sprain: Special Tests

A

Acute: brush/stroke

SubA/Chronic: Valgus Ligamentous Stress Test, Apley’s Distraction

118
Q

LCL Sprain: MOI

A

Excessive varus and rotational stress; blow to medial knee

rarely damaged in isolation

119
Q

LCL Sprain: Sx

A

ADL: problem with lateral change of direction; pain/instability with decel

120
Q

MCL sprain will also often involve

A

ACL

medial meniscus

121
Q

LCL sprain will also often involve

A

bicep femoris
popliteus
ITB
gastrocs

122
Q

LCL Sprain: Special test

A

Acute: brush/stroke

SubA/Chronic: Varus ligamentous stress test, Apley’s distraction

123
Q

ACL Sprain: MOI

A

Excessive IR, valgus or varus stress
Forced hyperextension
Direct blow with foot planted; indirect twisting

124
Q

ACL Sprain: ADLs

A

Unable to run forward

125
Q

ACL Sprain: Which muscle needs strengthening?

A

Hamstrings (resist anterior glide); emphasis on closed chain exercises until able to do MOI

126
Q

ACL Sprain: Special Tests

A

Acute: brush/stroke

SubA/Chronic: Lachman’s, Anterior Drawer

127
Q

PCL Sprain: MOI

A

Direct injury to flexed knee
Hyperextension
Dashboard injury

128
Q

PCL Sprain: ADLs

A

Can’t squat, run backwards, descend stairs

129
Q

PCL Sprain: Remex focus

A

Quadricep strength, closed chain exercises

130
Q

Coronary Ligament Sprain: Sx

A

persistent, intermittent knee pain

when chronic, painful PROM/POP flex/ext/ER due to scarring

131
Q

Which coronary ligaments are most frequently sprained?

A

medial/anteromedial. Often accompany meniscal injuries

132
Q

Meniscal Injuries: MOI

A

Forced opposite rotation during flex/ext; excessive knee flexion while weight bearing; poor (grinding) biomechanics

133
Q

Which meniscus is more prone to injury?

A

Medial (less mobile)

134
Q

Meniscal Injuries: Sx (Acute)

A

Acute: “something giving out”; bowel-liquifying pain
Joint effusion, palpable tenderness
Refusal to return to activity

135
Q

Meniscal Injuries: Sx (Chronic)

A

Clicking and catching

Locking of knee in flexion around 25º

136
Q

Meniscal Injuries: Special Tests

A

The Twist
MacMurray’s
Apley’s Compression

137
Q

Patellofemoral Syndrome

A

Painful degenerative changes to the patella

138
Q

Patellofemoral Syndrome: predisposing factors

A 
Biomechanics (pronation, tibial ER, anteversion, Q angle)
Structural issues (patella alta -- not blocked by lat condyle)
Posture (hyperlordosis)
Muscle Imbalances (Vast lat: VMO)
139
Q

Patellofemoral Syndrome: Sx

A 
Movie Theatre Sign
Pain with compression (Clarke Sign)
Crepitus
Edema
Peripatellar or subpatellar pain (ant/med)
140
Q

Patellofemoral Syndrome: Special Tests

A

Grind Sign/Clarke/Patellofemoral Compression

Patellofemoral Apprehension

141
Q

Chondromalacia Patella

A

Softening of the articular cartilage of the patella
May lead to patellofemoral syndrome

** In H & K same as patellofemoral/patellar tracking **

142
Q

Chondromalacia Patella: Sx

A

Grating, grinding sensation with knee flexion
Anterior knee pain when standing after sittings
Increased pain going up stairs, getting out of chair

Positive for Grind test

143
Q

Plica Syndrome

A

Synovial fold in 55% of population which runs from superomedial medial condyle to infrapatellar fat pad.

May become fibrosed and cause pain, snapping and clicking similar to a meniscal or patellofemoral problem

144
Q

Patellar Tendonitis

A

Jumpers knee

inflammation of the patellar tendon from repetitive strain, often in jumping sports

145
Q

Patellar Tendonitis: Sx

A

Burning pain at superior pole, inferior pole, or tibial tuberosity.

Similar presentation to patellofemoral syndrome

Pain with RROM Flexion OR extension (depending on what book you read). Grrrrrrr.

146
Q

Patellar Tendonitis: Special tests

A

Tendonitis differentiation test
Grind test
Ely’s (pain with POP)

147
Q

ITB Friction Syndrome

A

Inflammation and pain with ITB crosses at lateral femoral condyle

MOI: repeated hip/knee flexion, postural imbalances

148
Q

ITB Friction Syndrome: Sx

A

Gradual onset, worse with activity (especially downhill running)
Pain along lateral thigh, into lateral knee
Decreased adduction, extension/flexion, rotation

149
Q

ITB Friction Syndrome: Presentation

A

HT, TrPs at TFL, glutes, vast lat

150
Q

ITB Friction Syndrome: Special Tests

A

Noble’s Compression Test
Ober’s
Thomas

151
Q

Knee OA

A

Painful degenerative condition affecting articular cartilage of the joint and subchondral bone

Pain inside knee with (over)use; stiff with disuse

Ortho Tx 700 (12 decks)

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