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Block III > Knee joint > Flashcards

Knee joint Flashcards

1
Q

Anastomoses between branches of the major arteries at the knee

A
  • Superior medial genicular artery anastomoses with descending genicular artery (from fem a.)
  • Superior lateral genicular artery anastomoses with descending branch of lfca
  • Inferior medial & inferior lateral genicular arteries anastomose with recurrent branch of anterior tibial artery
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2
Q

Motions of the knee

A

Extend/flex

Rotate

Translate

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3
Q

Anatomy of the knee

A
  • Knee joint is a synovial, hinge joint
  • Patella is teh largest sesamoid in the body; its articulation with the femur allows for quads to be pulled
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4
Q

What artery supplies the cruciate ligament?

A

Middle genicular artery off the popliteal artery

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5
Q

The popliteal artery is the main artery of the knee and it can be injured in femur fracture or knee joint dislocation.

What are the major branches of the popliteal artery?

A
  • Superior lateral genicular a. : deep to biceps femoris tendon
  • Superior medial genicular a.: deep to semimembranosus and semitendinosus; enters vastus medialis
  • Inferior lateral genicular artery: passes laterally above the fibula head and then deep to teh fibular collateral ligament
  • Inferior medial genicular artery: passes medially along the upper border of the popliteus muscle, deep to the popliteus fascia
  • Middle genicular artery: pierces the oblique popliteal ligament and enters the knee joint
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6
Q

The popliteal artery splits into ___ and __ at the lower border of the popliteal muscle

A

Anterior and posterior tibial arteries

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7
Q

Where are vessels in the knee?

A

Behind the posterior horn of the lateral meniscus

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8
Q

What’s the anterior-to-posterior order of the vessels & nerve behind the knee?

A

Artery (anterior)

Vein

Nerve (posterior)

You can’t injure the vein or nerve without injuring the ones more anterior to it (if you’re entering anteirorly).

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9
Q

The ___ meniscus is shaped like a C.

The ___ meniscus is shaped like an O.

A

Medial = C

Lateral = O

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10
Q

Which meniscus is more prone to injury and why?

A

Medial meniscus because it’s constrained by attachment to the capsule; whereas, the lateral meniscus is more mobile.

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11
Q

What muscles allow knee extension? Which ones allows knee flexion?

A

Knee extension - quads, innervated by femoral nerve (L2-4)

Knee flexion - hamstrings

  • Biceps femoris, innervated by common fibular nerve
  • Semitendinosus & semimembranosus, innervated by the tibial branch of the sciatic nerve (L5-S2)
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12
Q

“say grace before tea” - pes anserinus

A

Pes anserinus

  • Sartorius (sailor’s crossing); femoral nerve
    • Longest muscle in the body
  • Gracilis (abduct+ext rotation); anterior branch of obturator a.
  • Semitendinosus: tibial branch of sciatic nerve
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13
Q

Compartment syndrome

A
  • Fluid enters the fascia between muscles, compressing the muscles so that they die.
  • Fatal
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14
Q

What is in the anterior compartment of the leg?

A
  • Anterior tibialis artery
  • Deep peroneal nerve
  • Anterior tibialis muscle, extensor digitorum longus, extensor hallucis longus, peroneal tertius
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15
Q

Contents of lateral compartment

A
  • Peroneus longus, peroneus brevis
  • Superficial peroneal nerve
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16
Q

Contents of posterior deep compartment

A
  • Flexor hallucis longus, flexor digitorum longus, popliteus, tibialis posterior
  • Posterior tibilais artery
  • Tibial nerve
17
Q

Contents of posterior superficial compartment

A
  • Soleus, plantaris, gastrocnemius
  • Sural nerve
18
Q

Static stabilizers of the knee vs dynamic stabilizers

A

Static stabilizers - architecture of bone

Dynamic stabilizers - ligaments & menisci

19
Q

Femur as a static stabilizer

A
  • Trochlear groove
  • Medial condyle
  • Lateral condyle
  • Intercondylar notch (site of ACL origin
  • 5 types of trochlear grooves:
    • Large & rounded
    • Small & rounded
    • Tent-shaped (rare)
    • Lateral angled wave -> ACL tears
    • Smaller angled wave -> ACL tears
20
Q

Tibia & patella as static stabilizers

A
  • Tibia
    • Medial TP- concave - more stable
    • Lateral TP- convex - more motion
  • Patella
    • Facets- median, middle, lateral (superior, middle, and inferior of each), and odd
    • If dislocated, it usually dislocates laterally
21
Q

Which horn of the meniscus keeps your knee from dislocating when your cruciate ligament is compromised?

A

Posterior horn doesn’t allow translation of knee when bending

22
Q

ACL vs PCL direction

A

ACL: lateral to medial

PCL: medial to lateral

They cross each other, which is why it’s a cruciate ligament.

23
Q

Most common way to get a PCL injury vs an ACL injury

A

PCL injury: dashboard injury

ACL injury: twisting

24
Q

Baker’s cyst (not an LO)

A

Swelling behind the knee from arthritis, meniscus injury, herniation, or tear of the joint capsule.

Impairs flexion and extension; pain worsens when the knee is fully extended

25
Q

In an acute ACL tear, which meniscus is more likely to get injured?

A

Lateral meniscus.

Medial meniscus for chronic or old ACL injuries.

26
Q

Explain the consequence of a lesion of the tibial nerve in the popliteal fossa.

A
  • Loss of plantar flexion of the foot
  • Paralyzed tibialis posterior
    • Impaired inversion
    • difficulty in getting heel off the ground
    • Shuffling of the gait.
  • Results in a characteristic clawing of the toes and sensory loss on the sole of the foot.
27
Q

Hallus valgus vs Hallux varus

A

Hallux Valgus: Lateral deviation of the big toe; bunion

Hallux Varus: Medial deviation of the big toe

28
Q

Consequence of damaging superficial fibular nerve

A

Via fibularis longus & brevis:

–> Loss of foot eversion

–> Loss of innervation of dorsum of foot an distal 1/3 of anterolateral leg

29
Q

Consequence of damaging deep fibular nerve

A

Via tibialis anterior, hallucis longus, extensor digitorum longus, and fibularis tertius:

  • Foot drop
  • High-stepping gait
  • Loss of innervation at the skin of the 1st interdigital cleft
30
Q

Anterior vs Posterior drawer sign

A

Anterior drawer sign: Forward sliding of the tibia on the femur due to a rupture of anterior cruciate ligament

Posterior drawer sign: Backward sliding of the tibia on the femur caused by a rupture of the posterior cruciate ligament

31
Q

What are bursa and what are the major ones of the knee?

A

Bursa: Synovial fluid filled sac, found between moving structures in a joint (purpose is to reduce wear and tear on these structures)

32
Q

Explain the consequence of a lesion of the tibial nerve in the popliteal fossa

A
  • Loss of plantar flexion
  • Impaired inversion (via tibialis posterior)
  • Shuffling gait: hard to get heel of the ground
  • Clawing of the toes
  • Sensory loss of the sole of the foot
33
Q

Housemaid’s knee

A

Inflammation and swelling of the prepatellar bursa (on superficial surface of patella)

34
Q

Clergyman’s knee

A

Inflammation of the superficial infrapatellar bursa

35
Q

Lachman’s test

A

Anteiror drawer test in 30 degree flexion

36
Q

the ACL is taut with knee ___xion.

The PCL is taut with knee ___xion.

A

ACL taut with extension

PCL taut with flexion

Block III (6 decks)

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