Knee Joint Flashcards by Deleted Deleted

What are the 2 joints of the knee?

tibiofemoral joint

•patellofemoral joint

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Patellofemoral articulation have what type of biomechanics?

7x body weight w/squats
2-3x body weight descending stairs
Reaction force

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Motion of the knee is a _____ articulation allowing patella to move __ cm causally in full flexion.

Sliding
7
Note: max contact b/t femur/patella 45 degree of flexion

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An increased Q angle can result in

Patella instability characterized by patella subluxation/dislocation

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Name the 3 characteristics that lead to an increased Q angle.

Femoral anteversion
Genu Valgum
External tibial torsion/pronated foot

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What are the biomechanics of the tibiofemoral articulation?

What is its motion?

Joint reaction force
3x body weight walking
4x body wight climbing

3 degrees of hyper extension to 155 degrees of Flexion in Sagittal plane. Thigh-calf limiting factor to full flexion
Norm gait ROM 0-70 degree

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What is the relevance of of Tibiofemoral articulation rotates instant center, points at direct contact?

Rolls posterior
Knee flex: instant center of rotation on femur moves posteriorly
Allows: inc knee flexion by avoids impingement

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Which side is the longest on Tibial plateau and what is the cause of screw home mechanism?

Medial

Tibial Externally rotates 5 degrees in 15 degrees of extension

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What is is the relevance of rotation in TF articulation?

Locks knee decreasing the work performed by quads while standing

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The tibia is subject to ——— w/knee flexion. External rotates on femur as the knee performs what action?

Internal rotation

Extends

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The lateral condyle shifts in what direction on the axis of rotation when the knee is in flexion?

Posterior

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Tibial internal rotation occurs with what movement?

Knee flexion

Note: 120 degrees to full flexion both condyle participate in Roll Back

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Which ligament has a varus stress at the knee?

Lateral collateral ligament

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Which collateral ligament experiences a valgus stress?

Superficial portion of the medial collateral ligament

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What is the function of the stability of the knee?

Primary: static restraint to anterior translation

Also, play a role in axial rotation

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What are the stabilizing components for the anterior cruciate liagment of the knee?

Anteromedial bundle tight in Flexion

Posterolateral bundle tight in Extension

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What is the primary function of the posterior cruciate ligament?

Primary static restraint to posterior translation

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What is the primary stabilizer of external tibial rotation of the knee?

Posterolateral corner

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Knee and joint pain must b distinguished b/t what?

Radiating or referred pain and local knee problems

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The knee joint can receive Refetred pain from where else in the body?

Low back
Hip
Ankle
Foot 
Note: frequently the knee joint is injured b/c of position exposure to outside trauma

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What is the most commonly injuries joint of the body?

Knee joint

Note: the knee relies mainly on ligaments and muscles for its stability

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True or Fail:
Joint effusion (swelling) provides stability to the knee.

True

Note: all ortho exams will be painful

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True or False:

Reactive muscle spasms and swelling will make testing unreliable to an acute knee injury.

True

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Are soft tissue injuries usually the result of overuse, disuse or both?

both

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Knee pain d/t pronation, supination, lower leg torsion, patellar tracking problems and an increased Q-angle are the result of overuse or disuse?

Disuse | Notes: disuse is the biomechanics predisposition of knee joint and pain

The history concerning activities d/t overuse are what?

W/repetitive movements or prolonged awkward positing of the knee

Patellofemoeral arthralgia, patellar instability and tracking disorders are all common presentations for what group of people? ID the specific are of knee pain.

Athlete w/anterior knee pain

Elderly pt’s commonly presents w/knee pain and stiffness as a result of what condition?

Osgood-Schlatter dz is a condition that ___ experience pain around or directly on the tibial tuberosity.

Young athlete

Chronic ACL damage is a common presentation for pt’s with what condition?

Instability

A pt presents with painful locking of the knee. This likely is a common presentation for what condition?

Meniscus tear

An ACL tear or patellar dislocation present in the history indicates a trauma with what motion?

Hyperextension

The pt has a history of a tear in the PCL. What motion has most likely occurred from this type of trauma?

Hyper-flexion

A history of a sudden declaration trauma is likely to be due to what type of damage and specifically to what muscle filter?

ACL tear

Valgus force with no rotation is a tear to what specific ligament?

MCL

Valgus force w/ration (foot fixed) can lead to trauma on what fibers?

ACL, MCL and menisci

Which of the following is not d/t valgus force w/rotation to the knee? ACL, MCL, PCL and menisci

PCL

What structure make up the terrible triad of the knee? | What is the aka of this condition?

ACL MCL Meniscus O’Donoghue triad

O’Donoghue triad aka is

The Terrible Triad | Note:ACL, MCL, meniscus

What injury occurs when the foot is planted or fixed and outside force applied in a valgus direction?

The terrible triad aka O’Donoghue triad | Made of Anterior Cruciate Ligament, Medial Collateral ligament and Meniscus

``` Which of the following are included in the “Terrible Triad”? Anterior Cruciate Ligament Posterior Cruciate Ligament Medial Collateral ligament Lateral Collateral ligament Meniscus ```

Anterior Cruciate Ligament, Medial Collateral ligament and Meniscus

A pt has a history of feeling a pop and pain deep with immediate swelling (hemarthrosis) to the knee. What fiber has been damaged?

Anterior cruciate ligament

A pt has generalized knee pain, instability that prevents to return to sports and difficulty weight bearing. These are symptoms involve what ligament?

Anterior cruciate ligament (ACL)

On physical exam the doc might observe an effusion and what else during inspection?

Quadricep avoidance gait (pt will not actively extend the knee).

The lack of what motion is secondary to meniscus injury or arthrofibrosis?

Full extension

The McMurray varus/valgus stress test evaluates the motion of what structures?

Meniscus or concomitant ligamentous injuries

ACL tears are common athletic injuries leading to what type of instability of the knee?

Anterior and lateral rotatory instability

The dx of an ACL tear or damage can be supspected clinically with the presence of a dame to the knee. What test is required to confirm dx? What ortho is used to check for damage?

Traumatic knee effusion w/increased laxity on Lachman’s test (also any drawers test). This requires a MRI to confirm dx.

The treatment of choice for ligamentous reconstruction depends upon what?

Pt’s age and activity level

Will a chronic ACL issue have a previous acute presentation in the history?

Yes

A pt complains of instability of the knee and not pain with the occurrence of a non-traumatic joint line swelling and an acute presentation in their history. This pt likely has an issue with what ligament?

ACL

ACL tears occur from hyperextension and what other actions?

Sudden stopping/cutting | Quadriceps contraction

ACL tears occur from hyperextension a sudden stop and quadriceps contraction. Contact with rotation can affect what structures?

Menisci and MCL

What section of the ACL usually tears?

Mid-substance

What other structure may rupture with the anterior cruciate ligament?

Middle Genicular artery

True or False | An anterior cruciate ligament causes sudden selling and is Stengel and painful.

True

A. What visual information can be gathered from taking a MRI of the ACL? B. Why are x-ray’s taken?

A. Integrity of the ACL B. To rule out a fracture

What orthopedic test is used to evaluate a suspected ACL injury? What structure is eliminated with this test? Note: may need to update this question later.

Anterior Drawer Test Hamstrings functions are considered here Lachman’s test in the acute setting

What injury accounts for half of all knee injuries and has a common incidence?

ACL

A. ACL injuries are more common among in what demographic? B. What leg is most subject to injury?

A.Female athlete, Sustained at younger age than males B. Supporting leg (its kicking leg w/males)

What are the risk factors for an ACL injury?

1. Female soccer player, 2. Male basketball player 3. Valgus moment at the Knee and Adduction moment at the Hip upon LANDING