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MSK > Knee joint > Flashcards

Knee joint Flashcards

1
Q

Which articulation is the weight bearing joint of the knee

A

Tibiofemoral - particularly medial condyle as it is larger

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2
Q

What lines the articulating surfaces

A

Hyaline cartilage

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3
Q

Patella is formed inside which tendon

A

Quadriceps femoris (main knee extensor) tendon which inserts directly over the knee, increasing the muscle’s efficiency

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4
Q

What is between the femoral condyles and what is the significance

A

Anteriorly - shallow depression to allow knee articulation

Posteriorly - intercondylar fossa

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5
Q

Significance of femoral epicondyles (above condyles)

A

Site of attachment for collateral ligaments

Medial epicondyle of femur has adductor tubercle (insertion of hamstring part of adductor Magnus)

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6
Q

Describe surface of tibia

A

Medial surface is concave
Lateral surface is convex
Medial and lateral surfaces are separated by intercondylar eminence

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7
Q

What strengthens the knee joint

A

Menisci,
Ligaments,
Capsule,
Muscles

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8
Q

How does the menisci strengthen the knee joint

A

Deepens the articulation (of tibial element)

Act as shock absorbers

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9
Q

Features and attachments of menisci

A

Crescentric plates of fibrocartilage,
Thicker at edges (wedge shaped),
Attached to intercondylar areas,
Attached to joint capsule via coronary ligaments,
Anteriorly connected (medial and lateral menisci) by transverse ligament of knee

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10
Q

What intracapsular ligaments are involved in the knee joint

A

Anterior cruciate ligament,

Posterior cruciate ligament

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11
Q

How are cruciate ligaments named

A

Attachment to tibia

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12
Q

Course of anterior and posterior cruciate ligaments

A

Posterior passes anteriorly and inserts medially (posterior intercondylar region of tibia to femoral intercondylar fossa)

Anterior passes posterior and inserts laterally (anterior intercondylar region of tibia to femoral intercondylar fossa)

Pam’s apples!

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13
Q

Features of anterior cruciate ligament

A

Weaker than posterior cruciate ligament,
Relatively poor blood supply,
Limits anterior movement (prevents anterior dislocation) of tibia on femur,
Limits knee hyperextension

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14
Q

Features of posterior cruciate ligament

A

Stronger than anterior cruciate ligament,
Main stabiliser in weight bearing flexed knee,
Limits posterior movement (prevents posterior dislocation) of tibia on femur,
Limits knee hyperflexion

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15
Q

Where is joint capsule absent and why

A

Anteriorly

Allows synovial membrane to extend up beneath patella

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16
Q

How is the joint capsule strengthened laterally

A

Inferior fibres of vastus lateralis and medialis

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17
Q

How is the joint capsule strengthened posteriorly

A

Oblique popliteal ligament (an expansion of semimembranosus)

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18
Q

What are the extra capsular ligaments of knee joint

A

Medial (tibial) collateral ligament,

Lateral (fibular) collateral ligament

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19
Q

attachments of lateral collateral ligament

A

Proximally - lateral epicondyle of femur

Distally - depression on lateral fibular head

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20
Q

Attachments of medial collateral ligament

A

Proximally - medial epicondyle of femur
Distally - medial tibia

Attaches to medial menisci at its midpoint (clinically important)

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21
Q

What reinforces the lateral collateral ligament

A

Ilio-tibial tract

22
Q

What is the patellar ligament

Where does it attach

A

Continuation of quadriceps femoris tendon, distal to patella.
It attaches to tibial tuberosity

23
Q

What muscles permit knee extension

A

Quadriceps femoris

24
Q

Which muscles permit knee flexion

A

Hamstrings, gracilis, sartorius, popliteus

25
Q

Which muscles permit lateral rotation of knee (knee must be flexed)

A

Biceps femoris

26
Q

Which muscles permit medial rotation of knee (knee must be flexed)

A 
Semimembranosus,
Semitendinosus, 
Gracilis,
Sartorius,
Popliteus
27
Q

Benefit of locking knee in extension

A

Uses less energy to stand

28
Q

How does the knee lock in extension

A

Femur rotates internally over tibia

29
Q

How does the knee unlock

A

Popliteus helps to rotate femur externally

30
Q

Why is the lateral menisci injured less than the medial

A

Smaller and doesn’t have any extra attachments (this makes it less likely to be damaged)

31
Q

What is torn in an unhappy triad

A

Medial collateral ligament, medial menisci,

Anterior cruciate ligament

32
Q

How do you obtain the unhappy triad

A

Blows to side of extended knee,

Lateral twisting of flexed knee (ACL is taut during flexion)

33
Q

How can ACL be torn

A

Hyperextension of knee joint,

Large force to back of knee with the joint partly flexed

34
Q

Test for ACL damage

A

Anterior draw test -

Attempt to pull the tibia forwards, positive test if it moves

35
Q

How can PCL be torn

A
  1. ‘Dashboard injury’ - large force applied to shins when knee is flexed.
    This pushes tibia posteriorly
  2. Hyperextension of knee joint
  3. Damage to upper tibial tuberosity
36
Q

Test for PCL damage

A

Posterior draw test -

Hold knee in flexed position and attempt to push shin posteriorly, positive test if it moves

37
Q

Why do peripheral menisci tears usually heal easily

A

Reasonable blood supply

38
Q

Articulating surfaces of knee joint

A

Tibiofemoral - medial and lateral condyles of femur with tibia
Patellofemoral - anterior and distal part of femur with patella

39
Q

Describe patella dislocation

A

Patella displaced out of patellofemoral groove.

Mostly occurs laterally

40
Q

How do patella dislocations occur

A

Direct trauma on patella,

Forceful sudden twisting of knee

41
Q

How are patella fractures obtained

A

Direct trauma to patella,

Sudden contraction of quadriceps femoris

42
Q

Consequence if patella fractures into fragments

A

Fragments usually separate:
Proximal fragment - displaced superiorly by quadriceps femoris tendon
Distal fragment - displaced inferiorly by patellar ligament

43
Q

Important bursae in knee

A

Supra-patellar,
Pre-patellar,
Superficial infrapatellar

44
Q

Location of supra patellar bursa

A

Extension of synovial cavity of knee.

Found between quadriceps femoris and femur

45
Q

Location of pre patellar bursa

A

Between apex of patella and skin

46
Q

Location of superficial infrapatellar bursa

A

Between patella ligament and skin

47
Q

What is Housemaids knee and how is it caused

A

Inflammation of pre patellar bursa which produces swelling on anterior side of knee.
Caused by chronic friction/direct trauma between skin and patella

48
Q

What is clergyman’s knee and how is it caused

A

Inflammation of superficial infrapatellar bursa

Caused by chronic friction/direct trauma between skin and tibia

49
Q

Arthritis in knee

A

Osteoarthritis is common as knee is weight bearing

Rheumatoid occurs in severe progression of disease

50
Q

How do you investigate the knee

A

MRI,
Arthroscopy (camera into joint)
Aspiration (removal of fluid from joint)
Clinical examination

MSK (87 decks)

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