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Musculoskeletal 2 > Knee Anatomy > Flashcards

Knee Anatomy Flashcards

1
Q

List the anatomical structures of the knee

A
  1. Femur
  2. Tibia
  3. Fibula
  4. Patella
  5. Knee Meniscus
  6. Ligaments
  7. Capsule
  8. Hoffa’s Fat Pad
  9. Plicae, Bursae, Synovial lining
  10. Musculature
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2
Q

describe the femoral shaft

A
  1. inclined ~10º from vertical
  2. made up of dense compact bone with a medullary cavity
  3. trabecular bones at proximal and distal ends
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3
Q

What is the Q-angle? What is a normal value for it?

A

angle formed by

  • line from midpoint of patella to tibial tubercle
  • line from ASIS to mid point of patella
  • normal = 13.5º (+/- 4.5)
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4
Q

describe the distal femur osseous structures

A
  1. Patellar surface
    • anterior expansion of both condyles
    • groove for patella
  2. Medial condyle
    • slightly curved, medial convexity
  3. Lateral condyle
  4. Intercondylar fossa
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5
Q

list and describe osseous structures found at the proximal tibia

A
  1. Condyles
  2. Tibial tuberosity
    • anterior ridge where anterior surface of condyles meet
  3. Fibular facet
    • posterio-inferior lateral condyle
  4. Gerdy’s tubercle
    • anterio-lateral lateral condyle
    • insertion of ITB
  5. Intercondylar area
    • attachments for horns of menisci
    • intercondylar eminence is the central, most narrow raised portion and ACL attachment
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6
Q

T/F: the fibular is a good weight bearing bone?

A

FALSE

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7
Q

patellar orientation

A

Base = superior

apex = inferior

typically, apex should be slightly proximal to tibiofemoral joint line in extended position

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8
Q

describe the articular surface of the patellar

A
  • vertical ridge fits into intercondylar groove of femur’s patellar surface
    • divides patellar articular area into M/L facets
      • facets further divided into equal 3rds
      • 7th odd facet located on the medial border that contacts the femoral condyle in full flexion
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9
Q

describe the infrapatellar (Hoffa’s) Fat Pad

A
  1. Intra-capsular
  2. Extra-synovial
  3. Contacts infrapatellar plica
  4. Highly vascularized
  5. Highly innervated
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10
Q

what is the function of Hoffa’s Fat Pad?

A
  1. Biomechanical role
    • space decreases f/b lateral protrusion of this in increasing flexion
  2. Reservoir for reparative cells
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11
Q

describe the knee joint capsule

A
  1. fibrous sleeve spanning from distal femur to proximal tibia
  2. cylindrical shape
  3. blends with PCL posteriorly
  4. Patella recieved in window of anterior surface
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12
Q

describe the femoral insertion of the knee capsule

A
  1. anteriorly forms supratrochlear fossa
  2. posteriorly condylar plates, distal to gastroc insertions
  3. Cruciate ligaments blend with capsule at insertion
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13
Q

List the ligaments of the knee

A
  1. MCL
  2. LCL
  3. ACL
  4. PCL
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14
Q

describe the structure of the MCL

A
  1. origin/insertion
    • medial condyle to upper tibia
    • posterior horn of medial meniscus and capsule
  2. general orientation
    • obliquely, anteriorly, inferiorly
  3. taut during extension, slackened during flexion
  4. least taut at 30º of flexion
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15
Q

what is the function of the MCL

A
  1. checks/limits genu valgus
  2. prevents lateral rotation (with knee in extended position)
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16
Q

describe the structure of the LCL

A
  1. Origin/Insertion
    • lateral epicondyle to head of fibula (blends with biceps femoris insertion
  2. Orientation
    • inferiorly and posteriorly
  3. Distinct from capsule
  4. separated from lateral meniscus by popliteus tendon
17
Q

what is the function of the LCL?

A
  1. checks/limits varus force
  2. least taut at 30º of flexion
18
Q

describe the structure of the ACL

A
  1. attachment sites
    • posterior aspect of the lateral femoral condyle’s medial surface
    • anterior and lateral to the medial tibial spine
  2. courses anteriorly, medially, and distally
  3. made up of an AMB and PMB
    • intermediate bundle described by some authors
19
Q

what is the vascularization and innervation to the ACL?

A
  1. Vascularization = proximal > distal portion
  2. Innervation:
    • branches of the posterior articular branches of the tibial nerve (proprioceptive)
20
Q

what is the function of the ACL?

A
  1. Sagittal plane → stability to the knee joint, resisting anterior tibial translation
  2. Frontal plane → varus and valgus (minimally)
  3. Horizontal plane → tibial rotation
21
Q

describe the structure of the PCL

A
  1. thicker and stronger than ACL
  2. attachment sites
    • lateral surface of medial femoral condyle to anterior roof of the intercondylar notch
  3. Fan-like structure, fiber orientation variable
  4. anterolateral and posteriomedial bundles
    • named to femoral attachments
22
Q

what is the function of the PCL?

A

pulls condyles posteriorly during extension

23
Q

describe the medial meniscus

A
  1. broader posteriorly
  2. nearly semicircle
  3. anterior horn attached to anterior tibial intercondylar (anterior to ACL)
  4. posterior horn attached to posterior tibial intercondylar area
  5. peripheral border attached to capsule and deep MCL
  6. coronary ligament is the tibial attachment of the meniscus
24
Q

which menisci moves more?

A

lateral > medial

25
Q

describe the lateral meniscus

A
  1. 4/5ths of a circle
  2. anterior horn attached anterior to the intercondylar eminence
  3. meniscofemoral ligaments often only attachment of the posterior horn
    • tendon of popliteus is attached to the lateral meniscus
  4. no peripheral bony attachment in area of popliteus
26
Q

how well vascularized are the knee menisci?

A
  1. vascularized by middle genicular artery and branches
  2. peripheral 10-30% vascularized
  3. rich innervation at horns
  4. inner portions
    1. avascular
    2. non-innervated
27
Q

what is the function/purpose of the menisci?

A
  1. Increase congruency of joint
    • spread loading
    • physical stability
  2. provide proprioceptive input
  3. lubrication
  4. attenuate loading during extremes of flexion and extension
28
Q

what/where is the patellar retinaculum?

A
  1. expansions form VM and VL that is separated by a plane of vascularized loose CT
  2. attached to the patellar margins and patellar tendon
  3. laterally reinforced by ITB
29
Q

what muscles extend the knee?

A
  1. quads
  2. TFL
30
Q

what muscles flex the knee?

A
  1. Biceps femoris
  2. Semitendinosus
  3. Semimembranous
  4. Gracilis
  5. Sartorius
  6. Popliteus
  7. Gastroc and Plantris (with stationary foot)
31
Q

list the medial rotators of the knee

A
  1. Semimembranosus
  2. Semitendinosus
  3. Popliteus
  4. Gracilis
  5. Sartorius
32
Q

list the lateral rotators of the knee

A

biceps femoris

33
Q

describe normal osteokinematics and ranges for motion at the knee

A
  1. Flexion
    • Active → 130
    • Passive → 160
  2. Extension
    • 5-10
  3. IR and ER
    • 60-70 (total)
34
Q

what is the resting pack and close-pack position for the knee?

A
  1. resting position → ~30º flexion
  2. close-pack position → full extension
35
Q

describe the arthrokinematics of the patella during knee motion

A
  1. extended knee
    • inferior patella contacts trochlea
    • posterior surface points directly posteriorly
  2. 30º knee flexion
    • mid-patella contacts trochlea
  3. Full flexion
    • superior and superiolateral patella contacts trochlea
    • posterior surface faces cranially
36
Q

describe the screw home mechanism

A
  1. ER of tibia in terminal knee extension
  2. bony congruency
  3. tauted supportive soft tissue structures

Musculoskeletal 2 (7 decks)

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