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Orthopaedic Sports Medicine- Orthobullets > Ligaments of the Knee > Flashcards

Ligaments of the Knee Flashcards

1
Q

What type of joint is the knee and what does it allow ?

A

diarthrodial (synovial) joint that allows simultaneous rotation and translation

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2
Q

Anterior Cruciate Ligament (ACL)

  1. primary fxn
  2. secondary fxn
A
  1. resists anterolateral displacement of the tibia on the femur
  2. resists varus displacement at 0 degrees of flexion
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3
Q

Posterior Cruciate Ligament (LCL)

  1. primary fxn
  2. secondary fxn
A
  1. resists posterior tibial displacement, esp at 90 degrees of flexion
  2. resists varus displacement at 0 degrees of flexion
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4
Q

Lateral Collateral Ligament (LCL)

  1. primary fxn
  2. secondary fxn
A
  1. resists various displacement at 30 degrees of flexion

2. resists posterolateral rotatory displacement with flexion that is less than approximately 50 degree

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5
Q

Popliteofibular Ligament/Posterior Lateral Corner (PLC)

  1. primary fxn
  2. secondary fxn
A
  1. Resists posterolateral rotation of the tibia on the femur

2. resists various angulation and posterior displacement of the tibia on the femur

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6
Q

Medial Collateral Ligament (MCL)

  1. primary fxn
  2. secondary fxn
A
  1. resists valgus angulation

2. works in concert with ACL to provide restraint to axial rotation

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7
Q

What are the Lateral Structures of the knee-Layer 1?

A
  1. illiotibial tract

2. biceps femoris

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8
Q

What are the Lateral Structures of the knee-between Layer 1 and 2?

A

common peroneal nerve

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9
Q

What are the Lateral Structures of the knee-Layer 2?

A

Patellar retinaculum

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10
Q

What are the Lateral Structures of the knee-Superficial Layer 3?

A
  1. LCL
  2. fabellofibular ligament
  3. ALL
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11
Q

What are the Lateral Structures of the knee-btw the Superficial and Deep Layer 3?

A

lateral geniculate artery

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12
Q

What are the Lateral Structures of the knee-Deep Layer 3?

A
  1. Arcuate Ligament
  2. Coronary Ligament
  3. Popliteus tendon
  4. popliteofibular ligament
  5. capsule
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13
Q

What are the Medial Structures of the knee- Layer 1?

A
  1. Sartorious

2. Fascia (patellar retinaculum)

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14
Q

What are the Medial Structures of the knee- btw Layer 1 and 2?

A
  1. gracilis
  2. semitendinosis
  3. saphenous nerve
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15
Q

What are the Medial Structures of the knee- Layer 2?

A
  1. Semimembranosus
  2. Superficial MCL
  3. MPFL
  4. Posterior Oblique Ligament
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16
Q

What is the function of the ACL?

A

prevent anterior translation of the tibia relative to the femur

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17
Q

ACL- Intra or extra synovial structure?

A

intrasynovial structure

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18
Q

ACL- Origin

A
  1. Lateral Femoral Condyle

2. PL bundle originates posterior and distal to AM bundle

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19
Q

ACL- Insertion

A
  1. Broad and irregualr

2. anterior and between the intercondylar eminences of the tibia

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20
Q

ACL- Structure

A
  1. 33mm x 11mm in size
  2. 2 Bundles
  3. Anteromedial bundle
  4. Posterolateral bundle
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21
Q

ACL AM Bundle- Structure

A
  1. fibers are parallel in extension
  2. fibers are externally rotates in flexion
  3. high in both flexion and extension
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22
Q

ACL PL bundle- Structure

A
  1. PL bundle prevents pivot shift
  2. prevents internal tibial rotation with knee near extension
  3. tight in extension, loose in flexion
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23
Q

ACL- blood supply

A

middle geniculate artery

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24
Q

ACL- innervation and fxn of innervation

A
  1. contains significant innervation by posterior articular branches of tibial n.
  2. contains mechanoreceptor (Ruffini, pacing, Golgi tendon organs, free-nerve endings)

fxn-

  1. proprioception
  2. modulation of quadriceps function
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25
Q

ACL- Composition

A
  1. 90% Type 1 Collagen

2. 10% Type 3 Collagen

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26
Q

ACL- Biomechanics Tensile Strength

  1. Native ACL?
  2. BPTB
  3. Quadrupled Hamstring
A
  1. 2000 N
  2. 3000 N
  3. 4000 N
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27
Q

ACL vs PCL Bundles

Tight in flexion

A

ACL- AM

PCL- AL

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28
Q

ACL vs Bundles

Tight In extension

A

ACL- PL

PCL- PM

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29
Q

PCL- function

A
  1. prevents posterior translation of the tibia relative to the femur
  2. PCL and PLC work in concert to resist posterior and translation and posterolateral rotatory instability
30
Q

PCL- origin

A

medial femoral condyle

31
Q

PCL- insertion

A

tibia sulcus

32
Q

PCL- structure

A
  1. 38mm x 13 mm

2. 2 Bundles- AL and PM

33
Q

PCL- AL bundle

A
  1. shorter, thicker and stronger

2. double bundle recon- tensioned in midflexion

34
Q

PCL- PM bundle

A
  1. longer, thinner weaker

double bundle recon-tension in extension and high flexion-protects against hyperextension

35
Q

PCL- what makes proximal border of femoral insertion

A

medial intercondylar ridge

36
Q

PCL- what separates the AL from the PM bundle

A

medial bifurcate ridge

37
Q

PCL- origin of meniscofemoral ligaments and their insertion

A

O: posterior horn lateral meniscus
I: substance of the PCL

38
Q

what is the ligament of Humphrey?

A
  • meniscofemoral ligaments

- anterior to PCL

39
Q

what is the ligament of Wrisberg?

A
  • meniscofemoral ligaments

- posterior to PCL

40
Q

PCL- Blood supply

A

Middle Geniculate Artert

41
Q

PCL- Biomechanics

A

25oo N (vs posterior translation)

42
Q

LCL (also called fibular collateral ligament)- Fxn

A
  1. resists varus angulation

2. works in concert with MCL to provide restraint to axial rotation

43
Q

LCL- origin

A

lateral femoral condyle posterior and superior to insertion of popliteus

44
Q

LCL- Path

A

runs superficial to popliteus

45
Q

LCL- Insertion

A
  1. on the fibula anterior to the popliteofibular ligament on the fibula
  2. capsule’s most distal extent is just posterior to the fibula
46
Q

LCL- structure

47
Q

LCL- biomechanics

A
  • tight in extension and lax in flexion

- strength 750N (vs various stress)

48
Q

Posterior Lateral Corner (PLC)- fxn

A

works synergistically with PCL to control external rotation and posterior translation

49
Q

Posterior Lateral Corner- Included structures and Strength

A
  1. LCL (295 N)
  2. Popliteus Muscle and Tendon (680 N)
  3. Popliteofibular ligament (229N)
  4. Lateral Capsule
50
Q

Posterior Lateral Corner - Variable Anatomy

A
  1. Arcuate Ligament
  2. iliotibial band
  3. fabellofibular ligament
51
Q

MCL- Fxn

A
  1. resists valgus angulation

2. works in concert with ACL to provide restraint to axial rotation

52
Q

MCL- Origin

A

MFC to medial tibia extending down several cm

53
Q

MCL- structure

A
  • has 2 components Superficial Portion (tibial collateral ligament) and deep portion (medial capsular ligament)
54
Q

MCL- Superficial Portion (tibial collateral ligament)

A
  1. lies deep to gracilis and ST
  2. O- medical femoral epicondyle and I- periosteum of proximal tibia deep to pos anserinus
  3. contributes to 57% and 78% of medial stability at 5 deg and 25 deg of knee flexion respectively
  4. primary stabilizer to valgus stress at all angles
55
Q

MCL- Deep Portion (medial capsular ligament)

A
  1. separated from superficial portion by a bursa
  2. attaches to medial meniscus (coronary ligament)
  3. divided into meniscofemoral and meniscotibial portions
  4. posterior fibers of the deep MCL blend with posteromedial capsule and POL
  5. deep MCL and posteromedial capsule act as secondary restraints to values stress at full knee extensions
56
Q

MCL- biomechanics

A

4000 N (vs valgus stress)

57
Q

Posterioromedial Corner- fxn

A

important for rotatory stability

58
Q

Posterioromedial Corner- Lies deep to…

59
Q

Posterioromedial Corner- formed by…

A
  1. Insertion of ST
  2. posterior oblique ligament-resists tibial internal rotation at full extension
  3. oblique popliteal ligament
  4. posterior capsule
60
Q

Medical patellofemoral ligament (MPFL)- fxn

A

provide restraint against lateral translation of the patella from 0 to 30 of knee flexion

61
Q

Medical patellofemoral ligament (MPFL)-characteristics

A
  1. low tension throughout flex-ex (2-10N)
  2. isometric btw 0 and 90 deg, then becomes slack beyond 90 deg
  3. can withstand 200N before tearing- much lower load to failure than ACL (1725N)
62
Q

Medical patellofemoral ligament (MPFL)- Anatomy

A
  1. 2nd layer of medical soft tissue complex

2. 2 bundles - Short oblique bundle (insert on superior patellar pole) and inferior straight bundle

63
Q

Medical patellofemoral ligament (MPFL)-femoral inserion

A

medial femoral condyle, distal to adductor tubercle and prox to MCL attachement

64
Q

Medical patellofemoral ligament (MPFL)- Schottle’s Point

A
  1. 1.3mm anterior to posterior femoral diaphysial cortex
  2. 2.5mm distal to posterior origin of medial femoral condyle
  3. proximal to level of posterior point of Blumensaat’s line
65
Q

Medical patellofemoral ligament (MPFL)- patellar attachment

A
  1. fan-like structure inserting at junction between proximal-middle thirds of superomedial border of patella
66
Q

Medical patellofemoral ligament (MPFL)-pathoanatomy

A
  1. tears off femoral attachment > patellar attachement

2. res of 2nd dislocation is 13%- 3rd dislocation is 50%

67
Q

Anterolateral Ligament-fxn

A

rotational stability

68
Q

Anterolateral Ligament- anatomy

A

layer 3 with LCL

69
Q

Anterolateral Ligament- Characteristics

A
  1. width 7mm at midpoint/near joint line
    - femoral attachement Edith 8mm
    - tibial attachment width 11mm
  2. length 59mm
70
Q

Anterolateral Ligament- Attachments

A

Femoral- Lateral Femoral epicondyle

Tibial- Midway between Gerdy’s and head of fibula

71
Q

What is contained btw lateral meniscus and ALL at level of joint line

A

lateral inferior vehicular artery and vein

72
Q

Anterolateral Ligament- Pathoanatomy

A

Segond Fracture (a/w ACL rupture) is avulsion fracture of ALL

Orthopaedic Sports Medicine- Orthobullets (3 decks)

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