m8: thigh and knee Flashcards
4 bones
- Femur
- Tibia
- Fibula
- Patella
Thigh
●
○ Head
○ Neck
○ Body/shaft
○ Greater trochanter
○ Lesser trochanter
○ Medial and lateral condyles
○ Medial and lateral epicondyles
○ Adductor tubercle
● Femur
Femoral Condyles
●
○ Larger
○ Longer
● Medial Condyle
Femoral Condyles
●
○ More anterior
● Lateral Condyle
Tibia
1.
2.
Tibial plateau
Tibial tuberosity
Tibial plateau
○ _ meniscus - C-shaped
Medial meniscus
Tibial plateau
○ _ meniscus - O-shaped
Lateral meniscus
● Head
● Neck
● Shaft
Fibula
● Sesamoid bone
● Diamond shaped
● Increases leverage power by _% of quads
● It has five facets, or ridges: _, _, _, _, and _.
Patella
35%
superior, inferior, lateral, medial, and odd.
● _ – High, Camel Sign (prominence of infrapatellar bursa)
● _ – Low, decrease quads leverage, prone to stiff knee (arthrogenic knee)
Alta
Baja
- Improve the efficiency and increase torque of the knee extensors throughout the knee’s range of motion;
- Centralize the forces of the four quadriceps muscles into one concerted direction of pull;
- Provide a smooth gliding mechanism for the quadriceps muscle and tendon to reduce compression and friction forces during activities such as deep knee bends;
- Contribute to the overall stability of the knee; and
- Provide bony protection from direct trauma to the femoral condyles when the knee is flexed.
Patella functions
Q-angle
● _ angle
● Angle formed between the _ muscle and the _ tendon
● Normal Q-angle
○ Male - _°
○ Female - _°
Patellofemoral angle
quadriceps muscle and the patellar tendon
13
18
● Genu _ - bowleg (less than 13°)
● Genu _ - knock-knee (greater than 18°)
varum
valgum
Joints
1.
2.
Tibiofemoral Joint
Patellofemoral Joint
Tibiofemoral Joint
● Modified _ joint
● 2 joints:
○ _ tibiofemoral (more weightbearing)
○ _ tibiofemoral (more synovium)
hinge
Medial
Lateral
Tibiofemoral Joint
● (N) position of the knee: Genu _; _ degrees
● OPP: _ degrees ; _
● CPP: _ + _
● Capsular pattern: _ > _
● (N) position of the knee: Genu valgus 6 degrees
● OPP: 25 degrees flexion
● CPP: Full extension + ER
● Capsular pattern: Flexion > Extension
● Normally, when the knee moves into _, the tibia laterally rotates about _° on the fixed femur.
● This motion occurs in the last 20°of knee _.
● Last 20 degrees of extension
○ _ ER on femur (OKC)
○ _ IR on Tibia (CKC)
Screw Home Mechanism
extension
20°
extension
Tibia
Femur
Screw Home Mechanism
● Muscles:
○ Unlocks the knee: _ (deepest muscle of back of knee)
○ Locking: None
popliteus
Patellofemoral Joint
● _ joint
● Functions:
○
○
Modified
○ Leverage
○ Protection
Patellofemoral Joint
● During the movement from flexion to extension, different parts of the patella articulate with the _ condyles
● The _ _ does not come into contact with the femoral condyles until at least _° of _ is reached.
femoral
odd facet; 135°; flexion
PATELLAR LOADING WITH ACTIVITY
Walking: _ times the body weight
Climbing stairs: _ times the body weight
Descending stairs: _ times the body weight
Squatting: _ times the body weight
0.3
2.5
3.5
7
Meniscus
1.
2.
- Medial Meniscus
- Lateral Meniscus
● attached to the _ _via its anterior horn and posterior horn.
● definitive crescent “C” shape
● less variability with size and thickness, and covers a smaller part of the tibial plateau
● attached to _ meniscus by transverse ligament and patella directly or by anterior capsular thickenings called _ ligaments
Medial Meniscus
tibial plateau
● attached to lateral meniscus by transverse ligament and patella directly or by anterior capsular thickenings called patellomeniscal ligaments
● almost circular and covers a larger portion of the _ articular surface
● no attachment of the _ meniscus to the _ collateral ligament
○ _ attachment is interrupted _ to where the popliteal tendon passes
● more mobile than the medial meniscus| can translate _ to _ mm in an anteroposterior direction
○ lack of attachment to the _ ligament posterolaterally
Lateral Meniscus
● almost circular and covers a larger portion of the tibial articular surface
● no attachment of the lateral meniscus to the lateral collateral ligament (LCL)
○ peripheral attachment is interrupted posteriorly to where the popliteal tendon passes
● more mobile than the medial meniscus| can translate 9 to 11 mm in an anteroposterior direction
○ lack of attachment to the capsular ligament posterolaterally
Ligaments
1.
2.
Cruciates
Collaterals
● Cruciates
○
○
○ ACL
○ PCL
● Collaterals
○
○
○ MCL
○ LCL
● SPL from _ tibial plateau to _ femoral condyle
● Slack = _ - _ degrees ; _
● Taut = _/ _
● WEAKEST ligament of knee
● Prevents: _ translation of the tibia on the femur
● MOI: _, _
Anterior Cruciate Ligament
● SPL from medial tibial plateau to lateral femoral condyle
● Slack = 30-60 degrees flexion
● Taut = Extension/ IR
● Weakest ligament of knee
● Prevents: anterior translation of the tibia on the femur
● MOI: hyperextension, rotation
Triad of O’Donoghue
1.
2.
3.
● ACL
● MCL
● Medial meniscus
● SAM from _ tibial plateau to _ femoral condyle
● STRONGEST ligament in the knee
● Slack: _
● Taut: _
● Prevents: _ translation of tibia on femur
● MOI: _, _
Posterior Cruciate Ligament
● SAM from lateral tibial plateau to medial femoral condyle
● STRONGEST ligament in the knee
● Slack: Extension
● Taut: Flexion
● Prevents: posterior translation of tibia on femur
● MOI: Dashboard, hyperflexion
●
● _ Collateral Ligament
● Slack: _ degrees _
● Taut: in _ + _
● Prevents _ force/ _
● Ossification of MCL: _ _ Disease
● _ knee (MCL)
Medial Collateral Ligament
● Tibial Collateral Ligament
● Slack: 90 degrees flexion
● Taut: in extension + ER
● Prevents Valgus force/ abduction
● Ossification of MCL: Pellegrini Stieda Disease
● Swimmer’s knee (MCL)
●
● _ Collateral Ligament
● Slack: _ degrees _
● Taut: _ + _
● Prevents = _force/ _
Lateral Collateral Ligament
● Fibular Collateral Ligament
● Slack: 90 degrees flexion
● Taut: extension + ER
● Prevents = Varus force/ adduction
● AKA: _ Ligaments
● connect the inferior edges of the menisci to the of the tibial plateau
● support rotational stability of the knee and prevent anterior tibial translation
● Medial meniscus to the tibia
Coronary/Meniscal Ligament
Meniscotibial Ligaments
Muscle that pulls the synovial capsule and bursa superiorly during knee extension to move them out of the way of the joint to prevent the capsule from being compressed between the femur and patella
Genu Articularis
Muscles of the Anterior Fascial Compartment of the Thigh
Quadriceps
1. Rectus Femoris
2. Vastus Lateralis
3. Vastus Medialis
4. Vastus Intermedius
Muscles of the Posterior Fascial Compartment of the Thigh
Hamstrings
1. Biceps Femoris
2. Semimembranosus
3. Semitendinosus
4. Adductor Magnus (Hamstring Portion)
3 Other Knee FLEXORS (GPP)
● Gastrocnemius
● Plantaris
● Popliteus
3 MEDIAL ROTATORS of the Knee (SGS)
● Sartorius
● Gracilis
● Semitendinosus
2 LATERAL ROTATORS of the Knee (BT)
● Biceps Femoris
● Tensor Fascia Lata
● Common in individuals who run and/or kick hard (e.g., in running, jumping, and quick-start sports such as baseball, basketball, football, and soccer)
● The violent _ _ required to excel in these sports may avulse (tear) part of the _ _ attachments of the hamstrings to the _ _.
● Hamstring strains are twice as common as _ strains.
Hamstring Strain
muscular exertion; proximal tendinous; ischial tuberosity
quadriceps strain
● Avulsion (tearing away) of the _ _ at the proximal attachment of the _ _ and _ may result from forcible flexion of the hip with the knee extended (e.g., kicking a football).
Hamstring Strain
ischial tuberosity; biceps femoris and semitendinosus
● Tears of the ACL are the most functionally devastating because of the crucial role of the _ in the dynamic stability of the knee, especially during activities involving side-to-side or cutting maneuvers.
● The ACL restrains anterior displacement of the tibia relative to the femur, and internal rotation of the tibia relative to the femur.
ACL Tear
ACL
● Although different mechanisms can place the ACL at risk, the individual is often rotated on a planted foot with the knee in _ and the _ activating strongly.
● The patient will often report hearing or feeling a “pop.”
● The patient will also describe a sense of knee instability, especially with twisting activities such as changing direction when walking.
ACL Tear
flexion ; quadriceps
