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Lower Extremity Anatomy II > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

Rearfoot angle

A
  • Angle between a line that bisects the distal 1/3 of the leg and a line that bisects the calcaneus
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2
Q

Patellofemoral joint

A
  • Part of knee joint (patellofemoral and tibiofemoral)

- Posterior surface of patella and trochlear surface (groove) of femur

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3
Q

Posterior surface of patellofemoral joint

A
  • Thick layer of hyaline cartilage up to 7mm
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4
Q

Trochlear sulcus (intercondylar groove)

A
  • Distal femur forms inverted U-shaped patellar surface

- Extends further on lateral condyle

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5
Q

Patellofemoral articulation stability depends on

A
  • Sufficient depth of trochlear sulcus
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6
Q

Soft tissue structures in patellofemoral articulation

A
  • Medial and lateral retinacula
  • Medial and lateral patellofemoral ligaments
  • Medial and lateral patellotibial ligaments
  • Iliotibial band
  • Crural fascia
  • Quadriceps aponeurosis
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7
Q

Dynamic stability of patellofemoral joint

A
  • Muscles that stabilize the knee also stabilize the PFJ
  • Quadriceps are important stabilizers of patella
  • Pes anserine muscles
  • Hamstring muscles
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8
Q

Quadriceps as important stabilizers of patella

A
  • Vastus medialis obliquus

- Oblique portion of VM that attaches to medial patella

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9
Q

Chondromalacia Patella

A
  • Degeneration of the articular cartilage of patella
  • Caused by trauma and/or microtrauma
  • Softening, erosion, fraying and fissuring
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10
Q

Cartilage loss can reach down to

A
  • Subchondral bone
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11
Q

Typical chondromalacia patella representation

A
  • Anterior knee pain that is aggravated by activities the increase patellofemoral contact
  • Tenderness around patella borders
  • Can have mild swelling
  • Grinding sensation or crunching/crackling sound with squatting/stairs
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12
Q

Biomechanical abnormalities believed to contribute to chondromalacia patella

A
  • Abnormal patellar tracking
  • Q-angle
  • Pes planus
  • VMO to VL imbalance in strength or timing
  • Weak hip abductors
  • Femoral anteversion, tibial torsion, Genu valgum
  • Trochlear dysplasia
  • Patella alta
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13
Q

VMO to VL imbalance in strength or timing

VMO

A
  • Inferior fibers of VM
  • Have more horizontal orientation
  • Important in patella stabilization and proper tracking
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14
Q

Q-angle

A
  • Assess overall line of pull of the quadriceps relative to the patella
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15
Q

2 lines involved with Q-angle

A
  • Line from the ASIS to the patella center (corresponds to force of quadriceps)
  • Line from the patella center to the tibial tuberosity
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16
Q

Normal ranges of Q-angle

A
  • Vary by source (~10-20ᵒ)

- Females: 15-18 > males: 10-13

17
Q

Q-angle reflects

A
  • Lateral pull of the quadriceps in relation to the patella
18
Q

Increased Q-angle causes

A
  • Excessive lateral tracking and lateral subluxation forces on patella
  • Increases patellofemoral contact pressure, can cause pain, cartilage wear
19
Q

Mechanical positions increasing Q-angle

A
  • Femoral anteversion
  • External tibial torsion
  • Genu valgus
20
Q

Mechanical axis

A
  • A straight line connecting the center points of the proximal and distal joints
21
Q

Mechanical axis of lower limb

A
  • Center of femoral head to center of ankle

- Crosses center of knee joint

22
Q

Changes in hip or knee alignment can alter the forces crossing neighboring joints

A
  • Associated with the development and progression of osteoarthritis
  • Advanced osteoarthritis can cause angular deformity
23
Q

Normal angle of inclanation

A
  • 125-135⁰ in adults
24
Q

Coxa valga

A
  • Angle of inclination > 135⁰ (some say 140⁰)
  • Can cause genu varum (bow-legged)
  • Can increase risk of knee osteoarthritis
25
Q

Coxa vara

A
  • Angle of inclination < 120⁰
  • Can cause genu valgum (knocked knee)
  • Can increase risk of knee osteoarthritis
26
Q

Genu recurvatum

A
  • Knee deformity where the knee angulates backwards
  • Knee extension of > 5⁰ (past 0)
  • Sagittal plane abnormality
27
Q

Injuries that can cause genu recurvatum

A
  • Tibia growth plate trauma

- Knee ligaments injury (ACL + posterior/lateral capsule)

28
Q

Musculoskeletal abnormalities that can cause genu recurvatum

A
  • Connective tissue disorders causing knee ligaments laxity
  • Quadriceps muscle weakness
  • Quadriceps spasticity
  • Conditions that cause quad weakness or spasticity (CP, Muscular dystrophy, polio)
  • Malformation of tibia (increased slope)
29
Q

Patella alta

A
  • Abnormally high patella
  • Associated with patellofemoral pain and instability
  • Chondromalacia patella and Knee OA
30
Q

Causes of patella alta

A
  • Rupture of patellar ligament

- Congenitally long patellar tendons

31
Q

Patellar tendon (ligament) length

A
  • > 1.2 patella alta
32
Q

Patellar tendinitis (tendinopathy/tendinosis)

A
  • “Jumper’s knee”
  • Overload/overuse injury that is more common in sports involving repetitive jumping
  • Higher load on patellar tendon/ligament during landing
33
Q

Patellat tendon heals poorly (inadequate reapair)

A
  • Thicker but collagen more disorganized

- Can eventually result in tenoncyte cell death and tendon degeneration

34
Q

Patellar tendinitis most commonly involves

A
  • Patellar ligament (patella to tibial tuberosity) at its patellar inferior pole attachment
  • Pain at the inferior pole of patella
35
Q

Iliotibial band syndrome

A
  • Overuse injury that is caused by repetitive knee flexion and extension
  • Typically see in cyclist and runner
36
Q

IT band syndrome measurements

A
  • At 0⁰ the band is anterior to the femoral epicondyle

- ~ 30⁰ it moves posterior

37
Q

Causes of IT band syndrome

A
  • Repetitive knee flexion/extension can create friction between lateral femoral epicondyle
38
Q

Symptoms of IT band syndrome

A
  • Presents with pain over lateral femoral condyle that can extend into lateral thigh/calf
  • Can have snapping of ITB

Lower Extremity Anatomy II (9 decks)

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