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Musculoskeletal Exam 4 > Knee Anatomy and Biomechanics > Flashcards

Knee Anatomy and Biomechanics Flashcards

1
Q

What are the 3 types of common injuries in the knee joint?

A
  • Unspecified sprains, strains, or overuse injuries
  • Contusions
  • Meniscal or ligamentous injuries
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2
Q

What is the largest joint in the body?

A

Tibiofemoral joint

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3
Q

What type of joint is the tibiofemoral joint?

A

Modified hinge joint

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4
Q

What originates at the lateral condyle of the femur?

A
  • Popliteus
  • Lateral head of the gastrocnemius
  • Lateral collateral ligament (LCL)
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5
Q

What originates at the medial condyle of the femur?

A
  • Adductor magnus
  • Medial head of the gastrocnemius
  • Medial collateral ligament (MCL)
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6
Q

How are the tibial plateaus oriented?

A

They are both concave in the mediolateral direction
The medial plateau is concave in the A/P direction
The lateral plateau is convex in the A/P direction

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7
Q

The ______ plateau has a surface area that is approximately _____% greater than that of the ______ plateau.

A

Medial 50% greater than lateral

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8
Q

The _______ pleateau’s articular surface is _____x thicker.

A

Medial, 3

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9
Q

What is the resting position of the tibiofemoral joint?

A

25 degrees flexion

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10
Q

What is the closed-packed position of the tibiofemoral joint?

A

Full extension, external rotation of the tibia

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11
Q

What is the capsular pattern of the tibiofemoral joint?

A

Flexion, Extension

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12
Q

What type of joint is the patellofemoral joint?

A

Modified plane joint

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13
Q

The patellofemoral joint has a wider ______ surface.

A

Lateral

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14
Q

What has the thickest layer of cartilage in the body?

A

Patellofemoral joint

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15
Q

What are the 5 facets of the patellofemoral joint?

A

Odd, Superior, Inferior, Medial, Lateral

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16
Q

What facet is most affected with chondromalacia patella?

A

Odd facet

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17
Q

The patellofemoral joint functions to:

A
  • Provide articulation with low friction
  • Protect distal femur from trauma and quads from wear
  • Improve cosmetic appearance of the knee
  • Improve moment arm of the quads
  • Decrease amount of A/P tibiofemoral shear stress
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18
Q

The knee joint capsule ascends superiorly/anteriorly above the patella to form the _________.

A

Suprapatellar pouch

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19
Q

The cruciates are ________, yet ________.

A

Extrasynovial, Intra-Articular

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20
Q

What type of joint is the proximal tibiofibular joint?

A

Plane synovial joint

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21
Q

The proximal tibiofibular joint has a slight _____ on the oval tibial facet. and a slight _______ on the fibular head.

A

Convexity, Concavity

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22
Q

The tibial articulating facet faces ______, _____, and _____.

A

Laterally, Posteriorly, and Inferiorly

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23
Q

The _______ tibiofibular joint has more motion than the ______.

A

Proximal has more motion than the distal

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24
Q

What are the two glides that can be done on the proximal tibiofibular joint?

A

Superioinferior, Anteroposterior

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25
Q

The Anterior Cruciate Ligament (ACL) is the primary restraint for which motions?

A

Anterior translation and medial rotation of the tibia on the femur

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26
Q

The Posterior Cruciate Ligament (PCL) is the primary restraint for which motions?

A

Posterior translation and medial rotation of the tibia on the femur

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27
Q

The ACL and PCL are both secondary restraints for which motions?

A

Valgus and varus rotation of the tibia

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28
Q

The Medial Collateral Ligament (MCL) is the primary restraint for which motions?

A

Valgus and lateral rotation of the tibia

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29
Q

The Lateral Collateral Ligament (LCL) is the primary restraint for which motions?

A

Varus and lateral rotation of the tibia

30
Q

The MCL and LCL are both secondary restraints for which motions?

A

Anterior and posterior translation of the tibia on the femur

31
Q

The ACL and PCL both contain __________. What can disruption of these structures cause?

A

Mechanoreceptors

Interruption or elimination of sensory nerve fibers of the joint

32
Q

A normal ACL is capable of microscopic adjustments to internal stresses. What do these adjustments influence?

A
  • Laxity
  • Stresses
  • Kinematics
33
Q

Tensile strength of the ACL is equal to which other ligament(s)?

Tensile strength of the _____ is half of that of the _____.

A

MCL and LCL

ACL is 1/2 of the PCL

34
Q

Forcing the ACL more than _____% beyond its resting length may result in rupture.

A

5%

35
Q

The PCL is _______% thicker and has _______x the tensile strength of the ACL.

A

50% thicker

Twice the tensile strength of the ACL

36
Q

The PCL provides _______% of the total restraint to posterior translation of the tibia on the femur.

A

90-95%

37
Q

The MCL and LCL are both considered to be ________ ligaments.

A

extra-articular.

38
Q

Which of the collateral ligaments develops as a thickening of its meniscus?

A

MCL

39
Q

The MCL is subdivided into _______ and ______.

A

Superficial band and deep band.

40
Q

What are the characteristics of the MCL’s superficial band?

A

Thick, flat band
Fan-like attachment proximally on the medial femoral condyle
Blends with the posteromedial corner of the capsule
Typically, the first ligament injured with valgus stress

41
Q

What are the characteristics of the deep band of the MCL?

A

Continuation of the capsule

Blends with the medial meniscus

42
Q

The LCL arises from the ________ and runs ________ and _______ to insert into the _________.

A

Arises from the lateral femoral condyle and runs distally and posteriorly to insert into the head of the fibula.

43
Q

What are the secondary restraints of the knee and what purpose do they serve?

A

They include the structures in the posterolateral and posteromedial corners of the knee and they serve to control anterior tibial translation relative to the femur.

44
Q

What provides dynamic stability to the knee?

A

Unopposed contraction of the quadriceps complex, increasing anterior tibial translation (synergistic to the PCL)
Isolated contraction of the hamstrings resulting in a posterior translation of the tibia (synergistic to the ACL)

45
Q

What other structures provide support to the knee joint?

A
  • Popliteus
  • Patellar Tendon
  • Oblique Popliteal Ligament
  • Fabella: a small sesamoid bone embedded in the lateral gastrocnemius tendon
46
Q

How are the menisci shaped?

A

Like a race track:

  • Outer edges are thicker
  • Inner edges are thinner and more subject to tear with trauma
47
Q

The outer _______% of the lateral meniscus is vascularized.

A

25%

48
Q

The outer _______% of the medial meniscus is vascularized.

A

30%

49
Q

The remaining inner portions of the menisci are considered what?

A

avascular

50
Q

What are the characteristics of the medial meniscus?

A
  • Semilunar
  • Wider separation of its anterior and poster horns
  • Larger and thicker than the lateral meniscus
  • Sits in the concave medial plateau
  • Attached to the anterior and posterior tibial plateau
  • Coronary ligament connect the outer meniscal border with the tibial edge and restrict movement of the meniscus
  • Medial meniscus also has attachment to the deeper portion of the MCL and the knee joint capsule.
51
Q

What are the characteristics of the lateral meniscus?

A
  • C-shaped
  • Sits on the convex lateral tibial plateau
  • Smaller, thinner, more mobile than the medial meniscus
  • Lateral meniscus excursion approx 10 mm (2mm for medial)
  • Attaches to tibia, capsule, and coronary ligament
  • Does not attach to the LCL
52
Q

What are the functions of the MM and LM?

A
  • Load transmission
  • Shock absorption
  • Joint lubrication
  • Nutrition
  • Secondary mechanical stability
  • Guiding of movements
53
Q

What is plica?

A

Remnant of the 3 cavities in the synovial mesenchyme of the developing knee

54
Q

What is the retinacula?

A

formed from structures in the first and second layers of the knee joint

55
Q

How many degrees of freedom does the tibiofemoral joint have?

A

3

56
Q

Joint stability is reliant on the restraints of:

A
  • Joint capsule
  • Ligaments
  • Menisci
  • Musculature
57
Q

During knee flexion the femur rolls ______ and glides _____.

A

rolls posteriorly, slides anteriorly

58
Q

During knee extension the femur rolls ______ and glides ______.

A

rolls anteriorly, slides posteriorly

59
Q

The screw-home mechanism occurs during the last ____ degrees of extension. Is is a complex function of what?

A

5

  • surface geometry
  • tension in the ligamentous structures
  • action of the muscles
60
Q

What are the static and dynamic restraints of the patellofemoral joint?

A
  • medial retinaculum
  • bony configuration of the trochlea
  • medial patellomeniscal ligament
  • lateral retinaculum
  • quadriceps muscles (esp VMO)
61
Q

What is the Q angle formed by? What does it measure?

A

Biisection of two lines:

  1. ASIS to patella
  2. Center of patella to the tibial tubercle

It measures the tendency of the patella to move laterally when the quadriceps muscles are contracted

62
Q

What is the normal Q angle for males? Females? What is considered abnormal?

A

Males= 8-14 degrees
Females= 15-17 degrees
Angles >20 are considered abnormal and may be indicative of potential displacement of the patella

63
Q

Patellofemoral joint reaction force is a function of:

A
  • Quadriceps and patellar tendon tension

- Angle formed between the quadriceps and patellar tendon

64
Q

During OKC exercise, going from 90-full extension results in what?

A

Increased quad/PT tension, increasing PJRFs

65
Q

OKC exercises ar 90-40 degrees provide what?

A

The lowest PJRF while producing the greatest amount og PF contact

66
Q

During CKC exercises, at what angle is the maximum force in the Quad/PT generated?

A

60 degrees

67
Q

What position are CKC exercises typically prescribed at? What should you progress to?

A

0-16 degrees

0-30 degrees where the PJRFs are lower

68
Q

The patella covers a distance of ______ with respect to the femur during tracking.

A

5-7 cm

69
Q

A lateral C-shaped curve is produced by the patella as it moves in ROM from about _____ to _____ degrees.

A

120-30 degrees

70
Q

Between 45 degrees and 15 degrees patellar tracking, the lateral curve produces:

A
  • gradual medial glide of the patella

- medial tilt of the patella

71
Q

Between 15 degrees and 0 degrees patellar tracking, the lateral curve produces:

A
  • lateral glide of the patella

- lateral tilt of the patella

Musculoskeletal Exam 4 (6 decks)

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