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MSK > Lecture 7 - Bones of the lower limb > Flashcards

Lecture 7 - Bones of the lower limb Flashcards

1
Q

Ridge of bone on the posterior femoral shaft

A

Medially - pectineal line
Laterally - Gluteal tuberosity

Come together to form the linear aspera

The linera aspera branches to form the medial and lateral supracondylar line

The medial supracondylar line ends at the adductor tubercle

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2
Q

Medial condyle of the distal femur

A

Larger than the lateral condyle therefore bears more weight when standing

Articulates with the meniscus of the knee and the tibia

The posterior cruciate ligament attaches to the lateral aspect of the medial condyle

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3
Q

Patellofemoral groove

A

Known as the trochlear groove

  • on the anterior surface of the femur
  • articulates with the patella
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4
Q

Lateral femoral condyle

A

More prominent
Prevents lateral displacement of the patella
People with flatter lateral condyles are more likely to have patella instability

The anterior cruciate ligament attaches to the medial aspect of the lateral condyle

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5
Q

Where do the collateral ligaments originate from?

A

Medial and lateral epicondyles

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6
Q

Intercondylar fossa

A

Between the 2 condyles of the femur

On the posterior surface of the femur

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7
Q

Patella

A

Anterior within the trochlear groove

Superior aspect attached to the quadriceps tendon

Inferior aspect attached to the patellar ligament therefore apex connected to the tibial tuberosity

Sesamoid bone

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8
Q

Posterior surface of the patella

A

Medial facet: articulates with the medial femoral condyle

Lateral facet: articulates with the lateral femoral condyle

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9
Q

Functions of the patella

A
  1. Allows extension of the knee as enhances leverage due to the insertion of the quadriceps tendon and acts as fulcrum
  2. Protection of knee joint
  3. Stabilises - reduces friction forces on the femoral condyles
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10
Q

Tibial plateau

A

Flat surface formed by the tibial condyles that articulates with the femoral condyles

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11
Q

Proximal tibiofibular joint

A

Head of the fibular articulates with the proximal tibia

Not apart of the knee joint

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12
Q

Intercondylar eminence

A

Area between the 2 tibial condyles in the centre

Main site of attachment of the anterior cruciate ligament and the menisci of the knee joint

(The posterior cruciate ligament attaches to the posterior edge of the intercondylar area)

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13
Q

Intercondylar tubercles

A

Either side of the intercondylar eminence of the tibia

Articulates with the intercondylar fossa of the femur

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14
Q

Borders of the tibia

A

Anterior
Posterior
Lateral

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15
Q

Anterior border of the tibia

A

Palpable

Proximally - tibial tuberosity (insertion of the patella ligament)

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16
Q

Posterior border of the tibia

A

Soleal line (bony ridge)

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17
Q

Lateral border of the tibia

A

Interosseus border

Attachment of the interosseus membrane that binds the tibia and fibula together

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18
Q

Medial malleolus

A

Articulates with tarsal bones to form the ankle joint

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19
Q

Inferior tibiofibular joint

A

Distally, the tibia articulates with the fibular via the fibular notch

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20
Q

Fibula

A

Lateral

Attachment site for muscles (doesn’t weight bear)

21
Q

3 main articulations of the fibula

A

Proximal tibiofibular joint - articulates with the lateral condyle of the tibia

Distal tibiofibular joint - the fibular notch articulates with the tibia

Ankle joint - Articulates with the talus bone of the foot

22
Q

Proximal fibular fracture

A

Proximal end of the fibula has an enlarged head that articulates with the lateral tibial condyle.

The common fibular (peroneal) nerve wraps around the posterior and lateral surface of the neck so is vulnerable to damage.

23
Q

Surfaces of the fibula

A

Anterior
Lateral
Posterior

24
Q

Distal lateral surface of the fibula

A

Continues as the lateral malleolus inferiorly

The lateral malleolus is more prominent

25
Q

Knee joint

A

Hinge synovial joint allowing flexion, extension and a small degree of lateral and medial rotation

Formed via the articulations of the patella, femur and tibia

26
Q

Articulations of the knee joint

A

Tibiofemoral- medial and lateral condyles of the femur articulate with the medial and lateral condyles of the tibia

(weight-bearing joint)

Patellofemoral- The patella articulates with the femur via the trochlear groove

27
Q

Blood supply to the knee joint

A

Genicular branches of the femoral and popliteal arteries

28
Q

Nerve supply of the knee joint

A

Femoral nerve
Tibial aspect of the sciatic nerve
Common peroneal aspect of the sciatic nerve

29
Q

Stability

A

Unstable

Stabilising factors:

  • Menisci - deepens articulation
  • Joint capsule
  • Collateral and cruciate ligaments
  • Surrounding muscles
30
Q

Menisci of the knee

A

Fibrocartlilaginous

  • deepens the articular surface of the tibia - increasing stability
  • shock absorber - increases SA

C shape and thicker on the periphery

The peripheral rims are loosely attached to the joint capsule and to the tibia via coronary ligaments

31
Q

Medial meniscus

A

Attaches to the medial collateral ligament and the joint capsule

Damage to the medial collateral ligament can lead to a medial meniscus tear

32
Q

Lateral meniscus

A

Smaller
Not attached to the lateral collateral ligament
More mobile

33
Q

Transverse ligament of the knee

A

Attaches the medial and lateral menisci anteriorly

34
Q

Posterior meniscofemoral ligament

A

Stabilises the posterior horn of the lateral meniscus by attaching it to the medial femoral condyle

35
Q

Blood supply of the menisci

A

From the periphery

Decreases with age - central meniscus is avascular by adulthood

Therefore impaired healing after childhood

36
Q

Ligaments of the knee joint

A

Intracapsular ligaments - cruciate ligaments

Extracapsular ligaments - collateral and patellar ligament

Ligaments that strengthen the capsule - oblique popliteal ligament

37
Q

Anterior cruciate ligament

A

Attaches proximally - posterolateral aspect of the femoral intercondylar fossa

(travels anteromedially)

Attaches distally - anterior aspect of the intercondylar eminence

Adherent to the medial meniscus

Resists anterior movement and medial rotation of the tibia

38
Q

Posterior cruciate ligament

A

Proximally: Medial aspect and roof of the intercondylar fossa of the femur

(passes posterolaterally)

Distally: Posterior intercondylar area of the tibia

The main stabiliser of the weight-bearing flexed knee
Prevents the anterior displacement of the femur on the tibia

Prevent posterior dislocation of the tibia

39
Q

Joint capsule

A

Surrounds the sides and posterior aspect of the knee joint
Capsule is strengthened:
laterally- inferior fibres of the vastus lateralis muscle
medially - inferior fibres of the vastus medialis
posteriorly - oblique popliteal ligament

40
Q

Medial tibial collateral ligament

A

Broader and weaker

Proximally attaches to the medial epicondyle of the femur
Distally attaches to the medial condyle of thr tibia
Adherent to the medial meniscus
Resists valgus (lateral) angulation of the tibia on the femur

41
Q

Lateral collateral ligament

A

Thinner and rounder than the MCL

Proximally: attaches to the lateral epicondyle of the femur
Distally: attaches to a depression on the lateral fibula head

Reinforced by the iliotibial tract

Resist varus angulation of the tibia on the femur

42
Q

Bursa

A

Small sac lined by a synovial membrane containing a thin layer of synovial fluid
Cushion between bones, tendons and muscles surrounding a joint

Reduces friction
Allows free movement

43
Q

6 bursae of the knee joint

A 
Suprapatella bursa
Subcutanoues prepatella bursa 
Subcutanous infrapatella bursa 
Deep infrapatella bursa
Subsartorial bursa (pes anserinus)
Semimembranosus bursa
44
Q

Movements

A

Extension - quadriceps femoris
Flexion - Hamstrings, gracilis, sartorius, popliteus, plantaris and gastrocnemius
Lateral rotation - Biceps femoris
Medial rotation - Semitendinosus, semimembrinosus, gracilis, sartorius and popliteus

45
Q

Knee locking

A

When the knee is fully extended, the knee passively locks.

5 degrees of medial rotation of the femoral condyles on the tibial plateau

Cruciate ligaments tighten

46
Q

How does the knee unlock

A

The popliteus contracts

Rotates the femur laterally by 5 degrees on the tibial plateau allowing flexion

47
Q

Which muscles stabilise the knee

A

Inferior fibres of the vastus medialis - vastus medialis obliquus (VMO) - contract to resist lateral displacement of the patella out of the trochlear groove

48
Q

Q angle

A

Angle between the line of pull of the quadriceps muscle and the patella ligament

When the knee is flexed it naturally tends to displace laterally

49
Q

Factors that resist lateral displacement

A
  • Deep trochlear groove has a more prominent lateral femoral condyle anteriorly
  • VMO fibres are inserted more distally and horizontally
  • Iliotibial tract

MSK (28 decks)

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