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MSK > Session 4.1 Osteology of the distal femur , patella , tibia and fibula > Flashcards

Session 4.1 Osteology of the distal femur , patella , tibia and fibula Flashcards

1
Q

What makes up the knee joint ?

A

1) patella
2) distal femur
3) proximal tibia

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2
Q

What are the two femoral condyles called ?

A

Medial and lateral

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3
Q

Which femoral condyle is larger - the medial or the lateral ?

A

The medial condyle is larger because more weight goes through the medial condyle than the lateral one.

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4
Q

Where on the distal femur does the patellar reside in ?

A
  • on a shallow depression called the trochlear/ patellofemoral groove.
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5
Q

Is it the lateral or medial lip of the trochlear/patellofermoral groove which is more prominent ?

A

The lateral lip is more prominent because it helps to resist patellar dislocation as the patellar tends fo want to move in the lateral direction.

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6
Q

On the posterior side of the distal femur , what is the notch called ?

A

Intercondylar fossa

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7
Q

Does the fibula make up the knee joint ?

A

No

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8
Q

What makes up the proximal surface of the tibia ?

A

1) medial condyle
2) lateral condyle
3) intercondylar area ( non articular area in between the lateral and medial condyle) - at the centre of the this area there is the ‘ intercondylar eminence’

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9
Q

What is the main function of the intercondylar area ?

A

Attachment for ligaments

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10
Q

What is the largest sesamoid bone in the body ?

A

Patella

  • this resides within tendons
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11
Q

What is menisci and what is its anatomy ?

A

ANATOMY :

C shaped plates of fibrocartilage that lays between the tibia and the distal femur.

Has a thicker periphery

Attached to the intercondylar area of the tibia

Connected anteriorally by the transverse ligament of the knee

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12
Q

What is the medial meniscus attached to ?

A

Medial collateral ligament

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13
Q

What is the function of the menisci?

A

1) act as a shock absorber

2) deepens the surface of articulation

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14
Q

What are the ligaments classified into - the ones involved in the knee joint ?

A

1) intra capsular - cruciate ligaments
2) extra capsular - collateral ligaments
3) ligaments that strengthen the capsule - oblique popliteal ligament

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15
Q

What are the two cruciate ligaments called ?

A

1) anterior cruciate ligaments ( ACL)

2) posterior cruciate ligaments ( PCL)

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16
Q

PAMs APples

A

Posterior passes anterior inserts medial.y ( PCL)

Anterior passes posterior inserts laterally ( ACL)

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17
Q

Which is weaker of the two cruciate ligaments ?

A

ACL

because it has a relatively poor blood supply

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18
Q

What is the function of the ACL ?

A
  • during running the tibia often moves anterior to the femur. The ACL prevents the tibia moving far too forward relative the to distal femur.
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19
Q

What is the function of the PCL?

A

Prevents excessive posterior movement of the tibia relative to the femur.

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20
Q

Where is the joint capsule of the knee mainly located?

A
  • surrounds the sides and posterior aspect of the joint

- it is deficient anteriorly

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21
Q

How is the joint capsule in the knee strengthened laterally and medically ?

A

By inferior fibres Kd the vastus lateralis and medialis

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22
Q

How is the joint capsule strengthened posteriorally?

A

Oblique popliteal ligament which is an expansion of the semimembranosus

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23
Q

What are the two extra capsular ligaments called ?

A

1) medial collateral ligament

2) lateral collateral ligament

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24
Q

What is the function of the medial collateral ligament ?

A

Resists valgus forces on the tibia

VaLgus = L for lateral

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25
Q

Describe tha anatomy of the medial collateral ligament

A

The medial collateral ligament attaches to the medial femoral epicondyle to the tibia.

  • it also attaches to the medial meniscus at its midpoint.
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26
Q

Describe the anatomy of the lateral collateral ligament

A

Attaches to the lateral femoral epicondyle to the lateral surface of the fibula head.

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27
Q

What is the function of the lateral collateral ligament ?

A

Resists varus force on the tibia ( varus= medial)

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28
Q

How many bursae are found in the knee joint ?

A

6

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29
Q

Name the 6 bursae found in the knee joint

A

1) suprapatellar
2) prepatellar
3) superficial ( subcutaneous) infrapatellar
4) deep infrapatellar
5) semimembranous
6) subsartorial

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30
Q

What is the function of bursae?

A
  • they are fluid filled sacs located around a joint that cushions bones when muscles , tendons or skin rub against the bone.
  • they are very important in the movement of bones because they reduce friction,
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31
Q

What muscles in the leg aid with flexion of the knee ?

A

Hamstrings muscles - biceps femoris , semi membranous, semitendinosus

  • this is assisted by gracilis , sartorius , popliteus , gastrocnemius
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32
Q

What muscles help with extension of the knee ?

A

Quadriceps muscles ( there are 4) = recurs femoris, vastus medialis, vastus lateralis, vastus intermedius

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33
Q

What joints does the recurs femoris cover ?

A

The hip and knee joint

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34
Q

What innerverts the quadriceps muscles ?

A

Femoral nerve

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35
Q

Where does the recurs femoris insert into ?

A

Tibial tuberosity via the patella tendon

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36
Q

When the knee is flexed , some rotation can occur - what aids medial rotation ?

A

1) semitendinosus
2) semimembranosus
3) gracilis
4) sartorius
5) poplitues

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37
Q

When the knee is flexed, some rotation can occur. What aids lateral rotation of the knee ?

A

Bicep femoris

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38
Q

Which muscle that forms part of the knee joint , has a very important stabilising effect ?

A

Inferior fibres of vastus medialis called the vastus medialis obliquus ( obliquus genus).

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39
Q

Outline the mechanism of locking the knee

A

Occurs during extension of the knee.

  • the femur rotates internally by 5 degrees.
  • the cruciate ligaments tighten
  • the knee becomes more solid and thigh and leg muscles can relax briefly without instability
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40
Q

Outline the mechanism of unlocking the knee

A

Poplitues contracts and rotates femur externally

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41
Q

How can the borders of the femoral triangle be remembered?

A

SAIL

S = sarotorius ( lies on the lateral border of the femoral triangle)

A= adductor longus ( medial border of the femoral triangle );

I = inguinal

L = ligament

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42
Q

What are the contents of the femoral triangle ?

A

N~ femoral nerve

A ~ femoral artery

V ~ femoral vein

E ~ empty space

L ~ lymphatics

GOES IN ORDER

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43
Q

What makes up the femoral canal?

A

Empty space and lymphatics

44
Q

Where can you feel the femoral pulse ?

A

Felt at mid-inguinal point

  • midpoint between the anterior superior iliac spine and pubic symphysis
  • just inferior the to the inguinal ligament
  • blood can be taken from the fermoral vein or artery.
45
Q

How can you tell the difference between the posterior and anterior surface of the femoral shaft ?

A

On the posterior surface , there is a roughened ridge of bone called the line of aspera.

46
Q

Proximal , what does the medial border of the linea aspera become ?

A

The pectineal line

47
Q

Priximally, what does the lateral border of the linea aspera become ?

A

Gluteal tuberosity - where the gluteas maximus inserts

48
Q

Distally , the linea aspera widens and the medial and lateral borders form …..

A

Medial and lateral supracondylar lines

49
Q

What does the more prominent lateral femoral condyle help to prevent ?

A

Lateral displacement of the patella .

  • people with a flatter lateral femoral condyle are more likely to experience patellar instability
50
Q

Where does the ACL attach ?

A

The anterior cruciate ligaments attaches to the medial aspect of the LATERAL femoral condyle.

51
Q

Where does the PCL attach to ?

A

The posterior cruciate ligament attaches to the lateral aspect of the MEDIAL femoral condyle.

52
Q

What is the superior aspect and inferior aspect of the patella attached to ?

A

The superior aspect is attached to the quadriceps tendons and it’s inferior aspect is attached to the patellar ligament.

53
Q

The apex of the petalla is situated inferiorlu or superiorly ?

A

Inferioroly

54
Q

What does the patella ligament connect the patella to ?

A

The tibial tuberosity

55
Q

What are the two facets called which help the posterior surface of the patella articulate with the femur ?

A

1) medial facet : articulates with the medial condyle O.F. the femur
2) lateral facet : articulates with the lateral condyle of the femur.

56
Q

What are the functions of the patellla ?

A

1) protection : protects the anterior aspect of the knee joint from physical trauma.
2) it enables the quadriceps muscle to directly cross the anterior aspect of the knee and by acting as a fulcrum , the patella enhances the leverage that the quadriceps tendon can exert on the femur - increasing mechanical efficiency by 33-50%.
3) it reduced frictional forces between the quadriceps and the femoral condyles during extension of the leg.

57
Q

What does the head of the fibula articulate with ?

A

Articulates with the proximal tibia at the proximal tibiofibular joint . This does not form part of. The knee joint,
.

58
Q

What does the tibial platue articulate with ?

A

The condyles form a flat surface known as the tibial plateau - this articulates with the femoral condyles to form a major articulation of the knee joint.

59
Q

Where is the insertion site of the patellar ligament ?

A

Tibial tuberosity

60
Q

What is the main ffunction of the fibula ?

A

It’s main function is to act as an attachment for muscles - rather than weight bearing.

61
Q

What are the 3 main articulations sof the fibula ?

A

1) proximal tibiofibular joint : articulates with the lateral condyle of the tibia.
2) distal tibiofibular joint : articles with the fibular notch of the tibia
3) ankle joint : articulates with the talus bone of the foot.

62
Q

What type of joint is the knee joint ?

A

Hinge type synovial joint - which mainly allows for flexion and extension with a small degree of lateral and medial rotation.
.

63
Q

What are the two articulations that form the knee joint ?

A

1) patellofemoral: the patella articulates with the femur at the trochlear groove
2) tibiofemoral: the medial and lateral condyles of the femur articulate with the medial and lateral tibial condyles. ( weight bearing joint of the knee)

64
Q

What tendon does the patellar reside in ?

A

Quadriceps femoris tendon

65
Q

Where does the knee joint get their blood supply ?

A

Through the genicular anastomoses around the knee which are supplied by the genicular branches of the femoral and popliteal arteries.

66
Q

If the popliteal artery which supplies blood to the knee gradually becomes occluded , what happens ?

A

The genicular anastomoses can dilate to main blood supply to the leg

67
Q

The knee joint is inherently unstable , to improve stability ….

A

1) the tibial articular surface is depended by the menisci

2) the joint is supported by the joint capsule , ligaments and surrounding muscle.

68
Q

What are the two functions of the menisci ?

A

1) depend the articular surface of the tibia , increasing the stability of the joint
2) act as a shock absorber by increasing surface area.

69
Q

What happens in there is damage to the medial collateral ligament ? - what also tears

A

The medial me is all tears.

70
Q

Why is the lateral collateral ligament fairly mobile - in comparison to the medial collateral ligament ?

A

Because the lateral collateral ligament is not attached to the lateral menisci of the knee,

71
Q

How are th menisci connected to eachother anterioly?

A

By the transverse ligament of the knee

72
Q

Why is it difficult for the menisci to heal after trauma ?

A
  • the central meniscus is avascular by adulthood
73
Q

During extension of the knee , the patella naturally tries to be displaced laterally . What are a few factors that help to resist this lateral vector ?

A

1) the deep trochlear groove which has a more prominent lateral femoral condyle anterioly.
2) the fibres of the the vastus medialis obliquus ( VMO) which are inserted more ditslly into the patella and more horizontally than those of the vastus lateralis. Contraction of these fibres resists the lateral displacement of the patellar

74
Q

What are three compartments of the thigh

A

1) anterior
2) posterior
3) medial

75
Q

The muscles in the anterior compartment of the thigh are mostly innervated by which nerve ?

A

Femoral nerve ( L2-L4)

76
Q

Iliopsoas

A

Consists of two muscles - the spoas major and the iliacus

77
Q

Where does the psoas major originate?

A

Originates from the transverse processes of the aT12-L5 vertebrate and the lateral margins of the intervertebral discs between them.

78
Q

Where does the iliacus originate from ?

A

The iliac fossa O.F. the pevis

79
Q

What innerverts the psoas major ?

A

Anterior rami of L1-L3

80
Q

What innerverts the Iliacus?

A

Femoral nerve

81
Q

What are the actions of the iliopsoas?

A

Flexed the lower limb at the hip joint and assist in lateral rotation of the femur at the hip joint.

82
Q

What does the quadricep femoris consist of ?

A

1) rectus femoris
2) vastus medialis
3) vastus lateralis
4) vastus intermedius

83
Q

The muscles that form the quadricep femoris u tie proximal to the knee joint and insert onto the base of the patella via ….

A

The quadricep tendon.

84
Q

Vastus lareralis location

A

Originates from the greater trochanter and the lateral lip of the line of aspera

  • it inserts via the quadricep tendon into the base of the patella
85
Q

What is the action of the vastus lateralis and the innervation ?

A

1) femoral nerve inner ages

2) vastus lateralis extends the knee joint and stabilises the patellar.

86
Q

Location of the vastus intermedius

A

Vastus intermedius originates from the anterior and lateral surfaces of the fedora shaft and inserts into the base of the patella via the quadricep tendon

87
Q

Action of the vastus intermedius and innervation

A

Extends the knee joint and stabilises the patella

Femoral nerve innervate

88
Q

Location of the vastus medialis

A

Originates from the intertrochanteric line of the femur and medial lip of the linea aspera.

  • it inserts into the base of medial aspect of the patella via the quadriceps tendon.
  • inferior fibres are orientsted horizontally and are known as vastus medialis obliqus (VMO)
89
Q

Function of the vastus medialis

A

Vastus medialis extends the knee joint and stabilises the patellar.

  • contraction of the VMO resists the lateral displacement of the patellar.
90
Q

Innervation of the vastus medialis

A

Femoral nerve

91
Q

Location of recurs femoris

A
  • oringintes as two tendons ( the anterior tendon arises from the anterior inferior iliac spine , the posterior tendon arises from the acetabulum.
  • the two unite inserting into the base of the patella via the quadriceps tendon.
92
Q

Action of recurs fmeoris

A
  • only muscle of the quadricep to cross both the hip and knee joint.
  • it flexes they thigh at the hip joint and extends the leg at the knee joint.
  • innervated by the femoral nerve.
93
Q

Longest muscle in the body

A

Sartorius

94
Q

Location of sartorisu

A

Originates from the anterior superior iliac spine and attaches to the medial aspect of the proximal tibia.

95
Q

Action of sartorius

A

HIP JOINT: flexes , abducts, externally rotates the thigh,

KNEE JOINT : flexes and internally rotates the tibia at the knee joint.

96
Q

Innervation of the sartorius

A

Femoral nerve

97
Q

Action of pectinus.

A

Abducts and flexes the thigh at the. Hip joint

Innervation by the femoral nerve.

98
Q

Where anatomically is the femoral triangle located ?

A

Proximal region of the anterior thigh.

99
Q

What are the three borders of the femoral triangle

A

1) superior border : formed by the inguinal ligament.
2) lateral border : formed by the medial border of the sartorius muscle.
3) medial border : formed by the medial border of the adductor longus muscle.

100
Q

Adductor longus location

A

Forms the medial border of the femoral triangle - it originates from the pubis - attaching to linea aspera.

101
Q

Action of adductor longus

A

Abducts the thigh

102
Q

Innervation of adductor longus

A

Obturator nerve

103
Q

Location of gracilis

A
  • most superficial + medial muscle in medial compartments thigh.
  • crosses both hip N knee joint.
  • originates from pubic ramus + body of pubis ,

Descends almost vertically down the medial thigh , it inserts onto the medial surface of the proximal tibia .

104
Q

Action of the gracilus

A

Addictions of the thigh at hip joint and flexes the leg at the knee.

105
Q

Innervation of the gracilis

A

Obturator nerve

106
Q

Muscles that make up the anterior compartment for the thigh

A
  • posoas major

Iliacus

Rectus femoris

Vastus medialis

Vastus lateralis

Sartorius

Pectineus

MSK (14 decks)

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