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Kinesiology Term 1 > Knee Complex > Flashcards

Knee Complex Flashcards

1
Q

Knee

A

One of the most commonly injured areas of the body

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2
Q

What has a heavy influence on the knee?

A

The hip and ankle

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3
Q

What controls stability and mobility of the knee?

A

Boney, ligamentous, chondral, and muscular anatomy

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4
Q

3 Joint Articulations of the KNEE

A

Tibiofemoral

Patellofemoral

Proximal Tibiofibular

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5
Q

Boney Anatomy of the Knee

A

Femur
Patella
Tibia / Fibula

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6
Q

Ligamentous Anatomy of the Knee

A

ACL, PCL, LCL, MCL
MPFL
Posterolateral Corner

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7
Q

Chondral Anatomy of the Knee

A

Menisci
Chondral Cartilage

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8
Q

Muscular Anatomy:

Knee extensors
(Quad muscles)

A

Vastus Medialis
Vastus intermedius
Vastus Lateralis
Rectos Femoris

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9
Q

Muscular Anatomy:

Knee Flexors
(Hamstring muscles)

A

Semimembranosus
Semitendinosus
Biceps Femoris

Gracilis
Popliteus
Gastrocnemius

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10
Q

Muscular Anatomy:

Hip rotators

A

TFL and Glute Max into IT Band
Sartorius
Adductors

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11
Q

Tibiofemoral Joint
Structure

A

~Distal FEMUR approximating with proximal TIBIA
~Double Condyloid
~3 DOF

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12
Q

Tibiofemoral Joint
Osteokinematics

A

~Sagittal plane - flexion / extension around coronal axis
~Transverse plane - ER / IR around longitudinal axis
~Frontal plane - abduction/ adduction around A-P axis

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13
Q

Tibiofemoral Joint:
Femur

A

~Femoral condyles are medial to the head due to obliquity
~Medial condyle extends further creating a parallel surface to the ground
~Femoral condyles have a convex surface
~Intercondylar notch

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14
Q

Tibiofemoral Joint:
Tibia

A

~Relatively flat compared to femoral condyles
~Asymmetrical plateaus = medial > lateral
~Tibial plateau has a posterior slope of 7-10 degrees

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15
Q

Which osteokinematic motion does the tibial plateau angle/ posteriorslope assist with?

A

Flexion / Extension

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16
Q

Tibiofemoral Joint:
Weight bearing
Q-Angle

A

~Physiologic angulation
~Normal: 180-185 degrees
~Genu Valgum > 185 deg
~Genu Varum < 175 deg

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17
Q

Menisci Role

A

~Attached to the tibial plateau

~Greater contact area between surfaces
~Reduces stress/friction
~Enhance stability
~Shock absorption

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18
Q

Menisci Anatomy

A

~Fibrocartilaginous disc
~Semicircular / wedge shape
~Attached via roots, ligaments, capsule
~Compression 1-2x BW, 3-4x/BW
2 Menisci

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19
Q

Medial Meniscus

A

~Larger ‘C’ shape
~More ligamentous attachments, less mobile

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20
Q

Lateral Meniscus

A

~Smaller ‘O’ shape
~More mobile

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21
Q

Menisci Nutrition

A

~Blood supply - White vs Red Zones
—->More blood supply in the lateral aspects of menisci
~Innervation - anterior and posterior horns well innervated
~Central portions receive nutrients via reciprocal loading and diffusion through synovial fluid

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22
Q

Menisci Wedge

A

Allows for axial load to disperse radially “hoop stress”

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23
Q

Menisci Movement

A

~Allows for best joint congruency during knee motion
~Compressive forces increase at end ranges of motion
~Injury can occur POSTERIOR horn at end range FLEXION
~Injury can occur to ANTERIOR horn at end range EXTENSION

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24
Q

Tibiofemoral Joint:
Joint Capsule

A

~Poor boney congruency, more reliance on inert structures
~Synovial layer - meant to secrete and absorb fluid, providing nutrients and lubrication
~Strongly innervated to provide feedback -nociceptors and mechanoreceptors

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25
Joint Capsule Extension
Bony congruence and ligaments most taught "closed pack"
26
Joint Capsule Flexion
Passive structures get more lax, allowing more translation/ rotation of tibiofemoral joint "open pack"
27
Joint Capsule Anterior Portion
~Medial/lateral retinaculum ~Medial patellofemoral ligament (MPFL)
28
Joint Capsule Medial Portion
Medial collateral ligament (deep and superficial)
29
Joint Capsule Lateral Portion
Iliotibial (IT) Band reinforces
30
Joint Capsule Posterior Portion
Arcuate and posterior oblique ligament
31
Anterior Cruciate Ligament (ACL)
~Highly injured ~Lateral / posterior femur to Medial / anterior tibia ~Consists of 2 bundles ~Provides rotary stability with valgus/varus moments ~Intracapsular, extrasynovial
32
ACL is the primary restraint against _____________of the tibia and _______________of the knee
Anterior translation; Excessive valgus forces/moments
33
ACL Anteromedial Bundle
Taught in flexion
34
ACL Posterolateral Bundle
Taught in extension
35
Posterior Cruciate Ligament (PCL)
~Shorter and less oblique than ACL ~Attaches from posterior tibia to medial femoral condyle ~PCL and meniscofemoral ligament form PCL complex ~Contributes to rotary and valgus/varus stability ~Intracapsular, extrasynovial
36
PCL primary restricts _________________ of the tibia
Posterior translation
37
Medial Collateral Ligament (MCL)
~Divided into superficial and deep layers ~Deep layer connected to meniscus ~MCL is "less taught" as knee is flexed through ROM
38
MCL primarily restrains ______________ moment at the knee and secondarily restrains __________ rotation.
Valgus; lateral
39
Lateral Collateral Ligament (LCL)
~Attaches to the lateral femoral condyle and fibular head ~Considered part of the posterior lateral corner
40
LCL primarily restrains excessive _________ forces and secondarily restrains _________ rotation.
Varus; lateral
41
Iliotibial Band (ITB)
~Thick fibrous band / fascia forming from TFL fibers and posterior fiber of the glute max ~Inserts onto Gerdy's tubercle on lateral tibia ~NOT contractile, remains taught regardless of hip/knee position
42
ITB Main concern
Fat pad between ITB insertion and tibia can take on stress/friction and cause pain
43
Knee Extension
Normal: 0-10 degrees Genu recurvatum >10 degrees
44
Knee Flexion
Normal: 0-150 degrees
45
Knee Accessory Motion
IR/ER: ~10 degrees | Screw Home Mechanism Abduction/Adduction: Varus/Valgus
46
Tibiofemoral Joint Open Chain Arthrokinematics
Tibia (concave) on Femur (convex) = Same Flexion: Posterior roll and glide Extension: Anterior roll and glide
47
Tibiofemoral Joint Closed Chain Arthrokinematics
Femur (convex) on Tibia (concave) = Opposite Flexion: Posterior roll, anterior glide Extension: Anterior roll, posterior glide Example: squat
48
Screw Home
~Greater medial plateau, shorter lateral femoral condyle ~Tibial external rotation occurs at last 30 degrees, most noticeable in full or hyperextension ~Open chain: Tibial ER on Femur during extension ~Closed chain: Femoral IR on Tibia during extension
49
Screw Home
~Unlocking the knee ~From extension to flexion ~Laterally rotated tibia must IR upon initiation of flexion ~Open chain: Tibia must ER during last 30 deg of extension ~Closed chain: Tibia must IR during last 30 deg of extension
50
Factors guiding "Screw Home" rotation
1. Shape of medial femoral condyle 2. Tension in ACL 3. Lateral pull of quadriceps
51
Patellofemoral Joint: Patella
~Largest sesamoid bone in the body ~Embedded in the quadriceps muscle ~Incongruent joint
52
Primary Function of the Patella
Anatomical pulley for the quadriceps muscle
53
Patellofemoral Joint: Patellar Positioning
~Patella Alta = longer patellar tendon ------>less congruency, more risk of subluxation ~Patella Baja = shorter patellar tendon
54
As the knee _______, there is more contact of the patellofemoral joint.
flexes
55
Patellofemoral Joint: Patellar tracking
~Slight medial movement at initiation of flexion ~Continued inferior glide once in trochlear groove
56
Patellofemoral Stability
Frontal Plane ~Physiologic valgus at femur/tibia ~Quadriceps pulls patella slightly laterally ~Medial structures help stabilize
57
In knee extension, the patella sits in superior _________________.
Femoral sulcus
58
What helps stabilize the Patellofemoral Joint?
Inert Tissue Stability ~Boney congruency ~Retinaculum - ligamentous, synovial capsule ~Plica
59
Q - Angle
Frontal Plane : physiologic valgus at femur / tibia ~Angle formed between ASIS to midpoint of patella and a line connecting the tibial tuberosity and midpoint of patella
60
Normal Q-Angle between _____ and _____ degrees.
180; 185
61
Increased Q-angle associated with
increased subluxation
62
Tibiofemoral Joint Open-Packed Position
20-25 degrees
63
Tibiofemoral Joint Closed-Packed Position
Full extension with lateral rotation
64
How does genu valgum alter the mechanical axis of the lower extremity?
"Knock Knees" ~WB line is shifted onto the lateral compartment
65
What effect can genu valgum have on the compressive loading of the articular cartilage in each tibiofemoral compartment?
~Compression forces are increased on the lateral aspect of the TFJ
66
What are the patella plicae?
~Folds created by the failure of the synovial membrane to become fully reabsorbed ~Infrapatellar plica most common
67
What implications do plicae have in knee joint dysfunction?
~Can become impinged with knee flexion ~May become irritated and inflamed, leading to pain, effusion, and changes in joint structure and function
68
Identify and describe which muscles are capable of altering strain on the anterior cruciate ligament.
~Any muscle action that produces shear forces at the Tibiofemoral joint ~Quads and gastro -ant shear on tibia ~Hamstrings relieve ACL of ant shear of tibia
69
3 major bursae of knee joint
~Suprapatellar bursa -ant. brw quads tendon and ant femur super. to patella ~Subpopliteal bursa - post. btw popliteus tendon and lat femoral condyle ~Gastrocnemius bursa - btw tendon of the med head of gastro and medial femoral condyle
70
T/F All 3 major bursae are continuous with the synovial capsule of the knee
True; but mostly the suprapatellar
71
At which point in the knee’s ROM is axial rotation greatest?
90 deg knee flexion

Kinesiology Term 1 (16 decks)

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