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ACEM Primary Written > Musculoskeletal: Anatomy - Knee joint and popliteal fossa > Flashcards

Musculoskeletal: Anatomy - Knee joint and popliteal fossa Flashcards

1
Q

What makes up most of the contents of the popliteal fossa?

A

Fat

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2
Q

Four superficial boundaries of the popliteal fossa

A

Superolateral: medial border of biceps femoris
Superomedial: semimembranosus and semitendinosus
Inferior: lateral and medial heads of gastrocnemius
Roof: skin, popliteal fascia

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3
Q

Three deep boundaries of the popliteal fossa

A

Superior: medial and lateral condylar lines of femur
Inferior: soleal line of tibia
Floor: popliteal surface of femur, posterior aspect of knee joint capsule, popliteus and investing fascia

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4
Q

Six contents of the popliteal fossa

A
  1. Termination of small saphenous vein (pierces popliteal fascia)
  2. Popliteal arteries and veins (and their branches)
  3. Tibial nerve
  4. Common fibular nerve
  5. Posterior cutaneous nerve of thigh
  6. Popliteal lymph nodes and lymphatic vessels
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5
Q

What is the popliteal fascia continuous with superiorly and inferiorly?

A

Superiorly: fascia lata
Inferiorly: deep fascia of leg

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6
Q

Branches of tibial nerve and their functions

A
  1. Motor to:
    - Soleus
    - Plantaris
    - Gastrocnemius
    - Popliteus
    - Posterior compartment of leg
  2. Medial sural cutaneous
    - Joins sural communicating branch of common fibular to form the sural nerve (which then supplies sensation to the lateral leg and ankle)
  3. Medical calcaneal, and medial and lateral plantar nerves:
    - Sensory to dorsum of foot and posterior leg
    - Medial and lateral plantar nerves supply intrinsic foot muscles
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7
Q

Where does the sciatic nerve divide into the tibial and common fibular nerves?

A

At the apex of the popliteal fossa

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8
Q

Describe the course of the tibial and common fibular nerves in the popliteal fossa

A

Tibial: bisects popliteal fossa vertically, exits between heads of gastrocnemius
Common fibular: lateral to tibial nerve, follows medial border of biceps femoris then exits passing superficial to lateral head of gastrocnemius and head of fibula before winding around neck of fibula

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9
Q

Four branches of the common fibular nerve and their functions

A
  1. Sural communicating branch:
    - Joins medial sural nerve from tibial nerve to form sural nerve (supplies lateral leg and ankle)
  2. Lateral cutaneous nerve of calf:
    - Supplies skin over upper peroneal and extensor compartments
  3. Superior and inferior genicular nerves:
    - Travels with vessels to supply the knee capsule and lateral collateral ligament
  4. Recurrent genicular nerve:
    - Perforates tibialis anterior to supply capsules of superior tibiofibular joint and knee joint
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10
Q

Describe the course of the popliteal artery

A

Continuation of the femoral artery after it passes through the adductor hiatus
Ends at inferior border of popliteus by dividing into anterior and posterior tibial arteries

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11
Q

List in order of most superficial to deepest in the popliteal fossa: veins, arteries, nerves

A
  1. Nerves
  2. Veins
  3. Arteries
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12
Q

Five genicular branches and four muscular branches of the popliteal artery

A

Five genicular:
1. Superior medial
2. Superior lateral
3. Middle
4. Inferior medial
5. Inferior lateral

Four muscular:
1. To hamstrings
2. To soleus
3. To plantaris
4. To gastrocnemius

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13
Q

Which arteries make up the genicular anastamosis?

A
  1. Branches of popliteal artery:
    - Superior medial
    - Superior lateral
    - Middle
    - Inferior medial
    - Inferior lateral
  2. Branch of femoral artery:
    - Descending genicular
  3. Descending branch of lateral femoral circumflex
  4. Branch of anterior tibial artery:
    - Anterior tibial recurrent
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14
Q

Describe the course of the popliteal vein

A

Begins at distal border of popliteus as continuation of posterior tibial vein
Receives small saphenous vein in the popliteal fossa after it pierces the popliteal fascia
Becomes femoral vein as it passes through the adductor hiatus

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15
Q

Describe the relation of the popliteal vein to the popliteal artery and tibial nerve within the popliteal fossa

A

Inferiorly: lies posteromedial to popliteal artery and lateral to tibial nerve
Superiorly: overlies popliteal artery with tibial nerve on top

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16
Q

Where do the popliteal lymph nodes drain to?

A

Deep inguinal lymph nodes

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17
Q

Where do the superficial popliteal lymph nodes receive lymph from?

A

Lymphatics accompanying the small saphenous vein

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18
Q

Where do the deep popliteal lymph nodes receive lymph from?

A

From joint capsule of knee and from lymphatics accompanying the deep veins of the leg

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19
Q

Proximal and distal attachment, course of tendon, innervation and action of popliteus

A

Proximal: lateral femoral condyle and lateral meniscus
Distal: posterior tibia, superior to soleal line
Tendon course: lies within capsule of knee joint (enters beneath arcuate popliteal ligament)
Innervation: tibial nerve (L4-5, S1)
Action: weak knee flexor, unlocks knee during flexion (by rotating femur laterally on fixed tibia), acts with PCL to prevent anterior displacement of femur on tibia

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20
Q

What are the three articular surfaces of the knee?

A
  1. Medial tibiofibular
  2. Lateral tibiofibular
  3. Femoropatellar
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21
Q

Describe the posterior surface of the patella

A

Larger lateral and smaller medial surface

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22
Q

What gives the knee joint its stability?

A

Mechanically relatively weak due to incongruent surfaces
Dependent on strength and action of surrounding muscles and tendons, and connecting ligaments

23
Q

What is the most important stabiliser of the knee?

A

Quadriceps tendon (particularly inferior fibres of vastus medialis and lateralis)

24
Q

What is the most important stabiliser of the patella?

A

Inferior fibres of vastus medialis

25
Q

Describe the capsular attachments of the knee

A

Superoposterior: proximal margins of femoral condyles and intercondylar fossa (with attachment to lateral condyle interrupted by aperture for popliteus tendon)
Inferoposterior: tibial plateau (again with aperture for popliteus tendon)
Anterior: replaced by quadriceps tendon, patella, and patellar ligament (with deficiency in attachment to femur above level of patella: allows communication between joint and suprapatellar bursa)
Medial: articular margins of femur and tibia with attachment to medial meniscus and medical collateral ligament
Lateral: proximal to groove for popliteus tendon, and surrounds head of fibula with attachment to lateral meniscus

26
Q

Five extra-capsular ligaments of the knee

A
  1. Patellar ligament (distal quadriceps tendon)
  2. Lateral collateral ligament
  3. Medical collateral ligament
  4. Oblique popliteal ligament
  5. Arcuate popliteal ligament
27
Q

Describe the structure of the patellar ligament

A

Distal part of quadriceps tendon
Also receives medial and lateral retinacula from vastus medialis and lateralis respectively

28
Q

Describe the anatomy of the lateral collateral ligament. How does it relate to the biceps femoris and popliteus tendons?

A

Extends from lateral femoral epicondyle to lateral surface of fibular head
Splits biceps femoris tendon in two
Separated from lateral meniscus by popliteus tendon

29
Q

Describe the anatomy of the medial collateral ligament. How does it relate to pes anserinus and the medial meniscus?

A

Extends from medial femoral epicondyle to medial tibial condyle and superomedial tibial surface
Crossed by pes anserinus (tendons of sartorius, gracilis and semitendinosus)
Attaches to medial meniscus at midpoint

30
Q

What are the major differences between the lateral and medial collateral ligaments?

A

Lateral collateral is stronger and cord-like
Medial collateral is weaker and flat

31
Q

Describe the anatomy of the oblique popliteal ligament

A

Expansion of semimembranosus
Crosses intercondylar fossa from posteromedial tibial condyle to superolateral femoral condyle to reinforce joint posteriorly
Blends with posterior capsule

32
Q

Describe the anatomy of the arcuate popliteal ligament

A

Y-shaped ligament
Strengthens capsule posteriorly
Passes from posterior fibular head superomedially over popliteus tendon to posterior tibial intercondylar area
Lateral limb attaches to lateral femoral condyle

33
Q

Seven intracapsular ligaments of the knee

A
  1. Anterior cruciate ligament
  2. Posterior cruciate ligament
  3. Medial meniscus
  4. Lateral meniscus
  5. Coronary ligaments
  6. Transverse ligament of knee
  7. Posterior meniscofemoral ligament
34
Q

What are the major differences between the anterior and posterior cruciate ligaments?

A

Anterior: longer, weaker, poor blood supply
Posterior: shorter, stronger

35
Q

Describe the anatomy of the anterior cruciate ligaments

A

Extends from anterior intercondylar tibia (posterior to medial meniscus) to posteromedial aspect of lateral femoral condyle

36
Q

What is the role of the anterior cruciate ligament?

A

Prevents posterior displacement of femur on tibia in extension
Prevents hyperextension

37
Q

How is the anterior cruciate ligament tested?

A

With anterior draw test with knee in 90 degrees of flexion

38
Q

Describe the anatomy of the posterior cruciate ligament

A

Extends from posterior intercondylar tibia and passes medially to ACL to insert at anterolateral aspect of medial femoral condyle

39
Q

What is the role of the posterior cruciate ligament?

A

Prevents anterior displacement of femur on tibia
Prevents hyperflexion

40
Q

How is the posterior cruciate ligament tested?

A

With posterior draw test with knee in 90 degrees of flexion

41
Q

What are the major differences between the medial and lateral menisci?

A

Medial: C shaped, broader posteriorly than anteriorly, less mobile (attached to MCL -> more prone to tears)
Lateral: nearly circular, smaller and more freely mobile than medial

42
Q

Describe the attachments of the medial meniscus

A

Attached anteriorly to anterior intercondylar tibia (anterior to ACL)
Attached posteriorly to posterior intercondylar tibia (anterior to PCL)
Attaches to MCL medially

43
Q

Describe the attachments of the lateral meniscus

A

Attached anteriorly to anterior intercondylar tibia (posterior to ACL)
Attached posteriorly to posterior intercondylar tibia (anterior to PCL)

44
Q

What are the coronary ligaments?

A

Portions of the knee joint capsule between margins of menisci and periphery of tibial condyles

45
Q

What structures are joined by the transverse ligament of the knee?

A

Joints anterior aspects of medial and lateral menisci to tether them together during knee movement

46
Q

What structures are joined by the posterior meniscofemoral ligament?

A

Joins lateral meniscus to PCL and medial femoral condyle

47
Q

How many bursae are in and around the knee joint?

A

At least 12

48
Q

Describe the eight named bursae of the knee joint. Where are they located? Which communicate with the knee joint?

A

Anterior:
1. Subcutaneous prepatellar: between skin and anterior patella
2. Subcutaneous infrapatellar: between skin and tibial tuberosity
3. Deep infrapatellar: between patellar ligament and anterior tibia (separated from knee joint by fat pad)
4. Suprapatellar*: between femur and quadriceps tendon

Posterior:
1. Popliteus: between popliteus tendon and lateral tibial condyle
2. Anserine: between pes anserinus, and MCL and media tibia
3. Gastrocnemius*: deep to tendon of medial head of gastrocnemius
4. Semimembranosus: between medial head of gastrocnemius and semimembranosus tendon

49
Q

Which artery pierces the knee joint capsule? What does it supply?

A

Middle genicular artery pierces joint capsule to supply the cruciate ligaments, synovial membrane, and peripheral menisci

50
Q

Four nerves supplying the knee joint

A
  1. Femoral: branches to vasti supply anterior aspect
  2. Tibial: genicular branches supply posterior aspect
  3. Common fibular: genicular branches supply lateral aspect
  4. Saphenous: articular branches supply medial aspect
51
Q

What are the primary and secondary muscles responsible for knee flexion?

A

Primary: hamstrings (biceps femoris, semimembranosus, semitendinosus)
Secondary: gracilis, sartorius, popliteus, gastrocnemius, plantaris

52
Q

What are the primary and secondary muscles responsible for knee extension?

A

Primary: quadriceps femoris
Secondary: tensor fascia lata

53
Q

What are the primary and secondary muscles responsible for medial rotation of the knee?

A

Primary: semitendinosus, semimembranosus
Secondary: popliteus when knee in extension

54
Q

What are the primary and secondary muscles responsible for lateral rotation of the knee?

A

Primary: biceps femoris

ACEM Primary Written (160 decks)

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