Knee Flashcards
Knee joint is a ——axial joint with ——-degrees of freedom.
biaxial
2
Knee joint has 2 articulations
Tibiofemoral articulation
Patellofemoral articulation
Knee joint is what type of joint?
this is a test question
Ginglymus joint (a joint that allows movement in but one plane, forward and backward, as does a door hinge) A hinge joint`
Does fibula contribute in the knee joint?
NO
Sagittal plane motion provided by an axis
which passes through the femoral condyles located parallel to the frontal and transverse planes
What allows the knee to be aligned so that purely sagittal plane motion occurs?
changes in angle of inclination
The varus attitude of the femur is balanced by
the longer/larger medial femoral condyle to put the axis of the joint parallel to the transverse plane
Axes of the knee
The axis providing sagittal plane motion
The anatomical axis of the femur and tibia
The mechanical axis of the knee
The anatomic axes of the femur and tibia are their ———axes
Longitudinal
Longitudinal axes of femur and tibia form an angle of
185º-190º (5-10 degrees off of vertical)
The tibia is relatively———–on the femur
Abducted
tibia has a physiological valgus of
5-10º
Mechanical axis (weight-bearing line) of the knee joint normally passes
through the centers of the knee , hip and ankle joints
Mechanical axis forms an angle of ~
3º from the vertical
The mechanical axis represents the line through which
ground reactive forces passes
what happens if frontal plane angulation at the knee increases ( genu varum or genu valgum
The mechanical axis will no longer pass through the center of the knee joint
What does the mechanical axis represent?
It represents the path for ground reactive forces
if the mechanical axis falls medial to the knee , the condition is called
Genu Varum
In genu Varum, compressive forces will be ————– and ————-
increased medially
decreased laterally
If the mechanical axis falls laterally to the knee joint, it is called
Genu valgum
in Genu valgum
compressive forces will be increased laterally and decreased medially
A change in the mechanical axis of the knee will cause
a change in the ground reactive forces (external moment) across the knee.
constant overloading on the increased compression side of the knee may lead to
articular cartilage damage
increased frontal plane deformity
increased overload
foot orthoses changes
the mechanical axis
external moment examples
GRF
Gravity
Momentum
internal moment examples
muscles
ligaments
bony limitation
GRF causing ———————and the body responding with ————
External abduction moment
Internal adduction moment
Requirements for Knee joint function
- Great mobility
2. Stability
Knee joint flexibility is provided by
- Anatomical structure of the knee
- The instant axis of rotation of the tibiofemoral articulation
The change in location of instant axis of rotation is a result of
combination of gliding and rolling
Flexion of the knee from full extension to 25º flexion is purely——-
rolling
Flexion beyond 25º requires
Anterior gliding
posterior rolling of the femur on the tibia to prevent the femur from falling off the tibia posteriorly
the gliding motion during knee FLEXION is facilitated by
ACL
menisci
Knee EXTENSION is facilitated by
PCL
Menisci
As the knee flexes , the femur
slides forward on the tibia
What is the normal max motion of the tibiofemoral articulation in the sagittal plane?
140º of flexion
5-10º of extension (hyperextension)
Hyperextension greater than———is generally considered genu recurvatum
10º
minimum requirements for Sagittal plane knee motion in gait
60º of knee flexion ( on level ground)
minimum requirements for Sagittal plane knee motion in stair climbing
80º of knee flexion
minimum requirements for Sagittal plane knee motion in sitting
90º of knee flexion
In stance phase of the gait, the greatest amount of force is on
the medial plateau
In swing phase of the gait, the greatest amount of force is on
the lateral plateau
which one is larger? medial or lateral plateau?
Medial plateau is 50% larger and has cartilage 3X thicker than the lateral plateau
Hip and ankle position will effect sagittal plane knee RANGE OF MOTION in
OKC
Hip and ankle position will effect KNEE FUNCTION in
CKC
Transverse plane knee motion occurs via 2 separate mechanisms :
- true transverse plane knee motion
- the screw-home mechanism
How much true transverse plane knee motion occurs depends on
sagittal plane position of the knee
Fully extended knee
has no transverse plane motion due to interlocking mechanism between femoral and tibial condyles
When there is no transverse plane motion due to interlocking mechanism between femoral and tibial condyles this represents
closed-packed or locked position of the knee joint and the knee ligaments
When the knee is flexed at 90º, the ligaments are
lax
When the knee is flexed at 90º. external rotation may be as high as
45º
When the knee is flexed at 90º, internal rotation may be as high as
30º
As the knee moves further away from 90º in the direction of extension/flexion the amount of transverse plane motion available
decreases
Screw-Home mechanism occurs as a result of
The medial condyle being 1.7 cm longer than the lateral condyle which allows for spiral like motion to occur
in Screw-Home mechanism, what you see is
The tibia appears to externally rotate on the femur with knee extension
in Screw-Home mechanism, what actually happens is
the femur internally rotates relative to the tibia
this is most notable during the last 5º of knee extension
Screw-Home mechanism is a ———plane motion
Transverse
Screw-Home mechanism occurs with knees in what position ?
occurs with knee extension brings the knee into its closed packed position with menisci tightly interposed and the ligaments taut
Screw-Home mechanism benefits?
provides increased stability for the knee joint in the extended position
The Screw-Home mechanism sometimes referred to as
the automatic rotation of the knees
Axial or transverse plane rotations occure ———-from screw home mechanism
Separate
motion of the knees in this plane considered insignificant
Frontal plane
when the knee is flexed to about 30º we get the greatest—————–motion
frontal plane knee motion
postion most vulnerable to frontal plane injury
frontal plane injury and anterior-posteior displacement are considered to be the result of
joint incongruity and variable amounts of ligamentous laxity
stability of the knee is primarily provided by soft tissue structures
menisci
ligaments
menisci increase
concavities of the tibial surfaces upon which the femoral condyles sit
menisci act to improve
joint congruity for a joint whose bony structure is relatively incongruous
menisci reduce
friction
menisci distribute
weight bearing forces
Ligaments resist or control
- Excessive knee extension
- Varus or Valgus stresses at the knee
- Anterior or posterior displacement of the tibia beneath the femur
- medial or lateral rotation of tibia beneath the femur
- combinations of A/P displacements and rotations of the tibia (rotatory stablization )
When the knee is FULLY EXTENDED which articular facets of the femur articulate with the patella ?
Both medial and lateral articular facets
When the knee flexes past 90º which articular facets of the femur articulate with the patella?
Only the medial facet articulates with the patella
Patella helps to improve lever arm of
the quadriceps femoris
absent patella
decreased strength from the quads b/c you lost some of the lever arms
patella aids in Knee
Extension
How does the patella help in knee extension?
by lengthening the lever arm of the quadriceps femoris
Patella allows for better distribution of
compression stresses on the femur by increasing the contact between the patella and femur
Increased knee flexion will increase
the force of the quadriceps contraction
increase in the force of the quadriceps contraction
increases the force on the patellofemoral joint
patella as it glides in the intercondylar area adjusts
the angle of insertion of the quadriceps femoris into the tibia to conform the long axis of the leg
Q-angle
represents the angle of the pull of the quadriceps femoris- a vertical line from ASIS to the border of patella to the tibial tuberosity
Q-angle is involved with what deformities?
Patella femoral pain syndrome
tracking syndrome
Increased Q-angle can cause
dislocation of the patella
Increased Q-angle is more common in female or male?
Female