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Intro to Biomechanics > Pelvis, Hip, and Knee > Flashcards

Pelvis, Hip, and Knee Flashcards

1
Q

Lumbosacral joint

A
  • Connected by a large intervertebral disc
  • Transfers weight, along with the ilium
  • Iliolumbar ligament
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2
Q

Posterior strength of lumbosacral joint comes from

A
  • Interosseous

- Dorsal sacroiliac ligaments

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3
Q

Lumbosacral joint/ilium weight transfer

A
  • While walking, transferred to the femur

- While sitting, transferred to the ischial tuberosities

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4
Q

Iliolumbar ligament

A
  • Ventral and dorsal portion

- Restrains movement at the lumbosacral and sacroiliac joint

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5
Q

Pelvis in open kinetic chain

A
  • The thigh moves on the hip joint
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6
Q

Pelvis in closed kinetic chain

A
  • The hip joint moves on the thigh
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7
Q

Pelvis is made up of

A
  • Sacrum
  • Coccyx
  • Pubis
  • (Two os coxae = ishium, ilium and pubis)
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8
Q

Male pelvis

A
  • Longer and more curved sacrum

- Narrow sub-pubic arch

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9
Q

Female pelvis

A
  • Wider and broader

- Less prominent ischial spines

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10
Q

Sacroiliac joint

A
  • Synarthrodial joint
  • Allows little to no movement in adulthood
  • Helps absorb the weight bearing load from the legs
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11
Q

Sacroiliac joint stability provided by

A
  • Interosseous sacroiliac ligament (prevents anterior inferior ovemet of the sacrum)
  • Posterior sacroiliac ligament
  • Sacrotuberous ligament
  • Sacrospinous ligament
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12
Q

Sacroiliac joint movement

A
  • Anterior-posterior (sagittal plane)

- Movement limited to 2 to 4 mm due to architecture and ligamentous support

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13
Q

Pubic symphysis

A
  • Cartilagenous synarthrodial joint
  • Fibrocartilagenous interpubic disc
  • Small amount of translation and rotation
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14
Q

Pubic symphysis resists

A
  • Traction force inferiorly
  • Compressive forces superiorly
  • Shearing and compressive forces during stance
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15
Q

Pubic symphysis rotation

A
  • Will rotate in tandem with the sacroiliac joint

- Can move ~2 mm with 1 degree rotation

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16
Q

Pubic symphysis support

A
  • Supported by 4 ligaments

- Superior, inferior (arcuate), anterior and posterior pubic ligaments

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17
Q

Hip joint

A
  • A ball and socket synovial joint
  • Has three degrees of freedom
  • Motion in all three cardinal planes
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18
Q

Hip joint stability provided by

A
  • Anatomic shape

- Soft tissue attachments

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19
Q

Ischial component of acetabular fossa

A
  • ~>2/5 total surface

- Lower and side boundaries

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20
Q

Ilial component of acetabular fossa

A
  • ~<2/5 total surface

- Upper boundary

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21
Q

Pubis component of acetabular fossa

A
  • Remainder of fossa that is not ischial or ilial
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22
Q

Parts of the acetabular fossa

A
  • Hemispherical shape
  • Sides lined with articular cartilage
  • Acetabular notch (inferior, horse-shoe shaped)
  • Acetabular labrum (upper, thick rim that deepens the fossa)
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23
Q

Acetabular fossa alignment

A
  • Forward (30-40° from the frontal plane)
  • Lateral
  • Downward (30-40° (20-30°) from horizontal or transverse plane, roof overhangs head of femur)
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24
Q

Acetabular fossa function

A
  • Allows for stability medially, superiorly and posteriorly
  • Roof receives greatest pressure
  • Difficult to dislocate
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25
Q

Acetabular labrum

A
  • Fibro-cartilaginous rim attached to the margin of the acetabulum
  • Deepens the acetabular cavity
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26
Q

Characteristics of acetabular labrum

A
  • Horse-shoe shaped
  • Ends contacted at the acetabular notch via transverse ligament
  • Thicker posteriorly
  • Wider and thinner anteriorly
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27
Q

Three extracapsular hip ligaments

A
  • Iliofemoral
  • Ischofemoral
  • Pubofemoral
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28
Q

Iliofemoral ligament

A
  • Y-shaped
  • Strongest ligament in the body
  • Tighter when hip is extended
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29
Q

Iliofemoral ligament extends from

A
  • AIIS to intertrochanteric line
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30
Q

Iliofemoral ligament function

A
  • Prevents hip hyperextension during standing
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31
Q

Pubofemoral ligament extends from

A
  • Superior pubic rami to the intertrochanteric line
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32
Q

Pubofemoral ligament function

A
  • Triangular shape
  • Reinforces the joint anteriorly and inferiorly
  • Prevents excessive abduction and extension
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33
Q

Ischiofemoral ligament extends from

A
  • Body of ischium to the greater trochanter
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34
Q

Ischiofemoral ligament function

A
  • Spiral orientation
  • Prevents hyperextension
  • Supports head of femur in acetabulum
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35
Q

Ligamentum teres extends from

A
  • Ischial and pubic sides of acetabular fossa to the fovea capitus of the femur
  • Encloses a branch of the obturator artery
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36
Q

Ligamentum teres function

A
  • Stabilizes the hip in flexion

- Particularly in squatting position

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37
Q

Head of femur supported by

A
  • Femoral neck (obliquely set)

- Angulation within frontal plane

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38
Q

Angle of femoral inclination

A
  • Average adult = 128°
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39
Q

Angle of antetorsion

A
  • Deviated 10-30° from the frontal plane
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40
Q

Femur sagittal plane contour

A
  • Mild forward curvature

- Aided by pull of hamstrings

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41
Q

Femur frontal plane curvature

A
  • Outward curvature of the head, neck and upper shaft

- Tensor fascia lata and vastus lateralis aid valgus curve of distal femur

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42
Q

Bending of the femur

A
  • Only biarticular muscles can bend the femur
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43
Q

Factors that provide hip stability

A
  • Shape of acetabular fossa
  • Extracapsular ligaments
  • Intracapsular ligaments
44
Q

Hip joint frontal or lateral axis

A
  • Projects to body’s surface near greater trochanter

- Flexion and extension of hip

45
Q

Hip joint sagittal or anterior-posterior axis

A
  • At groin, midpoint of inguinal line

- Abduction and adduction of hip

46
Q

Hip joint vertical (mechanical) axis

A
  • Line that connects femur’s points of contact with acetabulum and tibia
  • Internal and external rotation of hip
47
Q

Hip joint has 3 degrees of freedom

A
  • Sagittal plane
  • Frontal plane
  • Transverse plane
48
Q

Hip sagittal plane degree of freedom

A
  • Flexion: 120 - 140 degrees

- Extension: 15 - 20 degrees

49
Q

Hip frontal plane degree of freedom

A
  • Abduction: 45 - 50 degrees

- Adduction: 20 - 30 degrees

50
Q

Hip transverse plane degree of freedom

A
  • Internal rotation: 45 degrees

- External rotation: 45 degrees

51
Q

Transverse plane motion at hip

A
  • Internal and external rotation
  • Each more distal limb segment rotates in the same direction as the pelvis
  • But, each distal segment rotates more than its proximal segment
52
Q

Infant hip transverse plane range of motion

A
  • 2-3:1 external to internal
  • Total range up to 155°
  • Decreases to 90° by age six
53
Q

Adult hip transverse plane range of motion

A
  • 1:1 external to internal

Total range ~90°

54
Q

Geriatric hip transverse plane range of motion

A
  • 2:1 external to internal
  • Concomitant increased angle of gait
  • Total range may be < 90°
55
Q

1st element of gait

A
  • Pelvic Rotation (transverse plane)
56
Q

Ligamentous causes of femoral anteversion/retroversion

A
  • Pubofemoral ligament
  • Iliofemoral ligament
  • Ligamentum teres
  • Intrauterine position?
57
Q

Muscular etiologies of femoral anteversion/retroversion

A
  • Tight medial hamstrings

- Tight adductor muscles

58
Q

Sagittal plane motion at hip

A
  • Allows forward movement of leg
  • Hip flexion and extension
  • Moves from flexed to full extension in midstance
  • Begins flexing during early propulsion
59
Q

Frontal plane motion at hip

A
  • Very slight movement during gait
  • Abduction and adduction
  • During gait, 5° drop on non-weight bearing side
  • Mild abduction during early swing
60
Q

2nd element of gait

A
  • Pelvic list (frontal plane)
61
Q

Angle of femoral inclination (Mickulicz angle)

A
  • Relationship of the long axis of the head and neck to the long axis of the femoral shaft
62
Q

Normal values of angle of femoral inclination (Mickulicz angle)

A
  • Birth: 35 - 150°

- Adult: 120 - 132°

63
Q

Hip positions in the stance phase of gait

A
  • Heel strike: extended
  • Loading response: mild flexion
  • Midstance: extended
  • Heel lift: extended
  • Toe off: staring to flex
64
Q

Hip positions in the swing phase of gait

A
  • Early swing: flexed
  • Midswing: flexed
  • Terminal swing: extending
65
Q

3rd element of gait

A
  • Knee joint extension/flexion
66
Q

Knee joint

A
  • Complex hinge joint
  • Endures the heaviest stresses of any joint
  • Two degrees of freedom
67
Q

Knee joint in extension

A
  • Stabilizer

- Shock absorber

68
Q

Knee joint in flexion

A
  • Great mobility
  • Helps foot to adapt to ground
  • Shortens the limb
  • Develops kinetic energy for running
69
Q

Knee joint components

A
  • Distal Femur
  • Proximal Tibia (transfers weight across the knee and to the ankle)
  • Patella
70
Q

Knee joint horizontal frontal plane axis

A
  • Runs through femoral condyles

- Sagittal plane motion (flexion and extension)

71
Q

Knee joint vertical axis

A
  • Transverse plane motion

- Movement in the final degrees of knee extension

72
Q

Knee joint horizontal sagittal plane axis

A
  • Potential frontal plane motion

- Generally pathologic

73
Q

Bony features of distal femur (knee joint)

A
  • Lateral and medial condyles
  • Lateral and medial epicondyles
  • Intercondylar notch
  • Intercondylar (trochlear) groove
  • Lateral and medial patellar facets
  • Popliteal surface
74
Q

Knee joint articular facets

A
  • Two facets between femur and tibia
  • One two-sided facet between patella and femur
  • Medial and Lateral condyles are not symmetrical
75
Q

Bony features of proximal tibia and fibula (knee joint)

A
  • Head of fibula
  • Medial and lateral condyles
  • Intercondylar eminence (with tubercles)
  • Anterior intercondylar area
  • Posterior intercondlar area
  • Tibial tuberosity
  • Soleal line
76
Q

Tibial plateau

A
  • Medial facet
  • Lateral facet
  • Peripheral portions
77
Q

Medial tibial facet

A
  • Oval and concave
78
Q

Lateral tibial facet

A
  • Nearly circular
  • Concave side to side
  • Convex from posterior
79
Q

Tibia peripheral portions

A
  • Fibrocartilagenous minisci
80
Q

Menisci properties

A
  • Semi-lunar
  • Poor vascular supply
  • Disperse friction
  • Shock absorbers
81
Q

Medial meniscus

A
  • Well attached

- Injured slightly more often

82
Q

Lateral meniscus

A
  • More mobile
83
Q

Bony features of the patella

A
  • Base
  • Apex
  • Anaterior surface
  • Posterior articular surface
  • Vertical ridge
  • Lateral, medial and odd facet
84
Q

Patella

A
  • Patella = “small plate” in Latin
  • Embedded within the quadriceps tendon
  • Functions as a pulley
  • Largest sesamoid in body
85
Q

Patella is tethered by

A
  • Patellar retinaculum
  • Anchored inferiorly by patellar tendon
  • Acts as a pulley to redirect the force of quadriceps contraction
86
Q

Patella function

A
  • It glides in the intercondylar notch

- This adjusts the oblique pull of the quadriceps

87
Q

Lateral facet of posterior patella

A
  • Broader and deeper
  • Roughly 2/3 of patella
  • Sagittal convexity
  • Coronal concavity
88
Q

Medial facet of posterior patella

A
  • Narrower and shallower

- Smaller and slightly convex

89
Q

Patellar movement in knee extension

A
  • Inferior portion of patella has greatest contact with femur
90
Q

Patellar movement in knee flexion

A
  • Superior portion makes greatest contact with femur
91
Q

Medial collateral ligament attachments

A
  • Originates on medial epicondyle of femur
  • Attaches to medial condyle of tibia
  • Attached to joint capsule and medial meniscus
92
Q

Medial collateral ligament fibers

A
  • Anterior: tight with knee flexion

- Posterior: tighter with knee extension, shorter and more oblique

93
Q

Lateral collateral ligament attachments

A
  • Originates on lateral epicondyle of femur

- Attaches to fibula

94
Q

Lateral collateral ligament fibers

A
  • Tight only

- Knee joint extension beyond 150°

95
Q

Anterior cruciate ligament function

A
  • Resists excess sagittal plane movement
  • Tight in full extension
  • Resists anterior movement of tibia
  • Tightens again with knee in full flexion
96
Q

Anterior cruciate ligament attachments

A
  • Anterior intercondylar area of tibia

- Medial posterior aspect of lateral femoral condyle

97
Q

Posterior cruciate ligament function

A
  • Resists excess sagittal plane movement

- Tightens with > 30° flexion

98
Q

Posterior cruciate ligament attachments

A
  • Posterior intercondylar area of tibia

- Lateral anterior aspect of the medial femoral condyle

99
Q

Knee joint axis

A
  • Moving axis, possesses two degrees of freedom
  • Predominant motion: sagittal plane
  • At end of knee extension: transverse plane motion to lock the knee
100
Q

Knee joint sagittal plane range of motion

A
  • Extension: to vertical; up 5° beyond vertical

- 130 - 135° flexion; limited by soft tissue impingement

101
Q

Knee joint transverse plane range of motion

A
  • Occurs during last 20° of knee extension
  • When knee is flexed: up to 40°motion is available
  • Locking mechanism of knee joint
102
Q

Knee joint flexion in closed kinetic chain

A
  • Femur rotates slightly lateral (relaxes LCL)
  • Menisci pulled posteriorly
  • PCL tightens
  • Femur “rocks” on tibial plateau
  • Tibia moves posteriorly
103
Q

Knee joint flexion in CKC during gait cycle occurs during

A
  • During propulsion after heel off but before toe off

- Limb is beginning to shorten for swing

104
Q

Knee joint extension in closed kinetic chain

A
  • Femoral condyles “roll” on tibial plateau
  • Femur rotates slightly medial and posterior
  • Medial condyle slides slightly posterior
  • Collaterals pulled tight
  • Tibia moves anteriorly
  • ACL pulled tight
105
Q

Locking mechanism of knee

A
  • Occurs due to the shape and convexity of medial femoral condyle
  • Facilitated by the quadriceps
  • Lateral condyle begins internal rotation
  • It occurs within the last 20° of knee extension
106
Q

Unlocking of the knee

A
  • The popliteus is the “key” to unlocking the knee

- It initiates lateral rotation of the femur to promote flexion

107
Q

Knee frontal plane deviations

A
  • Genu valgus (knock kneed)

- Genu varum (bow legged)

Intro to Biomechanics (8 decks)

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