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Knee Flashcards

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1
Q

ACL Fxn:

  • Primary?
  • Secondary?
A

Primary: Resists Anterolateral displacement of TIBIA on the femur
Secondary: resists VARUS displacement

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2
Q

ACL Insertion:

  • Tibia?
  • Femur?
A 
Tibia: 
- anterior and between intercondylar eminences of the tibia
Femur:
- lateral intercondylar ridge anteriorly
- bundles split by bifurcate ridge
-
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3
Q

ACL Bundles:

A
  1. Anterio-Medial
    - fibers parallel to EXTENSION
    - fibers externally rotate in flexion
    - tight in flexion and extension (tightest in flex)
    - Restrains Anterior tibial translation - ANTERIOR DRAWER SIGN
  2. Posterior-lateral
    - rotational stability: prevents PIVOT-SHIFT
    - prevents internal tibial rotation with knee near extension
    - Tight in extension, loose in flexion
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4
Q

ACL Blood supply

ACL innervation

A

Art: Middle geniculate artery
- branch from popliteal art
- pierces the oblique popliteal lig
- also supplies PCL
Nerve: post. articular branches of tibial N.
- has mechanoreceptors
- fxns for proprioception and modulation of quadriceps fxn

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5
Q

ACL composition

A

90% Type I

10% Type II

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6
Q

Biomechanics of ACL:

- Native vs BTB vs Quad hamstring

A

Native: 2200 N
BTB: 3000N
Hamstring: 4000N

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7
Q

ACL mechanism of injury

- associated with?

A

non-contact PIVOTING injury

- Assoc with Lateral meniscus tear

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8
Q

ACL deficient knees associated with?

A
  • chondral injuries
  • complex meniscal tears
  • questionable assoc with arthritis
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9
Q

ACL more common in male or female?

  • why?
  • Ratio?
  • age?
  • which leg?
  • other?
  • Gene?
A

Females: landing biomechanics and NM activation patterns: lower ham/quad ratio - quad dominant

  • happen younger in femaels
  • more common in supporting leg than kicking leg - opposite of males
  • Preovulatory phase: hormones affect coordination - OCP block this affect
  • Genetic: COL5A1 gene dec risk of injury in women
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10
Q

PCL Function?

A
  • Primary stabilizer of knee

- primary stabilizer to posterior tibial translation

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11
Q

Knee posterior tibial translation stabilizers:

  • Primary
  • Secondary
A

Primary: PCL

Secondary:

  • Posterior oblique ligament
  • fibular collateral ligament
  • Posterior-Lateral corner
  • Posterior joint capsule
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12
Q

Anterior-Lateral Knee Stability

A

ACL

LCL

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13
Q

Posterior-Lateral Knee Stability

  • Primary? Components?
  • Secondary?
A

Primary: Posterior-Lateral Corner
- Arcuate Complex: arcuate ligament, 1/3 of capsule, popliteofibular ligament, fabellofibular ligament

Secondary: Biceps Femoris, popliteus, popliteomeniscal ligament, Lateral head of Gastroc

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14
Q

Valgus Knee Stability?

  • Primary?
  • Secondary?
A

Primary: Medial collateral ligament, posterior oblique ligament

Secondary: ACL, Medial head of Gastroc

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15
Q

Pure Hyperextension Knee Injury

  • Mechanism
  • Injured structures
A

Injury of posterior structures

  • Posterior-Medial Corner: posterior oblique ligaments
  • Posteiror lateral corner: arcuate complex
  • ARCUATE SIGN: avulsion off of fibular head -> avulsion of arcuate complex -> PLC instability
  • Posterior capsule
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16
Q

Varus Hyperextension Knee Injury:

  • Mechanism:
  • Injured structures
  • Fracture location?
A
  • Mechanism: anterior-medial knee extension with INTERNAL rotation of tibia
  • Inj: PLC and PCL
  • Fx: Anterior-medial tibial plateau
17
Q

Valgus Hyperextension Knee Injury:

  • Mechanism:
  • Injured Structures
  • Fx Location?
A
  • Mech: Anterior-Lateral knee extension with EXTERNAL rotation of tibia
  • Inj: PMC: Post oblique ligament, post-medial capsule, MCL, PCL, semimembranous lig
  • Fx: Anterior-lateral plateau
18
Q

Pure valgus knee injury:

  • Mechanism
  • Fx?
  • Lig injury?
A
  • Mech: SHEAR
  • Lat plateau and lat femoral condyle
  • Inj: MCL, Post obl. lig, medial capsule, ACL
19
Q

Pure Varus Knee Injury:

  • Mechanims
  • Fx
  • Lig Injury?
A
  • Mech: Shear
  • Fx: Medial plateau and medial femoral condyle
  • Lig Inj: LCL, PLC, PCL.
  • – More destabilizing than medial injury
  • – PLC with ACL inj: increases AL&PL rotatory instabilioty
  • – PLC w/ PCL: increased straight lateral instability
20
Q

Anterior Tibial Translation

  • Injury?
  • Mech? Increased risk of injury?
A

Inj: ACL
Mech: sudden change in direction w/ extension. Quad overpowers hamstrings and creates shear at ACL
- Inc risk of ACL injury with tibial INTERNAL rotation

21
Q

Valgus Flexion and External Rotation knee injury:

  • Mech?
  • Instability?
  • Triad?
  • Other injury?
A
  • Mech: Pivot Shift injury
  • Inj: ACL/MCL
  • Instability: Anteriomedial rotatory instability
  • Triad of O-Donoghue: ACL, MCL medial meniscus
  • injury to posterior horn of lateral meniscus is also common
22
Q

Varus flexion and Internal Rotation Injury:

  • Instability
  • Fx?
A
  • Inj: lateral
  • Fx: Lateral femoral condyle/lateral plateau
  • Segond Fx: avulsion of lateral aspect of proximal tibia
23
Q

Pure Flexion:

  • Mech?
  • Fx?
  • Ligament inj?
A
  • Mech: Posterior tibial translation “dashboard injury”
  • Fx: anterior tibial plateau fx
  • Inj: ACL loos and PCL taunt –> PCL injury
24
Q

Apy test for knee injury:

A

Tests for Meniscal tear
- axial compression with internal rotation (lateral meniscus) and external rotation (medial meniscus) with knee at 90 degrees

25
Q

Ege’s Test for knee injury:

A

for Meniscal injury:

- Pt squats with maximal internal and external rotation

26
Q

McMurray’s Test for knee injury

A

for meniscal injury

- move knee from flexion –> extension with internal and external rotation

27
Q

Knee rotational stablilty: lateral

A
  • Flexion: popliteofibular ligament and popliteus muscle

- Extension: LCL

28
Q

Knee rotational stability: medial

A
  • Primary: superficial MCL, deep MCL and posterior oblique ligment
29
Q

Most common cause of failed ACL repair?

A

improper bone tunnel placement

  • Femoral: 6.1 mm posterior to resident’s ridge and 1.7 mm proximal to the bifurcate ridge
  • Tibial: 6mm anterior to medial eminence and 9 mm posterior to intermeniscal ligament

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