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OMS Peripheral > Knee > Flashcards

Knee Flashcards

1
Q

Where does the lateral collateral ligament originate?

A

The lateral epicondyle of the femur

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2
Q

Where does the medial collateral ligament originate?

A

The medial epicondyle of the femur

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3
Q

Where does the gastrocnemius originate?

A

The femoral condyles

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4
Q

What inserts onto the tibial tuberosity?

A

The infrapatellar tendon (ligamentum patellae)

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5
Q

What inserts onto Gerdy’s tubercle and where does it lie?

A
  • ITB

- Anterolaterally to the tibial tiberosity (2/3 of the way between tib tuberosity and fibula)

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6
Q

What attaches onto the fibular head? (2)

A

1- LCL
2- Biceps femoris

The common peroneal nerve wraps around the fibular head posteriorly

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7
Q

What are all the joints in the knee? (3)

Within how many capsules?

A

1- Superior tibiofibular joint
2- Patellofemoral joint: the extensor mechanism of the knee
3- Tibiofemoral joint: weight bearing activities

2&3 are in the same capsule

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8
Q

What are the four main patellar bursae?

A

1- Prepatellar bursa (subcutaneous)
2- Subcutaneous superficial infrapatellar bursa
3- Deep infrapatellar bursa (no communication with the joint, best felt with the knee in extension and it is just proximal to the tibial tuberosity)
4- Suprapatellar bursa (

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9
Q

Where does the infrapatellar fat pad of Hoffa lie?

A

It lies between the infrapatellar tendon and knee joint.

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10
Q

What is the quadriceps expansion/patella retinacula?

A

The tendons of vastus medialis and lateralis insert onto the medial and lateral borders of the patella.

Along with the ITB, it is responsible for transverse stability of the patella.

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11
Q

What does the medial aspect of the quadriceps expansion blend with?

A

The MCL

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12
Q

What type of joint is the tibiofemoral joint?

A

Hinge joint

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13
Q

What do the menisci of the knee do? (4)

A

1- Shock absorption
2- Load transmission
3- Lubrification
4- Stability

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14
Q

What are the coronary ligaments?

A

The ligaments that attach the menisci to the tibial condyles (“eyelashes of the menisci”)

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15
Q

Which coronary ligaments are longer between the medial and lateral?

A

Lateral due to the greater excursion of the lateral meniscus

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16
Q

What are the orientations of the knee’s menisci collagen fibres?

A

Superficial fibres - radial

Deep fibres - circumferential

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17
Q

What do the radial fibres of the knee’s menisci do?

A

Resistance to longitudinal stresses

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18
Q

What do the circumferential fibres of the knee’s menisci do?

A

Facilitates dispersion of compressive loads

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19
Q

What are the two types of injury to the menisci?

A

1- Longitudinal or transverse splitting of the fibrocartilage
2- Separation of the thinner inner part of the meniscus from the thicker outer portion (“bucket handle”)

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20
Q

What is the medial meniscus attached to?

A

The MCL

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21
Q

What is the lateral meniscus attached to?

A

It is separated from the capsule by the tendon of the popliteus. Posteriorly, the lateral meniscus contributes a ligamentous slip to the PCL –> Posterior meniscofemoral ligament

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22
Q

What are the three plicae of the knee?

A

1- Superior plica
2- Inferior plica
3- Medial plica –> alongside the medial border of the patella

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23
Q

What are the tendons that compromise pes anserinus (anteriorly to posteriorly)?
“Say Grace before Tea”

A

Sartorius
Gracilis
semiTendinosus

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24
Q

What is the size of the MCL and what are its attachments?

A

It originates from the medial femoral epicondyle, is 2.5 fingers wide and runs down approx 5 cm past the joint line (8-10cm in total length). It inserts into the tibia, posteriorly to pes anserus

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25
Q

What are the two parts of the MCL?

A

1- Superficial layer: 80% of the resistance to valgus forces, these are the strongest part of the ligament
2- Deep layer: attaches to the capsule and medial meniscus, these are more prone to injury

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26
Q

What does the MCL stabilise?

A

1- The medial side of the knee, preventing excessive valgus forces

Preventing…
2- lateral rotation of the tibia
3- anterior translation of the tibia
4- hyperextension of the knee

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27
Q

What is the size of the LCL and what are its attachments?

A
  • 5cm long and the width of half a pencil
  • It originates at the lateral epicondyle of the femur and inserts into the head of the fibula where it blends with the tendon of biceps femoris
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28
Q

What does the LCL stabilise?

A

1- Restrains varus movement

Controls…
2- posterior translation of the tibia
3- Lateral rotation of the tibia

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29
Q

Are the cruciate ligaments intracapsular?

A

Yes

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30
Q

Are the cruciate ligaments intrasynovial?

A

No

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31
Q

What is the size of the cruciate ligaments?

A

As thick as a pencil

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32
Q

Which fibres are taut in extension and flexion between the ACL’s anteromedial and posterolateral bands?

A

Anteromedial - taut in flexion

Posterolateral - taut in extension

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33
Q

Does the ACL stabilise throughout movement?

A

True

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34
Q

What are the ACL’s stabilising roles?

A

Resists…
1- anterior translation of the tibia
2- medial translation of the tibia

3- Valgus, varus and hyperextension stresses

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35
Q

What is the most common mechanism of injury to the ACL?

A

Lateral rotation combined with a valgus force applied to the fixed tibia

It may also be injured in hyperextension, medial rotation in full extension or anterior translation caused by direct injury to the calf

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36
Q

Which is stronger between the ACL and PCL?

A

The PCL is twice as strong as the ACL and less oblique.

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37
Q

Is the PCL a principle stabiliser?

A

Yes

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38
Q

What does the PCL stabilise?

A

Controls…
1- posterior translation of the tibia

2- produces and restrains rotation of the tibia because posterior translation of the tibia occurs with concomitant lateral rotation of the tibia

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39
Q

What is the most common mechanism of injury for the PCL?

A

Forced posterior translation of the tibia on the flexed knee (“Dashboard injury”)

May also be injured in hyperextension

40
Q

What forces go through the tibiofemoral joint in walking?

A

2-5 times body weight

41
Q

What forces go through the tibiofemoral joint in running/jumping?

A

24 times body weight

42
Q

What are the ranges of movement to the knee?

A

Extension - 0 degrees
Flexion - 140 degrees

Approx 5-10 degrees of passive extension
Approx 160 degrees of passive flexion

43
Q

When are active and passive axial rotations possible?

A

With the knee at 90 degrees in order to relax the coronary ligaments

44
Q

What are the ranges for active axial rotation?

A

Lateral - 45 degrees

Medial - 35 degrees

45
Q

When does automatic, involuntary rotation occur at the knee to achieve locked and unlocked positions of the knee?

A

It occurs around 20 degrees extension, the tibia rotates laterally to produce the ‘locking’ phase of the knee.

The knee ‘unlocks’ with the popliteus medially rotating the tibia

46
Q

What are the two main function of the patellofemoral joint?

A

1- Produces anterior displacement of the quadriceps tendon during movement, assists knee expansion by increasing the lever arm of the quads
2- Increases the contact area between the patellar tendon and the femur –> distributing compressive forces over a wider area

47
Q

What can patellofemoral symptoms arise from?

A 
1- Instability
2- Maltracking
3- Malalignment
4- Biomechanical causes
5- Subluxation
6- Dislocation --> may lead to chondromalacia pattellae and OA of the joint
48
Q

Which direction does the patella tend to migrate on full extension:

A

Laterally

49
Q

What counteracts the natural displacement of the patella?

3

A

1- High lateral border of the patellar groove on the femur
2- Active pull from the oblique fibres of vastus medialis
3- Medial quadriceps expansion

50
Q

What type of joint is the superior tibiofibular joint?

A

Synovial plane joint

51
Q

What is vastus medialis obliquus (VMO) made out of?

A

1- Vastus medialis distal fibres

2- Adductor magnus

52
Q

Where does the apex of the patella lie with the knee in extension and flexion?

A

Extension - 1 finger’s breadth above the joint line

Flexion - Joint line

53
Q

What is the best position of the leg to palpate the LCL?

A

Have the leg in the FABER position

54
Q

What are possible conditions for knee pain in children?

A
  • Knee pain in children is often referred from the hip
  • Meniscal lesions don’t start until adolescence
  • Gradual onset of knee pain in adolescents: patellofemoral joint syndromes or Osgood-Schlatter’s disease
  • Males –> traumatic meniscal tears from sport
  • Females –> instability, subluxation, episodes of dislocation of the patella
55
Q

When does RA in the knee begin?

A

Between 30-40 yrs

56
Q

Where can the knee refer pain to?

A
  • Distally

- Occasionally proximally to the thigh

57
Q

What is the most common site for anterior knee pain?

A

Superolateral corner at the insertion of vastus lateralis

58
Q

What are the knee menisci and ligaments more prone to?

A

Acute lesions

59
Q

What is likely injured after a direct injury?

A

Muscular contusion - likely quadriceps

60
Q

What is likely injured after a direct blow to the patella (fall on bent knee)?

A
  • Fracture
  • Contusion of the periosteum
  • Prepatella bursa involvement
  • PCL injury
61
Q

What is likely injured after lateral side of the knee impact (rugby/football/etc)?

A

Results in excessive valgus:

- MCL

62
Q

What is likely injured after excessive force applied to a flexed knee while the foot is planted e.g. skiing?

A

MCL/ACL/Medial meniscus

63
Q

What is likely injured after a rotational injury?

A

Coronary ligaments

64
Q

What is likely injured after a hyperextension injury?

A

Any of the ligaments as they are all taut in extension but the MCL and ACL are more likely to be injured

65
Q

What would recurrent pain and swelling episodes be caused by?

A

Instability and derangement of the joint

66
Q

Whats does being able to continue with the activity after knee injury signify?

A

Indicates a minor ligamentous sprain

67
Q

If the patient is completely incapacitated after knee injury what does this indicate?

A

Major lesions:

  • ligament disruption and muscle tears
  • meniscal lesions or cruciate rupture
68
Q

What pain does partial ligament tear produce?

A

Severe pain on movement

69
Q

What does a pseudo locking of the knee after long period of sitting indicate?

A

Patellofemoral joint

70
Q

What are typical aggravating factors for patellofemoral joint pain?

A
  • Walking
  • Squatting
  • Using stairs (especially going down)

When the forces going through the knee increase to 3x body weight

71
Q

What is the most common structure in the knee to cause haemarthrosis?

A

ACL

72
Q

What does swelling over 6-24hrs after injury indicate?

A

Slower swelling = synovial in origin as less blood supply e.g. MCL, meniscus, subluxation of the patella

73
Q

What does swelling 2-6 hours after injury indicate?

A

Faster swelling = haemarthrosis e.g. ACL

74
Q

What is a Baker’s cyst?

A

Synovial effusion into the gastrocnemius or semimembranosus bursa due to effusion in the knee joint

75
Q

What does true locking of the knee indicate?

A

A meniscal tear, this has a tendency to repeat itself

76
Q

What is the treatment for traumatic arthritis of the knee

A

Direct treatment based on the cause

77
Q

What is the treatment for OA and inflammatory arthritis?

A

Injection

78
Q

What differential diagnosis needs to be made with a potential loose body in the knee?

A

ACL tear has similar symptoms, this needs to be considered if the symptoms have arisen post trauma

79
Q

What age group does osteochondritis dissecans affect?

A

15-20 year olds

80
Q

What are the characteristics of a Grade 1 MCL sprain?

A
  • Pain, tenderness, swelling at site of injury
  • Mild capsular pattern
  • No notable instability
  • Normal valgus laxity
81
Q

What are the characteristics of a Grade 2 MCL sprain?

A
  • Moderate-major tearing of the ligament fibres
  • Pain and tenderness at site
  • Moderate to severe swelling
  • Capsular pattern
  • Minor degree of laxity
  • Firm elastic end feel
82
Q

What are the characteristics of a Grade 3 MCL sprain?

A
  • Macrofailure or complete rupture of the ligament
  • Swelling
  • Possible haemaerthrosis
  • Full capsular pattern
  • Severe pain at time of injury but relatively little since
  • Definite ligament laxity
  • Soft end-feel
83
Q

What is the treatment for a MCL sprain?

A
  • Occasionally surgery
  • Conservative management for functional recovery from ligamentous laxity: strengthening the dynamic knee stabilisers of the knee (hamstrings and quadriceps) while maintaining control with appropriate braces
  • Aspirate haemarthrosis
84
Q

What is the treatment for an acute MCL sprain?

A
  • POLICE

- Gentle transverse frictions as early as possible + 6 deep sweeps (2 -3 fingers) –> followed by a Grade A

85
Q

What is the treatment for a chronic MCL sprain?

A

This is only if pt has end-range pain and/or limitation of movement (passive flexion or extension), pain on valgus stress

1- Friction for analgesic effect
2- Grade C mobilisation either in extension or flexion based on the limitations
3- Vigorous mobilisation post Grade C

86
Q

What are the main findings for coronary ligament sprain?

A
  • Pain on lateral rotation of the tibia if medial meniscus injured or medial rotation if lateral meniscus injured (less likely)
  • Pain on passive extension
  • Tender on palpation
87
Q

What is the treatment for coronary ligament sprains?

A
  • Friction

- Injection

88
Q

What is the presentation of a knee bursitis?

A
  • Localised pain

- Local swelling

89
Q

Which two bursae of the knee are most commonly injured?

A

1- Prepatellar bursa

2- Infrapatellar bursa

90
Q

What is the treatment for knee bursitis?

A
  • Injection
91
Q

What is the treatment for quadriceps lesions?

A
  • Friction with knee extended

- Grade A exercises

92
Q

What is the presentation for tendinopathy of the medial and lateral quadriceps expansion?

A
  • Gradual onset of pain
  • Felt locally
  • Pain on resisted knee extension
  • Tenderness over the medial, lateral or both sides of the patella
93
Q

What is the treatment for tendinopathy of the quadriceps expansion?

A
  • Friction to either or both sides (‘up’ and under) of the patellar borders
94
Q

Where are two sites of patellar tendinopathy?

A

1- Apex of the patella (infrapatellar tendon) –> MOST COMMON, linked with repetitive jumping
2- Base of the patella (suprapatellar tendon)

95
Q

What is the treatment for patellar tendinopathy?

A
  • Friction

- Injection

96
Q

What differential diagnosis can you make for patellar tendinopathy?

A

Infrapatellar fat pad (Hoffa’s disease) causes similar symptoms but produces pain when gently squeezed at either side of the lower patella

OMS Peripheral (8 decks)

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