KNEE PROC. Flashcards
_______ - KNEE JOINT, between 2 condyles of the femur
TYPE:
What else articulates with knee joint? AKA:_____-
Femorotibial joint
- synvoial, diathrotic joint, bicondylar type
patella
- patellofemoral joint
DISTAL FEMUR ANATOMY:
_____ - Located posterior view of femur, large & round
________ femoral condyle is ___* than lateral
__________ - sperates medial & lateral condyle posteriorly
_______ - rough prominences on outermost tips of condyle
________ - Superior part of medial epicondyle
_____ - Area posterior femur, right above intercond. fossa
-Condyles
-5-7* lower than lateral (this is why you angle on lateral)
-Intercondylar Fossa
- Epicondyles
-Adductor Tubercle
- Popliteal Surface
PROXIMAL TIBIA ANATOMY
____ & ______ - Large processes that make up medial & lateral aspects of tibia
_____ - Tibial spine, medial & lateral intercondylar tubricles
_____ - Tibial Plateau, Slopes _____, @ ______ *
Tibial Tuberocity can be affected by what disease?
- Medial & lateral condyle
-Intercondylar Eminence - Articular facets = tibial plateau, 10-20* posterior angle
-Osgood-Schlatter Disease
Ligaments in Knee:
1. _______, 2.________, 3. ________, 4. __________
Knee Joints contain 2 fibrocartilage disks called ______, provide ________.
- Anterior Cruciate Ligament (ACL), 2. Posterior Cruciate Ligament (PCL) 3. Tibial Collateral Ligament (MCL) 4. Fibular Collateral Ligament (LCL)
lateral & medial meniscus = stability & shock absorbers
LABEL THE IMAGE
A. Patella
B. Lateral epicondyle
C. Lateral condyle
D. Intercondylar eminence
E. Fibular head
F. Tibia
G. Femorotibial joint
H. Medial epicondyle
I. Femur
PROJECTIONS OF KNEE
ROUTINE:
ADVANCED:
TECHNICAL FACTORS:
SID:
IR SIZE:
GRID?
R: AP, AP OBLIQUE (MEDIAL &/OR LATERAL ROTATION), LATERAL
A: CAMP-CONVETRY METHOD, HOLMBLAD METHOD, BECLERE METHOD (TUNNEL VIEWS) & AP WEIGHT BEARING
T: TT = 60-65 @ 4-6 BUCKEY =. 70-75 @ 8-10
SID = 40
IR = 8X12
GRID: ONLY IF ANATOMY MORE THAN 10CM
AP KNEE
CR:
ANGLE?
ANATOMY:
CR: 1/2 IN DISTAL TO APEX PATELLA
ANGLE: BASED ON ASIS TO TABLETOP
- <19CM = 3-5 CAUDAD (THIN)
- 19-24 CM = 0* (AVERAGE)
- >24 CM = 3-5* CEPHALAD (THICKER)
ANATOMY: FIB HEAD SUPERIMP. BY TIBIA
- INTERCONDYLAR EMINENCE IN CENTER OF INTERCONDYLAR FOSSA
- FEMOROTIBIAL JOINT SPACE OPEN
- SYMMETRIC APPEARANCE OF FEMORAL & TIBIAL CONDYLES
AP OBLIQUE KNEE
CR:
POSITION:
ANGLE?
ANATOMY:
CR: 1/2 IN DISTAL TO APEX PATELLA
POSITION: 45* OBLIQUE MEDIAL OR LATERAL
ANGLE: BASED ON ASIS TO TABLETOP
- <19CM = 3-5 CAUDAD (THIN)
- 19-24 CM = 0* (AVERAGE)
- >24 CM = 3-5* CEPHALAD (THICKER)
ANATOMY:
MEDIAL = PATELLA SUPERIMP. MEDIAL FEMORAL CONDYLE, HALF PATELLA FREE OF FEMORAL SUPERIMP. & TIBIOFUBULAR JOINT OPEN
LATERAL = PATELLA SUPERIMP. LATERAL FEMORAL CONDYLE, HALF PATELLA FREE FEMORAL SUPERMP. & PROXIMAL FIBULA SUPERIMP. BY TIBIA
LATERAL KNEE
CR:
POSITION?
ANGLE:
ANATOMY:
CR: 1 IN DISTAL TO MEDIAL EPICONDYLE
POSITION: 20-30* KNEE FLEXION, EPICONDYLES PERP TO IR, PATELLA PERP TO IR
ANGLE: 5-7* CEPHALAD ALWAYS
ANATOMY: PATELLOFEMORAL & KNEE JOINT OPEN
- FEMORAL CONDYLES SUPERIMPOSED
- FIBULAR HEAD SLIGHT SUPERIMP. TIBIA
- PATELLA IN PROFILE
IF YOU FLEX KNEE TOO MUCH, WHAT CAN OCCUR?
WHAT ARE THE TUNNEL VIEWS?
WHAT IS THE CLINICAL INDICATION FOR THEM?
- WILL DRAW PATELLA INTO INTERCONDYLAR SULCUS
- CAMP COVENTRY METHOD, HOLMBLAD METHOD.
& BECLERE METHOD - BONY CARTILAGINOUS PATHOLOGY OR NARROWING JOINT SPACE
PA AXIAL PROJECTION - INTERCONDYLAR FOSSA
AKA: CAMP COVENTRY METHOD
ANGLE?
PATIEINT POSITION:
CR:
ANATOMY:
CR: PERP TO LOWER LEG @ MIDPOPLITEAL CREASE
ANGLE: 40-50* CAUDAD TO MATCH FLEXION
POSITION: PRONE, FLEX KNEE 40-50*, IR TO KNEE JOINT
ANATOMY: INTERCONDYLAR FOSSA OPEN
-Medial & lateral intercondylar tubercles of intercondylar eminence
- Open femorotibial joint space
- Symmetric femoral condyles
- Part of fibular head superimposed by tibia
PA AXIAL PROJECTION - INTERCONDYLAR FOSSA
AKA: HOLMBLAD METHOD
ANGLE?
PATIEINT POSITION:
CR:
ANATOMY:
CR: PERP TO IR & LOWER LEG @ MIDPOPLITEAL CREASE
ANGLE: NO ANGLE
POSITION: KNEELING OR PARTIALLY STANDING
- LEAN FORWARD 20-30* = 60-70* KNEE FLEXION
ANATOMY: INTERCONDYLAR FOSSA OPEN
-Medial & lateral intercondylar tubercles of intercondylar eminence
- Open femorotibial joint space
- Symmetric femoral condyles
- Part of fibular head superimposed by tibia
PA AXIAL PROJECTION - INTERCONDYLAR FOSSA
AKA: BECLERE METHOD
CR:
ANGLE?
PATIEINT POSITION:
ANATOMY:
CR: PERP TO LONG AXIS OF LOWER LEG @ 1/2 IN DISTAL
TO APEX PATELLA
ANGLE: (~40-45* CEPHALAD)
POSITION: SUPINE & FLEX KNEE 40-45*
ANATOMY: INTERCONDYLAR FOSSA OPEN
-Medial & lateral intercondylar tubercles of intercondylar eminence
- Open femorotibial joint space
- Symmetric femoral condyles
- Part of fibular head superimposed by tibia
- REVERSE CAMP METHOD
AP WEIGHT-BEARING KNEE
CLINICAL INDICATION:
CR:
POSITION:
ANATOMY:
EVALUATE FEMOROTIBIAL JOINT SPACE OF KNEES FOR NARROWING & POSSIBLE DEGENERATION / PATHOLOGY
CR: 1/2 IN BELOW APEX PATELLA
POSITION: BILATERAL, WEIGHT EVENLY DISTRIBUTED
ANATOMY: FEFMOROTIBIAL JOINT SPACE OPEN
- SYMMETRIC APPEARANCE OF FEMORAL & TIBIAL CONDYLES
- PART OF FIBULAR HEAD SUPERIMPOSED BY TIBIA
LARGEST SESAMOID IN THE BODY? LOCATION?
DISTAL PORTION:
SUPERIOR PORTION:
__________ - POSTERIOR SURFACE OF DISTAL FEMUR, ABOVE INTERCONDYLAR FOSSA
PATELLA, LOCATED OVER DISTAL ANTERIOR SURFACE OF FEMUR
APEX
BASE
POPLITEAL SURFACE
PATELLAR SURFACE AKA _____ OR ________ LOCATED AT DISTAL PORTION OF ANTERIOR FEMUR
WHEN EXTENDED, PATELLA MOVES:
WHEN LEG IS FLEXED, PATELLA MOVES:
INTERCONDYLAR SULCUS OR TROCHLEAR GROOVE
EXTENDED = UP & SUPERIOR TO PATELLAR SURFACE
FLEXED: DOWNWARD & OVER PATELLA SURFACE (INTO SULCUS)
JOINT INVOLVING PATELLA CALLED: ____________
ALSO INCLUDES: _____________
PATELLA ATTACHMENTS INCLUDE ___________ & __________
PATELLOFEMORAL JOINT
INLOVES PATELLA & DISTAL FEMUR
QUAD TENDON & PATELLA LIGAMENT
TENDON ATTACHMENT IS ______ TO _______
LIGAMENT ATTACHMENT IS ______ TO _________
WHY PA PATELLA?
WHY DONT YOU FLEX KNEE MORE THAN 5-10* IN LATERAL PATELLA?
MUSCLE TO BONE
BONE TO BONE (L FOR LIKE)
SHARPER DETAIL B/C DECREASED OID
decreases the patellofemoral joint space and may separate fracture fragments if present*
PROJECTIONS OF THE PATELLA
ROUTINE:
ADVANCED:
TECHNIQUE:
SID:
R: PA & LATERAL
A: MERCHANTS, SETTEGAST & HUGHSTON “SUNRISE”
60-65 & 4-6 && 70-75 @ 8-10 (BUCKY)
40 SID
PA PATELLA
CR:
POSITION:
ANATOMY:
CR: MIDPATELLA AREA (MIDPOPLITEAL CREASE)
POSITION: ROTATE ANTERIOR KNEE 5-10* INTERNALLY (HEEL 5-10* LATERALLY)
ANAT: PATELLA COMPLETELY SUPERIMPOSED BY FEMUR
- SHARP DETAIL B/C DECREASED OID IN PA
LATERAL PATELLA
CR:
POSITION:
ANATOMY:
CR: MID-PATELLOFEMORAL JOINT
PST: EPICONDYLES SUOERIMOISED & PERP TO IR, PATELLA PER TO IR
- FLEX KNEE 5-10*
ANAT: PATELLA IN LATERAL PROFILE
- PATELLOFEMORAL JOINT OPEN
3 ADVANCED PROJECTIONS OF PATELLA:
CLINICAL INDICATION FOR THEM:
ANATOMY FOR THEM:
MERCHANTS, SETTEGAST & HUGHSTON METHODS
CLIN IND: SUBLUXATION OF PATELLA, PATELLAR FXS,
- PATELLOFEMORAL JOINT ANATOMY & ASSES
- FEMORAL CONDYLES
ANAT: OPEN PATELLOFEMORAL JOINT
- PATELLA IN PROFILE
- INTERCONDYLAR SULCUS
- SYMMETRIC FEMORAL CONDYLES
PATELLA TANGENTIAL - MERCHANT METHOD:
CR:
POSITION:
CLINICAL INDICATION:
ANATOMY:
CR: PERP TO IR, THROUGH PATELLOFEMORAL JOINT
- ANGLE CR 30* CAUDAD (FROM HORIZONTAL)
PST: SUPINE, KNEES FLEXED 40* @ END OF TABLE
- USE MERCHANT BOARD
CLIN IND: SUBLUXATION OF PATELLA, PATELLAR FXS,
- PATELLOFEMORAL JOINT ANATOMY & ASSES
- FEMORAL CONDYLES
ANAT: OPEN PATELLOFEMORAL JOINT
- PATELLA IN PROFILE
- INTERCONDYLAR SULCUS
- SYMMETRIC FEMORAL CONDYLES
PATELLA TANGENTIAL - SETTEGAST METHOD:
CR:
POSITION:
CLINICAL INDICATION:
ANATOMY:
CR: TANGENTIAL TO PATELLOFEMORAL JOINT
- CR ANFLE 15-20* IF NEEDED
PST: PRONE OR SEATED, FLEX KNEE AT LEAST 90*
- PRP TO IR OR FLEX KNEE MUCH AS POSSIBLE
CLIN IND: SUBLUXATION OF PATELLA, PATELLAR FXS,
- PATELLOFEMORAL JOINT ANATOMY & ASSES
- FEMORAL CONDYLES
ANAT: OPEN PATELLOFEMORAL JOINT
- PATELLA IN PROFILE
- INTERCONDYLAR SULCUS
- SYMMETRIC FEMORAL CONDYLES
PATELLA TANGENTIAL - HUGHSTON METHOD:
CR:
POSITION:
CLINICAL INDICATION:
ANATOMY:
CR: 45& CEPHALAD ENTERING PATELLOFEMORAL JOINT
PST: PRONE, FLEX KNEE SO TIB-FIB FORMS 50-60* ANGLE WITH TABLE
- PATIENT HOLD FOOR W GAUZE OR SUPPORT DVCE
CLIN IND: SUBLUXATION OF PATELLA, PATELLAR FXS,
- PATELLOFEMORAL JOINT ANATOMY & ASSES
- FEMORAL CONDYLES
ANAT: OPEN PATELLOFEMORAL JOINT
- PATELLA IN PROFILE
- INTERCONDYLAR SULCUS
