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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
ACL- Composition
1. 90% Type 1 Collagen | 2. 10% Type 3 Collagen
26
ACL- Biomechanics Tensile Strength 1. Native ACL? 2. BPTB 3. Quadrupled Hamstring
1. 2000 N 2. 3000 N 3. 4000 N
27
ACL vs PCL Bundles | Tight in flexion
ACL- AM | PCL- AL
28
ACL vs Bundles | Tight In extension
ACL- PL | PCL- PM
29
PCL- function
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
PCL- origin
medial femoral condyle
31
PCL- insertion
tibia sulcus
32
PCL- structure
1. 38mm x 13 mm | 2. 2 Bundles- AL and PM
33
PCL- AL bundle
1. shorter, thicker and stronger | 2. double bundle recon- tensioned in midflexion
34
PCL- PM bundle
1. longer, thinner weaker | double bundle recon-tension in extension and high flexion-protects against hyperextension
35
PCL- what makes proximal border of femoral insertion
medial intercondylar ridge
36
PCL- what separates the AL from the PM bundle
medial bifurcate ridge
37
PCL- origin of meniscofemoral ligaments and their insertion
O: posterior horn lateral meniscus I: substance of the PCL
38
what is the ligament of Humphrey?
- meniscofemoral ligaments | - anterior to PCL
39
what is the ligament of Wrisberg?
- meniscofemoral ligaments | - posterior to PCL
40
PCL- Blood supply
Middle Geniculate Artert
41
PCL- Biomechanics
25oo N (vs posterior translation)
42
LCL (also called fibular collateral ligament)- Fxn
1. resists varus angulation | 2. works in concert with MCL to provide restraint to axial rotation
43
LCL- origin
lateral femoral condyle posterior and superior to insertion of popliteus
44
LCL- Path
runs superficial to popliteus
45
LCL- Insertion
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
LCL- structure
cord like
47
LCL- biomechanics
- tight in extension and lax in flexion | - strength 750N (vs various stress)
48
Posterior Lateral Corner (PLC)- fxn
works synergistically with PCL to control external rotation and posterior translation
49
Posterior Lateral Corner- Included structures and Strength
1. LCL (295 N) 2. Popliteus Muscle and Tendon (680 N) 3. Popliteofibular ligament (229N) 4. Lateral Capsule
50
Posterior Lateral Corner - Variable Anatomy
1. Arcuate Ligament 2. iliotibial band 3. fabellofibular ligament
51
MCL- Fxn
1. resists valgus angulation | 2. works in concert with ACL to provide restraint to axial rotation
52
MCL- Origin
MFC to medial tibia extending down several cm
53
MCL- structure
- has 2 components Superficial Portion (tibial collateral ligament) and deep portion (medial capsular ligament)
54
MCL- Superficial Portion (tibial collateral ligament)
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
MCL- Deep Portion (medial capsular ligament)
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
MCL- biomechanics
4000 N (vs valgus stress)
57
Posterioromedial Corner- fxn
important for rotatory stability
58
Posterioromedial Corner- Lies deep to...
MCL
59
Posterioromedial Corner- formed by...
1. Insertion of ST 2. posterior oblique ligament-resists tibial internal rotation at full extension 3. oblique popliteal ligament 4. posterior capsule
60
Medical patellofemoral ligament (MPFL)- fxn
provide restraint against lateral translation of the patella from 0 to 30 of knee flexion
61
Medical patellofemoral ligament (MPFL)-characteristics
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
Medical patellofemoral ligament (MPFL)- Anatomy
1. 2nd layer of medical soft tissue complex | 2. 2 bundles - Short oblique bundle (insert on superior patellar pole) and inferior straight bundle
63
Medical patellofemoral ligament (MPFL)-femoral inserion
medial femoral condyle, distal to adductor tubercle and prox to MCL attachement
64
Medical patellofemoral ligament (MPFL)- Schottle's Point
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
Medical patellofemoral ligament (MPFL)- patellar attachment
1. fan-like structure inserting at junction between proximal-middle thirds of superomedial border of patella
66
Medical patellofemoral ligament (MPFL)-pathoanatomy
1. tears off femoral attachment > patellar attachement | 2. res of 2nd dislocation is 13%- 3rd dislocation is 50%
67
Anterolateral Ligament-fxn
rotational stability
68
Anterolateral Ligament- anatomy
layer 3 with LCL
69
Anterolateral Ligament- Characteristics
1. width 7mm at midpoint/near joint line - femoral attachement Edith 8mm - tibial attachment width 11mm 2. length 59mm
70
Anterolateral Ligament- Attachments
Femoral- Lateral Femoral epicondyle | Tibial- Midway between Gerdy's and head of fibula
71
What is contained btw lateral meniscus and ALL at level of joint line
lateral inferior vehicular artery and vein
72
Anterolateral Ligament- Pathoanatomy
Segond Fracture (a/w ACL rupture) is avulsion fracture of ALL

Orthopaedic Sports Medicine- Orthobullets (3 decks)

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