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Orthopedic Diagnosis > Lecture: The Knee Complex > Flashcards

Lecture: The Knee Complex Flashcards

1
Q

3 articulating surfaces, form 2 distinct joints contained w/in a single joint capsule: (2 joints)

A
  • patellofemoral joint

- tibiofemoral joint

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2
Q

2 types of swelling of the knee occur:

A
  • localized swelling (i.e. bursal)

- generalized swelling (i.e. intra-articular; synovitis)

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3
Q

normally tibia has slight __ angulation in comparison to femur.
bowlegged=?
knock-kneed=?

A
  • valgus
  • (coxa)valga
  • (coxa)vera
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4
Q

genu recurvatum=

A
  • hyperextension of the knee
  • higher among females
  • & individuals with longer or “lax” ligs.
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5
Q

the tibiofemoral joint= __ end of femur & __ end of tibia.
the __ aspect of the femur= __ femoral __, separated by:
the anterior & posterior intercondylar areas serve as attachment sites for:

A
  • distal; proximal
  • distal; 2; condyles; intercondylar eminence
  • ACL & PCL
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6
Q

the tibiofemoral joint is a __, or modified hinge joint.
joint stability is therefore dependent upon:
-static restraints:
-& dynamic restraints:

A
  • ginglymoid
  • (static)=joint capsule, ligaments & menisci
  • (dynamic)=quadriceps, hamstrings & gastrocnemius
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7
Q

the femoral condyles project __ from the femoral shaft.
the __ lateral femoral condyle is __-__ & faces __.
the __-__ medial femoral condyle faces __.

A
  • posterioly
  • smaller; ball-shaped; outward
  • elliptical-shaped; inward
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8
Q

the lateral epicondyle (of the femur) = origin for: (2)

the medial epicondyle (of the femur) = insertion for: (2)

A
  • lateral head of gastrocnemius & lat. collateral lig.

- adductor magnus & medial collateral ligament

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9
Q

the __-__ width of the medial femoral condyle is greater than its lateral by __ cm.
the length of the articular surface of the medial femoral condyle is __ than the length of the lat. fem. condyle.

A
  • anterior-posterior
  • 1.7cm
  • longer
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10
Q

proximal tibia is composed of __ plateaus, separated by the __ eminence, including the med. & lat. __ __.
the tibial plateaus are __ in the __ to __ direction.
in the ant. to post. direction, the medial tibial plateau is concave, while the lateral is __, producing an __ in lateral __.

A
  • 2
  • intercondylar
  • tibial tubercles
  • concave
  • medial to lateral
  • convex
  • increase
  • mobility
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11
Q

patellofemoral joint is a __ articulation.
dependent on both __ & __ restraints for its fxn & __.
the post. surface of patella can include up to _ facets, w/ _ on the med. & lat. surfaces.

A
  • complex
  • static & dynamic
  • stability
  • 7; 3
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12
Q

the patella is a very __, __-shaped bone.
situated in the __ notch.
& embedded in the __ of the __ __ muscle above & the __ tendon below.
it is fixed in the __ groove in __ & mobile in __.

A
  • hard; triangular
  • intercondylar
  • tendon; quadriceps femoris
  • patella
  • trochlear; flexion; extension
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13
Q

the patellofemoral joint fxns to:
provide an __ w/ __ friction.
protect the __ aspect of the femur from __ & the quads from __ wear.
improve the __ appearance of the knee.
improve the moment(?) arm of the __.
DECREASES the amount of __-__ tibiofemoral __ stress placed on the knee joint.

A
  • articulation; low
  • distal; trauma; attritional
  • cosmetic
  • quads
  • anterior-posterior; shear
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14
Q 
the Quadriceps angle:
aka?
2 lines drawn:
male avg.=
female avg.=
>\_\_deg. are considered \_\_ & may be indicative of potential \_\_ of the patella.
A
  • “Q” angle
  • (1)=from ASIS to center of patella
  • (2)=center of patella to tibial tubercle
  • 8-14deg.
  • 15-17deg.
  • 20; abnormal; displacement
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15
Q

(increased Q-angle)
Bayonet Sign=
common in pts. w/ patellofemoral arthralgia=

A
  • quads, patellar tendon & tibial shaft resemble french bayonet
  • w/ the knee flexed 30deg., there is a failure of the tibia to derotate normally & failure of the patellar tendon to line up w/ the ant. crest of the tibia
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16
Q

patella stability is dependent on 2 factors:
purists (anatomists) classify the patella tendon as a __, b/c it serves as the connection b/w 2 bones (tibia & patella), but b/c it attaches the quads to the tibia, it fxns as a __.

A
  • static & dynamic restraints
  • ligament
  • tendon
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17
Q

in a normal knee, the patella glides in a path: __-__ during flexion & extension respectively.
covering a distance of - cm w/ respect to the femur.

A
  • inferiorly-superiorly

- 5-7cm

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18
Q

normal patellar posture w/ knee at 45deg. of flex.=
inf/lower patellar posture=
sup/higher patellar posture=

A

-patellar articular surface is squarely against the ant. femur
-represents patella BAJA
-represents patella ALTA (ALTitude is high in the sky!/sup.)
(*patella alta makes the patella less efficient in exerting normal forces)

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19
Q

the knee joint capsule is composed of a __, strong fibrous membrane.
the KJ is the __ synovial capsule in the body.
a __ membrane lines the inner portion of the KJC.
by lining the JC, the __ membrane excludes the __ ligs. from the interior portion of the knee joint, making them __ yet __-articular.

A
  • thin
  • largest
  • synovial
  • synovial
  • cruciate
  • extrasynovial; intra-articular
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20
Q

proximal tibiofibular joint:
an __ plane w/ a slight __ on the oval tibial facet &
slight __ of the fibular head.
has __ motion that its distal partner, the __.

A
  • almost
  • convexity
  • concavity
  • more; tail
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21
Q

Osgood-Schlatter’s Syndrome/Disease
aka?
partial disruption at the __ ligament-tuberosity __.
creating __ inflammatory changes.
__ stress on the knee causing __ at the tibial tuberosity.
commonly in __ usually during a “__ __”.
predisposing factors:

A
  • osteochondritis of tibial tubercle
  • patellar; attachment
  • localized
  • repetitive; traction
  • adolescents; “growth-spurt”
  • tight hamstrings, tight heel cord (achilles tendon) & tight quad m.’s
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22
Q 
Osgood-Schlatter's Syndrome/Disease
more in which gender?
ages?
\_\_, \_\_ & \_\_ over the tibial tubercle.
pain on \_\_ or \_\_ stairs.
Hx:
A
  • males
  • 10-15
  • pain, swelling & tenderness
  • ascending or descending
  • single violent injury OR repetitive FLEX/EXT. movement
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23
Q

the STATIC stability of the KJC depends on 4 major knee ligaments:
(which provide a __ restraint to __ knee motion)

A
  • anterior cruciate
  • posterior cruciate
  • medial collateral
  • lateral collateral
  • primary; abnormal
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24
Q 
Primary Restraints of the Knee:
anterior translation=
posterior translation=
valgus rotation=
varus rotation=
LATERAL rotation=
MEDIAL rotation=
A
  • ACL
  • PCL
  • MCL
  • LCL
  • MCL & LCL
  • ACL & PCL
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25
Q

cruciate ligaments are different from those of other joints, in that they __ normal motion, rather than __ abnormal motion.

A
  • restrict

- restrict

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26
Q

anterior cruciate ligament:
one of the most __ ligaments to knee __.
serves as a __ restraint to ant. __ of the tibia relative to the femur.
& a __ restraint to both __ & __ rotation in the __-weight bearing knee.

A
  • important; stability
  • primary; translation
  • secondary; internal & external; non-weight
27
Q

anterior cruciate ligament:
most common MOI=
__ kinetic chain, b/c?

A
  • sudden deceleration w/ an abrupt change of direction/speed and or velocity & a fixed foot
  • closed; b/c of foot on the ground
28
Q

posterior cruciate ligament:
provides __-__% of the total __ to posterior translation of the tibia on the femur.
with the remaining _-__% being provided by:

A
  • 90-95%; restraint
  • 5-10%
  • collateral ligs, post. portion of the med. & lat. capsules, & the popliteus tendon
29
Q

posterior cruciate ligament:

MOI where the PCL can tear include:

A
  • excessive hyperflexion (forced bending; i.e. falling not the shin w/ a ben knee and foot pointed)
  • OR hyperextension (leg bent backwards)
30
Q

dashboard injury=

A
  • (i.e. in a car)

- where the knee is bent to a right angle and a sudden force drives the tibia backwards

31
Q

the Medial Collateral Ligament:
aka?
the __ fibers of the ligament are __ in __, broad & fan shaped & can be __ palpated in this position.
the __ fibers are __ in __, & blend in with the capsule & the medial meniscus, making them __ to palpate.

A
  • TIBIAL collateral ligament
  • anterior; taut; flexion; easily
  • posterior; taut; extension; difficult
32
Q

the Lateral Collateral Ligament:
aka?
main fxn?
offers the majority of the __ restraint at __deg. of knee flexion & in full extension.

A
  • FIBULAR collateral ligament
  • resist varus forces
  • varus; 25deg.
33
Q

secondary restraints of the collateral ligaments include: (3)

A
  • the structures in the post.-lateral & post.-medial corners of the knee
  • the hamstrings & quads.
  • the patellar ligament, oblique popliteal ligaments & the fibula
34
Q

menisci:
__-shaped lateral & medial menisci.
attached on __ of the tibial __.
they are pieces of __ material that lie b/w the __ cartilage of the __ & the __.

A
  • crescent
  • top; plateaus
  • fibrocartilage; articular; femur & the tibia
35
Q 
medial meniscus:
semi-lunar or \_\_-\_\_.
\_\_ & \_\_ than its lateral counterpart.
sits in the \_\_ medial tibial plateau.
\_\_ posteriorly than anteriorly.
A
  • C-shaped
  • larger & thicker
  • concave
  • wider
36
Q

lateral meniscus:
rounder or __-__.
sits atop the __ lateral tibial plateau.
attached by __ ligaments.
__ & __ than its medial counterpart.
more __ than its medial counterpart.
__ menischofemoral ligaments attach to the lat. meniscus.

A
  • O-shaped
  • convex
  • coronary
  • smaller & thinner
  • mobile
  • two
37
Q 
menisci fxn:
\_\_ transmission.
\_\_ absorption.
\_\_ lubrication.
\_\_ stability.
& \_\_ of movements.
A
  • load
  • shock
  • joint
  • joint
  • guiding
38
Q

you are __ times more likely to hurt the __ meniscus.

A
  • 20X

- medial

39
Q 
a meniscectomy (define:)
can \_\_ the shock-absorbing capacity of the knee by up to \_\_%.
A
  • surgical removal of part of torn meniscus

- reduce; 20%

40
Q

triad of O’Donoghue:
2 aka’s?
=rupture of the __, __ & __.

A
  • “terrible triad” & “unhappy triad”

- MCL, ACL & medial mensicus

41
Q

the __ margins of the menisci are __ than the __ margins & taper __ the center.

A
  • outer
  • thicker
  • inner
  • toward
42
Q

the menisci are __ attached at their ends to the __area of the tibia.

A
  • firmly

- intercondylar

43
Q

the __ fibers which attach the menisci to the __ condyles, are called the medial & lateral __ ligaments.

A
  • capsular
  • tibial
  • coronary
44
Q

the middle genicular branch of the __ artery sends branches around the __ of the meniscus under the capsule.
small tortuous nonanastomotic vessels enter the __ fibrous zone of the meniscus.

A
  • popliteal
  • periphery
  • outer
45
Q

the __ third of the meniscus is __ & __ (won’t heal well).

A
  • inner
  • cartilaginous
  • & avascular
46
Q

the medial meniscus is attached to the=

A

-medial collateral ligament

47
Q

the lateral meniscus is __ & more __ moveable than the medial.

A
  • smaller

- freely

48
Q

the lateral meniscus is attached to the=

A

-popliteus muscle

49
Q

the bursae serve to reduce __ & to __ the movement of one body part over another.

A
  • friction

- cushion

50
Q

Prepatellar Bursitis=

A
  • a fluid swelling occurs subcutaneously over the lower 1/2 of the patella and the upper 1/2 of the patellar lig. which is the distribution of the prepatellar bursa.
  • the cause is any occupation that causes chronic trauma to the tissue overlying the patella, such as excessive kneeling or leaning forward.
51
Q 
Prepatellar Bursitis
aka?
MOI?
a \_\_ blow to the area.
\_\_ friction, such as from frequent kneeling.
pt. symptoms=
pain when?
A
  • Housemaid’s Knee
  • overuse
  • direct
  • chronic
  • pain & swelling over the front of the knee
  • bending or straightening the leg
52
Q

Infrapatellar Bursitis:
aka?
__ occurs on both sides of the __ ligament, near the __ __.
the cause is repeated __ to the region of the __ __, including a variety of occupations such as:

A
  • Clergyman’s Knee
  • swelling
  • patellar
  • tibial tuberosity
  • trauma
  • tibial tuberosity
  • roofers, painters & floor layers
53
Q 
popliteal fossa:
superior lateral border=
superior medial border=
inferior borders=
contents=
A
  • biceps femoris tendon
  • semitendinosous & semimembranosus
  • medial & lateral head of the gastrocnemius
  • posterior tibial nerve, popliteal artery & popliteal nerve
54
Q 
Morrant Baker's Cyst=?
location at=
protrudes when?
sometimes dull pain when?
may compress?
often associated with?
\_\_ joint disorder.
\_\_ common.
A
  • escaped synovial fluid in an enclosed membrane sac which is protruding thru the joint capsule of the knee
  • midline of popliteal fossa
  • when knee is extended & is not visible when knee is flex.
  • when walking is produced
  • popliteal vessels
  • RA
  • femorotibial
  • very
55
Q

Plica:
__ plica represents a remnant of the _ separate cavities in the synovial __ of the __ knee.
pain when __, closely resembles __ injury.

A
  • synovial
  • 3
  • membrane
  • developing
  • irritated; meniscal
56
Q

Retinacula:
formed from structures in the __ & __ layers of the KJ.
can be subdivided into __ & __ retinacula for __ examination & __ purposes.

A
  • first & second
  • medial & lateral
  • clinical
  • intervention
57
Q

the major muscles that act on the knee joint complex=

A
  • quadriceps
  • hamstrings (semi-mem./semi-tend. & biceps femoris)
  • gastrocnemius
  • popliteus
  • & hip adductors
58
Q

extension lag=

A
  • pt. may be unable to extend the knee thru the last 10deg. of motion, may only be able to w/ a great amount of effort
  • occurs w/ quadriceps weakness
59
Q

Helfet’s Helix=

A
  • the knee cannot fully extend w/o some amount of external tibial rotation on the femur
  • b/c of physical configuration of the knee joint & its cruciate ligaments
  • ACL & PCL cause this rotation
60
Q

major blood supply of the knee area= (3)

A
  • femoral
  • popliteal
  • genicular arteries
61
Q

neurology of the knee area=

A
  • femoral (saphenous) nerve
  • sciatic nerve (common peroneal palpable @ neck of fibula)
  • tibial nerve
62
Q

the position of the joint at the time of the traumatic force dictates=

A

-which anatomic structures are at risk for injury

63
Q

the primary MOI in the knee are= (6)

A
  • direct trauma
  • varus or valgus force
  • hyperextension
  • flexion w/ post. translation
  • twisting force
  • overuse

Orthopedic Diagnosis (20 decks)

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