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Human Loco-motor Systems > L9.3 - Knee Complex > Flashcards

L9.3 - Knee Complex Flashcards

1
Q

Knee Joint

1) Joint type and movements?
2) Max stability in?
3) What joints are involved?

A

Knee Joint

1) Modified Hinge Joint - F/E, some rotation, large ROM
2) Extension (during weight bearing)
3) 2 Articulations - Tibiofemoral, patellofemoral

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2
Q

Tibiofemoral Joint - weightbearing joint

1) Where is it found?
2) Poor or rich bony congruence?
3) Is weight transferred ant or post?

A

Tibiofemoral Joint - weightbearing joint

1) B/w condyles of femur and tibia
2) Poor bony congruence
3) Anterior to TFJ

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3
Q

Why does the TFJ have poor bony congruence? What increases articulation?

A

1) Femur is rounded and sits on flat tibia
2) Tibia has vertical axis and femur has oblique axis (sitting on top of tibia in an oblique way)
3) Medial condyles of both bones are larger than lateral ones.

Menisci

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4
Q

Articular Capsule

1) Where does it attach?
2) Deficiencies
3) Reinforced by
4) Muscles supporting it

A

1) Attached at articular margins and menisci. Goes from epicondyles of femur to proximal aspect of condyles of tibia
2) Anterior (Suprapatellar bursa - superior protrusion of synovial joint) Posterior (Popliteal tendon)
3) Anterior: Patellar lig. and retinaculae (medial and lateral patellar retinaculae)
Posterior: oblique (extends from semitendinosus muscle) and arcuate popliteal lig.
Medial: Medial collateral lig
Lateral: Lateral collateral lig, ITB
Inferior: coronary lig. - portions of the joint capsule which connect the inferior edges of the fibrocartilaginous menisci to the periphery of the tibial plateaus.
4) Quads, Hamstrings, Gastrocnemius

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5
Q

Synovial membrane - lines interior of joint capsule and extends from knee joint to go where? List the non-articular structures in the joint.

A

Goes deep to medial end of vastus intermedius- hence leading to protrusion of synovial membrane where suprapatellar bursa can be found.

1) Popliteus tendon - intracapsular but extrasynovial
2) Ant/Post cruciate lig - start off from tibia and push through synovial membrane (get a bit of covering) BUT extrasynovial
3) Intrapatellar fat pad - extrasynovial

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6
Q

Clinical significance of Synovial membrane in knee complex

A

With lig injury, there is rapid swelling due to tearing of synovium

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7
Q

List of Bursae at the Knee Joint

A
  • Suprapatellar, popliteus and semimembranosus (Communicating)
  • Subcutaneous prepatellar (Non-communicating, inflammed often - aka maid/clergyman bursa)
  • Deep intrapatellar
  • Gastrocnemius
  • Anserine
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8
Q

Synovial effusion of the knee

A

Knee effusion or swelling of the knee (colloquially known as water on the knee) occurs when excess synovial fluid accumulates in or around the knee joint.

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9
Q

Collateral ligaments

a) Which is wider?
b) Which has two parts?
c) Attachment of medial, lateral collateral lig.
d) What actions does each one resist?
e) Most commonly injured?
f) Which is taut in extension
g) What is the main role of the medial collateral lig?
h) How is lateral collateral lig damaged?

A

a) Medial is wider. Lateral is shorter
b) Medial has two parts (wider superficial part and smaller deeper part)
c) Medial - medial epicondyle (posterior) to proximal surface of tibial condyle (anterior) HAS OBLIQUE ORIENTATION. It is attached to medial meniscus

Lateral - Lateral condyle of femur to head of fibula, separated from lateral meniscus by popliteal tendon

d) Medial - Ab, ER, Lateral - Ad
e) Medial is most commonly injured as it attaches to more things comapred to lateral one.
f) Both are taut in extension
g) Main role of medial is to limit anterior displacement of tibia when ACL damaged
h) Impact on medial side (rarer), its more common to have an impact on the lateral side

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10
Q

Cruciate lig. - intracapsular/extracapsular, intrasynovial/extrasynovial

A

Intracapsular extrasynovial

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11
Q

Cruciate lig. - how is it named?

A

Named by tibial attachements - Anterior is anterior to intercondylar eminence of tibia, posterior is posterior to intercondylar eminence of tibia

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12
Q

Cruciate lig. - what movement do they allow?

A

Rotation

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13
Q

Cruciate lig. - Primary stabilizers in _ to _ direction

A

Anterior to posterior

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14
Q

ACL

a) What movements does it assist in?
b) What does it prevent?
c) When is it prone to injury?
d) Where does it start off at birth?
e) What happens to ACL in E?

A

ACL

a) IR of femur and contributes to locking of knee when standing up (weightbearing position)
b) Prevents backward displacement of femur on tibia in weightbearing and forward displacement of tibia on femur in non weightbearing
c) In hyperextended or flexed and rotated knee (kicking action)
d) At birth, they start off as a septum on the plateaus of the tibia and they invaginate (pushing up), taking with them, synovial membrane
e) Tightens and untwists in E

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15
Q

Way to figure out how cruciate lig are placed

A

Index finger goes behind middle finger and palm is facing towards myself.

Index - PCL (goes from post to anterior medial side)
Middle - ACL (starts medially, goes lat and sup)

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16
Q

Medial or lateral condyle longer?

A

Medial

17
Q

PCL

a) What movements does it prevent?
b) When is it taut?
c) Prone to injury in what position?

A

PCL

a) OPPOSITE OF ACL - prevents forward displacement of femur on tibia in WB and backward displacement of tibia on femur in NWB
b) Taut in full F
c) Prone to injury in flexed knee (bumper bar impact)

18
Q

Unhappy Triad

A

Medial mensicus, ACL, Medial collateral lig

19
Q

Other lig. of knee complex

A

1) Oblique popliteal lig
2) Arcuate popliteal lig
3) Transverse genicular lig

20
Q

Menisci are C shaped ___ wedges that improve ___ and __ knee. They increase contact area by (how much?). They bear weight and protect articular surfaces. They spread synovial fluid and allows separate movement in joint capsule (Menisci move with femur in (what movement?) and with tibia in (what movement?)).

A

Menisci are C shaped fibrocartilaginous wedges that improve congruency and stabilise knee. They increase contact area by 1/3. They bear weight and protect articular surfaces. They spread synovial fluid and allows separate movement in joint capsule (Menisci move with femur in rotation and with tibia in F/E).

21
Q

Why is medial meniscus more commonly injured?

A

It is longer, horns are further apart, less mobile due to attachment to MCL.

22
Q

Removal of menisci leads to loose bodies leading to

A

Osteoarthritis

23
Q

When is knee joint most stable?

A

Full E (locking)

24
Q

Is complete dislocation common?

A

No

25
Q

Anterior draw test and posterior draw test

A

Femur is kept stable. Knee flexed. Pull tibia forward and if it moves too much, then ACL is damaged.

Same but pushed posteriorly for posterior draw test.

26
Q

Muscles and movements

1) F/E
2) Conjunct Rotation (locking/unlocking)
3) Adjunct Rotation

A

1) Hamstrings/Quadriceps
2) Locking (passive - muscles are not exerted during locking, contact with lateral condyles (shorter), rotate internally and then makes contact with medial condyle), -
- unlocking (active) - popliteus
3) IR/ER with flexed knee
- Semitendinosus/biceps femoris

27
Q

Locking mechanism slide*

A

Locking mechanism slide*

28
Q

BS and NS

A

BS: Anastomoses b/w branches of femoral, popliteal, genicular arteries

NS: Branches of obturator, femoral, sciatic (tibial and common fibular)

29
Q

Genu varum, genu valgum

A

*Cue angle 155 degrees (where femur and patella meet)

Genu varum (bow legged knee)- centre of gravity falls on medial side of patella -> reduction of cue angle -> medial condyles making more contact hence more likely to get damaged

Genu valgum - lateral side of patella -> increased cue angle -> lateral condyles making more contact hence more likely to get damaged

30
Q

Patellofemoral Joint

1) Where is it?
2) WB or NWB
3) Patella is embedded in ___ tendon
4) What action is permitted by suprapatellar bursae
5) Inflammation in bursa leads to?

A

1) B/w posterior surface of patella and anterior surface of femoral condyles
2) NWB
3) Quadriceps
4) Vertical gliding
5) Knee stiffness

31
Q

Function of articularis genus (deep to vastus intermedius)

A

Pulls synovial membrane upwards in extension so it doesn’t get pinched between condyles of femur and tibia

32
Q

3 Factors preventing lateral dislocation of patella

A

1) Active contraction of vastus medialis muscle (VMO fibres)
2) Medial patella retinaculum (passive support)
3) Raised lip on lateral femoral condyle

33
Q

Maltracking

A

Patella maltracking is an imbalance problem. The muscles in the upper thigh, the vastus medialis (inside) and vastus lateralis (outside) pull on the patella tendon in different directions. If one side is tighter than the other, it will pull the patella out of balance.

Genu varum or valgum causes it. Cartilage of anterior aspect of patella making contact with femur can break down. (chondromalcia patella)

34
Q

Why is there a tendency for patella to dislocate laterally?

A

Rectus femoris + ITB tend to pull it laterally.

35
Q

Is the angle b/w patellar tendon and patellar lig greater in F or M?

A

F

36
Q

Is the shaft of femur vertical?

A

No (approx 165 degrees)

37
Q

Tibiofibular Joints - Is it part of the knee joint? Is dislocation common? High or low loading?

A

No, No, Low

38
Q

Proximal Tibiofibular Joints

1) Joint type
2) Movements
3) Reinforced by what ligs?

A

1) Plane synovial joint
2) Some gliding movements
3) Ant and post. tibiofibular ligs.

39
Q

Distal Tibiofibular Joints

1) Joint type
2) Movement compared to proximal
3) Reinforced by what ligs?

A

1) Fibrous joint (syndesmosis)
2) Much less movement compared to proximal, provides shock absorbtion - preventing tibia and fibula separation (in WB)
3) Ant, post, interosseous tibiofibular lig

Human Loco-motor Systems (21 decks)

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