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Biomechanics 4 (Carnes) > test2 > Flashcards

test2 Flashcards

1
Q

What is the largest joint of the knee complex?

A

The tibiofemoral joint.

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2
Q

Name the 3 joints of the knee and what type of joint they are?

A

Tibiofemoral- complex joint, patellofemoral- compound joint, proximal tibiofibular- simple joint.

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3
Q

The knee complex is the most common site of what type of impairment?

A

Permanent impairment in the lower limb

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4
Q

There are large forces at what 2 joints in the knee complex and this is due to what?

A

Tibiofemoral and patellofemoral due to very long levers.

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5
Q

What is the posterior compartment of the knee and what is the anterior compartment of the knee?

A

Posterior- tibiofemoral joint. Anterior- Patellofemoral joint.

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6
Q

At which knee joint is compression greater in the tibiofemoral or the patellofemoral?

A

Tibiofemoral

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7
Q

At which knee joint is distraction greater in the tibiofemoral or the patellofemoral?

A

patellofemoral

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8
Q

What are the femoral condyles like?

A

Egg shaped and separted by a fossa.

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9
Q

Will the radius of the femoral condyles be larger anterior or posterior?

A

Anterior.

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10
Q

What will the significance of egg shaped femoral condlyes be?

A

They will need a variable socket to articulate with the tibia and that is what the menisci are for.

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11
Q

What is conjoint rotation of the knee?

A

Screw home mechanism which is external rotation seen in the last few degrees of knee extension.

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12
Q

Conjoint rotation pivots around what?

A

The lateral femoral condyles during extension.

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13
Q

Whatis the direction of angulation of the femoral condyles and what is the reason for this angulation??

A

Posterior angulation to increase flexion and decrease extension of the knee.

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14
Q

What will valgus and varus mean?

A

Valgus- distal part bent outward (abducted), knocked kneed. Varus- distal part bent inward (adducted), bowlegged.

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15
Q

Which femoral condyle will have the longer larger articulare surface? Why?

A

Medial. It allows for conjoint rotation and more sliding to occur on the medial side.

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16
Q

The medial femoral condyle will also have a larger epicondyle, but why?

A

Has the adductor tubercle to receive the adductor magnus hamstring portion

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17
Q

What will the angle of the medial femoral condyle be like?

A

It will be more oblique than the lateral.

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18
Q

Which femoral condyle will extend more distally and what can this lead to?

A

Medial and this causes valgus of the knee.

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19
Q

What is the pivot point of conjoint rotation?

A

The shorter smaller articular surface of the lateral femoral condyle. (more spin occurs on the lateral condyle than medial condyle)

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20
Q

What muscle originates on the smaller lateral femoral epicondyle?

A

Politeus inserts between the epicondyle and condyle

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21
Q

What will the angle of the lateral femoral condyle be like?

A

Less oblique A-P.

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22
Q

The tibial femoral rotation of the skrew home mechanism happens when?

A

The last 15-0 degrees of extension of the knee.

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23
Q

What occurs with the tibia when the knee complex flexes?

A

Tibia rotates medially

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24
Q

What occurs with the tibia when the knee complex extends?

A

Tibia rotates laterally

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25
Q

What degree of tibia angulation classifies Genu Valgum?

A

Greater than 15 degrees that the tibia is angled outwards

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26
Q

What degree of tibia angulation classifies Genu Varum?

A

Less than 5 degrees that the tibia is angled outwards

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27
Q

What foot motion does genu valgum increase?

A

Pronation of the foot (greatest compensator)

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28
Q

What is femoral torsion?

A

anetversion ( degree to which an anatomical structure is rotated forwards (towards the front of the body) or backwards (towards the back of the body) respectively, relative to some datum position)

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29
Q

What is the normal femoral torsion or anteversion?

A

10-20 degrees.

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30
Q

What is an anteverted femur?

A

one rotated forward more than 20 degrees.

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31
Q

What will an anteverted femurs impact be on the knee?

A

Medial orientation.

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32
Q

What is a medial orentation of the the patella aka?

A

Squinting patella. (often seen with an anteverted femur)

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33
Q

What is a common compensation for a anteverted femur?

A

Genu valgum.

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34
Q

What is a retroverted femur?

A

One that has femoral torsion of 10 degrees or less.

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35
Q

What is the impact on the knee for a retroverted femur?

A

Lateral orientation.

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36
Q

What is the common compensation for a retroverted femur?

A

Genu varum.

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37
Q

What is a squinting patella?

A

Patella faces medially and increases external tibial torsion

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38
Q

What is the superior surface of the tibial condyles like?

A

Flat with tibial spines.

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39
Q

What is the purpose of the tibial spines?

A

Attachment site for ACL and menisci, and to resist side to side translation and rotation.

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40
Q

Are the tibial facets on the tibial plateau concave or flat?

A

Flat they are not concave.

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41
Q

Which tibial facet is larger medial or lateral?

A

Medial is larger to accommodate for the size of the femoral condyles

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42
Q

What allows for the tibial facets to be congruent with the femoral condyles?

A

The menisci improves the fit

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43
Q

What is the angle of the proximal tibia like? Why?

A

Posterior angulation. To increase flexion ROM.

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44
Q

What attaches to Gerdy’s Tubercles of the tibia?

A

Iliotibial band insertion

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45
Q

What type of torsion occurs at the tibial condyles d/t the ITB?

A

External tibial torsion

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46
Q

Where is the patellar surface of the femur at?

A

The anterior distal femur. Anterior to condyles.

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47
Q

What is the patellar surface of the femur like?

A

It has a medial facet/lip a lateral facet/lip and a central groove.

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48
Q

Which facet/lip of the anterior distal femur is bigger? Why?

A

Lateral because the patella wants to go laterally and this keeps it from displacing.

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49
Q

What is the significance of a small lateral facet and lip (shallow groove)?

A

Leads to patellar instability

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50
Q

What is the anterior distal part of the femur (facets/lips) lined with?

A

Hyaline cartilage.

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51
Q

What is the main function of the patella?

A

Increase angular pull of quadraceps (increase leverage at extension).

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52
Q

What is the shape of the patella like?

A

Triangular with the apex pointing down.

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53
Q

What is the posterior part of the patella like?

A

Medial and lateral facet with a central ridge, and once and a while there will also be an odd medial facet.

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54
Q

What is the purpose of the central ridge on the patella?

A

makes bone more wedge shaped.

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55
Q

What will cause the patella to have the odd medial facet?

A

repeated or sustained deep flexion.

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56
Q

What is the thickest cartilage in the body?

A

The thickest cartilage in the body is found in the knee complex (patellofemoral?) due to highest compression and shear forces on the body.

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57
Q

What is paradoxical knee extension?

A

Hamstring and gastroc finishing full extension of knee

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58
Q

What represents the pull of the quads?

A

The patellofemoral Q angle.

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59
Q

How is the patellofemoral Q angle measured?

A

First line goes from ASIS to center of the tibia. Second line goes from center of the patella to the tibial tuberosity. Then measure the angle.

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60
Q

What is the normal range for the patellofemoral Q angle?

A

5-15 degrees with a mean of 10 degrees.

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61
Q

What are the normal ranges for the patellofemoral Q angle for adult men and women?

A

Males- 8-10 degrees. Females- 10-12 degrees.

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62
Q

What does the patellofemoral Q angle affects?

A

The tendency of the patella to track laterally.

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63
Q

What does a larger Q angle lead to?

A

greater outward pull on patella (more lateral tracking of patella)

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64
Q

What affects the Q angle more, height or by the configuration of the pelvis?

A

Height therefore on average men have less of a Q angle because they are taller than the average woman

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65
Q

What is the patellofemoral ratio?

A

A ratio of distance; tibial tuberosity to patellar apex (inferior pole)/ height of the Patella (Patellar apex to base.)

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66
Q

What is a normal patellofemoral ratio?

A

one.

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67
Q

When would the patellofemoral ratio be considered low and what is this known as?

A

less than 0.8 aka Baja (the patella is too low/ patella tendon is too short)

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68
Q

When would the patellofemoral ratio be considered high and what is this known as?

A

More than 1.2 and this is aka alta. (the patella is too high or the length of tendon is too great or patella is too small)

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69
Q

What will a Warberg, magna and parva patella mean?

A

Warberg- too wedge shaped. Magna- too large. Parva- too small.

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70
Q

What will functionally increase and decrease the patellofemoral Q angle?

A

Increase- lateral/external rotation of the tibia. Decrease- medial/internal rotation of the tibia.

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71
Q

What will excessive foot flare do to the Q angle?

A

Increase the Q angle and lead to an unstable patella.

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72
Q

When will the patella be less stable with extension or flexion? Why?

A

Less stable with extension. Due to shallower groove.

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73
Q

What muscle was mentioned that if weak will make the patella less stable?

A

VMO. Also mentioned the medial retinaculum.

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74
Q

Will genu vagum or varum make the patella less stable?

A

Valgum.

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75
Q

What is the function of the VMO?

A

Holds the patella medially (stretched medial retinaculum can be from MCL sprain)

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76
Q

What muscle was mentioned that if too tight will make the patella less stable?

A

Vastus lateralis or ITB.

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77
Q

What shapes of the patella will make it less stable?

A

Too small or facet angle is too flat.

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78
Q

Will patella baja or alta make the patella less stable?

A

Alta.

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79
Q

What rotation of the tibia will make the patella less stable?

A

Externally rotated.

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80
Q

What foot position will make the patella less stable?

A

Pronation.

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81
Q

What position of the knee will make the patella more stable? Why?

A

Flexed knee. Due to deeper groove and increased compression force.

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82
Q

What muscle if strong will make the patella more stable?

A

VMO.

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83
Q

What will genu varum do to patellar stability?

A

Increase it.

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84
Q

What patellar shapes will increase patellar stability?

A

Normal, large lateral lip.

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85
Q

What will patella baja do to patellar stability?

A

Increase it but wil lead to increase wear and tear due to excessive compression.

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86
Q

What foot position will make the patella more stable?

A

Normal or under pronated.

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87
Q

Where is the thickest cartilage in the body found?

A

Patellofemoral joint

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88
Q

What type of large force is placed on the patellofemoral joint?

A

Compression.

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89
Q

Cartilage compression of the patellofemoral joint will increase with what knee position?

A

Flexion.

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90
Q

What will the comprssion forces be like on the patellofemoral joint with; walking, joggin, stair climbing (walking), Descending stairs (walking), 90 degree squat?

A

Walking- half of BW, jogging- 4 X BW, Stair climbing- 2.5 X BW, descending stairs- 3.5 X BW, 90 degree- 7.5 BW.

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91
Q

What will the compression forces on the patellofemoral joint be like with jumping?

A

10 X BW.

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92
Q

What are the compression forces on the patellofemoral joint like with full extension of the knee?

A

No compression force through this joint.

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93
Q

During flexion of the knee what direction will the patella travel?

A

It glides inferior and posterior in the patellar sulcus.

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94
Q

What part of the patella will contact the femur with; zero degrees of flexion, 20 degrees, 45 degrees, 90 degrees, 135 degrees?

A

zero- no direct contact, 20- distal or apex, 45- central, 90- proximal or base, 135- Lateral and medial part of patella.

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95
Q

How much will the extensor leverage of the patella increase with 90-120 degrees and 0-5 degrees flexion?

A

90-120- 13%. 0-5- 31%.

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96
Q

With a 5, 15, 30, 45, 75 degree squat how much of the body weight will the quadraceps be able to lift?

A

5- 30%. 15- 100%. 30- 200%. 45- 300%. 75- 500%.

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97
Q

Walking on a level surface produces _____ x BW on quadraceps tendon, jogging produces about ____ X BW on quadraceps tendon, and jumping produces about ____ X BW on Quadraceps tendon.

A

1, 5, more than 10.

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98
Q

What muscle would respond faster to tension and faster to stress the VMO or Vastus lateralus and why?

A

Tension- Vastus lateralus. Stress- VMO due to faster twitch.

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99
Q

What are the ligaments of the anterior compartment of the knee?

A

Medial and lateral retinaculum.

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100
Q

What will the medial and lateral retinaculum allow for with a quadraceps tendon injury?

A

Allow patient to still extend the knee.

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101
Q

What could cause a tear of the medial retincaulae of the knee?

A

Valgus sprains and patellar dislocations.

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102
Q

A medial retinacular tear would lead to what?

A

Lateral patellar instability.

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103
Q

What would a weak or stretched medial retinaculum or a tight lateral retinaculum cause?

A

Lateral patellar tracking.

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104
Q

Where will the ITB be located at and what compartment of the knee?

A

Lateral knee and is included in the anterior compartment.

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105
Q

What are the 2 parts to the ITB and where will it insert at?

A

Smaller patellar band, larger tibial band, and inserts on patella and Gerdy’s tubercle.

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106
Q

What would happen with a tight ITB?

A

Rubs on the lateral epicondyle of the femur and pulls on the patella. Leading to lateral tracking dysfunction.

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107
Q

What is a lateral release of the ITB?

A

CUT ITB and or lateral retincaulum leading to decreased tension on lateral patella.

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108
Q

What are synovial plica?

A

Remnant of 3 embryotic parts of the knee that if they remain can cause recurrent snapping and pain in the knee.

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109
Q

What are most synovial plica like?

A

Small and asymptomatic.

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110
Q

Which synovial plica is the most common?

A

Medial plica

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111
Q

What causes the growth of synovial plica?

A

Synovial membrane is innervated and therefore an increased inflammatory cycle which can cause scarring and progressive growth at the plica

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112
Q

What should be done with synovial plica?

A

No pain then leave alone, but if there is pain then they should be checked out.

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113
Q

What are the menisci made of?

A

Fibrocartilagenous.

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114
Q

How will the menisci help the joint articulation to fit?

A

Deepen socket and increases stability and congruency. Allow for flexible socket and this accommodates the egg shaped femoral condyles.

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115
Q

The menisci accommodate what type of movement? Why?

A

Slide which decreases shear

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116
Q

How will the menisci help reduce compression?

A

Force is directed to peripheray away from articular surfaces.

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117
Q

How much of the compressive load will the lateral and medial menisci direct to the periphery?

A

Lateral- 70%. Medial- 50%.

118
Q

With a partial and a total meniscectomy how much wear and tear increase will occur?

A

Partial- 50-60% increase in wear and tear. Total- 200-235% increase.

119
Q

What are the shapes of the lateral and medial meniscus?

A

Lateral- o shaped. Medial- C shaped.

120
Q

What are the designs of the lateral and medial meniscus and which one is injured most often?

A

Medial- skinnier, thinner, more fixed and is injured most often. Lateral- Stronger, more mobile and only about 25% of meniscus tears happen in the lateral menisci.

121
Q

What part ot the medial menisci will tear the most often?

A

The posterior horn.

122
Q

Where will the coronary ligaments attach to?

A

Inferior- tibia and menisci. Superior femur and menisci.

123
Q

Name the other attachments of the menisic besides the coronary ligaments?

A

Medial collateral ligament (meniscus to Intercondylar area), intermeniscal ligament, posterior meniscofemoral ligament, anterior meniscofemoral ligament, popliteus (to lateral meniscus), semimembranosus.

124
Q

What is another name for the posterior meniscofemoral ligament and what is its purpose?

A

Wrisberg and it stabilizes the posterior horn.

125
Q

What is another name for the anterior meniscofemoral ligament and what is its purpose?

A

AKA humphry and I donˍ脌 know its purpose but it is rare.

126
Q

What part of the menisci will the popliteus and semimembranosus attach to?

A

Popliteus- lateral meniscus. Semimembranosus- medial meniscus.

127
Q

What happens to the menisci with flexion of the knee?

A

They slide posterior.

128
Q

Which menisci will slide posterior the most with knee flexion and why?

A

Lateral because it is not attached to the Lateral collateral ligament.

129
Q

When flexed at the knee where will the focal weight bearing be at?

A

The posterior horn.

130
Q

Deep squats (over 90 degrees) will increase stress where?

A

Posterior horns.

131
Q

What happens to the synovial fluid of the knee joint complex when the knee is flexed?

A

It is squeezed in a posterior direction.

132
Q

What will support the posterior horn and the lateral meniscus?

A

Popliteus and meniscofemoral ligaments.

133
Q

What happens to the menisci with knee extension?

A

They slide anterior.

134
Q

Which menisci will slide anterior more with knee extension?

A

Lateral always

135
Q

Which menisci will deforme more with knee extension and why?

A

Medial because it is attached to the medial collateral ligament.

136
Q

What position is the knee in while fully extended?

A

Tight packed.

137
Q

What is the pressure on the menisici like with full extension?

A

More spread out so pressure is less.

138
Q

What happens to the synovial fluid of the knee joint complex when the knee is extended?

A

It shifts anterior.

139
Q

What motions can damage the meniscus?

A

Rotation, Flexion, Extension, Lateral Bending

140
Q

What does the menisci move with knee rotation?

A

With the femur and opposite the tibia.

141
Q

What happens to the medial menisci with internal rotation?

A

Medial- rotates anterior and is more prominent in anterior part of the medial joint line.

142
Q

What happens to the lateral menisci with internal rotation?

A

Lateral- moves posterior and deepr within the joint thus the lateral joint line deepens. MORE PRESSURE IS EXERTED ON THE MEDIAL MENISCUS WITH INTERNAL ROTATION.

143
Q

What happens to the medial menisci with external rotation?

A

Medial- joint deepens. PRODUCES MORE PRESSURE ON THE LATERAL MENISCUS.

144
Q

What happens to the lateral menisci with external rotation?

A

Lateral- rotates anterior into the anterolateral joint line.

145
Q

Abnormal movements of the menisci with fixation leads to what?

A

Meniscal tears.

146
Q

How can you prevent abnormal movements of the menisci with fixation?

A

Adjustments.

147
Q

What is the stress test that will test for movements/changes with VARUS and VALGUS?

A

Bohlers test.

148
Q

How is VARUS tested?

A

Pinches medial meniscus and tractions lateral meniscus thru coronary ligaments.

149
Q

How is the VALGUS test done?

A

Pinches lateral meniscus and tractions medial meniscus thru medial collateral and coronary ligaments.

150
Q

The potential for injury with the menisci is with what movement?

A

Any movement and creates a snap (type of crepitus)

151
Q

What are the common mechanisms of injury for the menisci?

A

Deep flexion, hyperextension, external rotation and valgus stress.

152
Q

What other conditions can cause symptoms to be similar to a meniscus tear?

A

Plica can be similar in presentation (snapping crepitus and edema)

153
Q

What is the old unhappy triad?

A

A severe knee injury involving damge to the medial meniscus, ACL, and MCL.

154
Q

What is the new unhappy triad?

A

A severe knee injury involving damge to the medial meniscus, ACL, and LCL.

155
Q

What is the healing of menisci like?

A

Poor healers since they are made of fibrocartilage and are mostly avascular.

156
Q

What is the blood flow like to the menisci?

A

Mainly avascular besides the outer 1/3 in young and healthy. If older and not healthy the outer menisci is more fibrous.

157
Q

Where will nutrients for the menisci come from?

A

Synovial fluid.

158
Q

What part of the menisci is most poorly supplied with blood?

A

Central portions especially the posterior horns.

159
Q

What is the innervation of the menisci like?

A

Outer part of meniscus with pain and proprioception @ junction with deep capsule.

160
Q

What happens to the menisci with age?

A

decreased vascularization, increased wear and tear, increased friability.

161
Q

Name the two collateral ligaments and both of their names?

A

Medial collateral ligament (MCL) aka tibial collateral ligament (TCL), Lateral collateral ligament (LCL) aka Fibular collateral ligament (FCL).

162
Q

What ligament is posterior to the LCL?

A

Poplitiofibular ligament (PFL).

163
Q

Where will the LCL attach to?

A

Lateral femoral epicondyle and fibular head.

164
Q

The LCL primarily resists what?

A

Varus stress.

165
Q

what are the 2 sprain mechanisms of the LCL?

A

Large varus stress and hyperextension.

166
Q

Where will the MCL attach to?

A

Medial femoral epicondyle and medial tibial condyle and shaft.

167
Q

What does the MCL primarily resist?

A

Valgus stress.

168
Q

What are the 2 sprain mechanismis of the MCL?

A

Valgus stess and hyperextension.

169
Q

Which ligament is larger the LCL or MCL?

A

Medial is larger.

170
Q

Which ligament is damaged more the LCL or MCL?

A

MCL.

171
Q

What will medial and lateral rotation do to the collateral ligaments?

A

medial- decreases tension on them. Lateral- increases tension on them.

172
Q

Which rotation, medial or lateral, allows for conjoint rotation?

A

Medial rotation allows conjoint medial rotation of tibial rotation that must accompany flexion

173
Q

If the collaterals limit medial rotation what action of the foot would it interfere with?

A

Decreased internal tibial rotation leads to decreased pronation

174
Q

What are the 3 parts to the posteromedial capsular complex of the knee?

A
  1. Posterior part of MCL. 2. Semimembranosis tendon and tendon expansion. 3. Oblique popliteal ligament.
175
Q

What will the posteromedial capsular complex of the knee resist?

A

Hyperextension, anterior translation, valgus stress, extremes of lateral tibial rotation.

176
Q

Name the 5 parts of the posterolateral capsular complex of the knee?

A
  1. Popliteofibular ligament. 2. LCL. 3. Arcuate ligament. 4. biceps femoris tendon and tendon expansion. 5. Popliteus.
177
Q

What will the posterolateral capsular complex of the knee resist?

A

anterior translation, hyperextension, varus stress, medial rotation and lateral rotation extremes.

178
Q

How is the posterolateral capsular complex of the knee palpated?

A

In a figure 4 pattern.

179
Q

What happens to the posterolateral capsular complex of the knee during knee flexion?

A

LCL- lax, PFL- tense.

180
Q

What will happen when the LCL is lax?

A

This allows the tibia to undergo its normal internal rotation(conjoint rotation).

181
Q

What will happen when the PFL becomes tense?

A

It doesnˍ脌 interfere with internal rotation; half as strong as the LCL.

182
Q

What is more resistant to anterior translation stability the LCL or PFL?

A

PFL.

183
Q

What is the order of ligament failure with increased carus stress?

A

LCL—> PFL—-> popliteus and acruate ligaments.

184
Q

Which ligament the PFL or LCL is more resistant to anterior translation?

A

PFL is more resistant to anterior translation

185
Q

What are the 2 cruciate ligaments?

A

ACL and PCL.

186
Q

Where are the cruciate ligaments found at in general?

A

Intracapsular and extrasynovial (outer lining by synovial membrane).

187
Q

What is the blood supply like to the cruciate ligaments?

A

they are relatively hypovascular however the synovial lining is highly vascular.

188
Q

What is the significance of a highly vascular synovial lining of the cruciate ligaments?

A

If the ligaments rupture then bleeding would occure and this is calle dhemarthrosis.

189
Q

Where will the anterior cruciate ligament attach to?

A

anterior tibial plateau and anterior tibial spine to the medial aspect of the lateral femoral condyle.

190
Q

Which cruciate ligament is largest?

A

Posterior is largest.

191
Q

What are the parts of the ACL?

A
  1. Anterior band. 2. Posterior band.
192
Q

What will the tension be like on the ACL during different positions?

A

Always tense. Since the anterior band is tense when knee is flexed and posterior band is tense when knee is extended.

193
Q

The ACL is primaraly resistint to what?

A

anterior tibial translation.

194
Q

Why will 3/4 of all knee hemarthrosis involve the ACL?

A

Because it supports the blood vessels of the femur.

195
Q

What is the name of the test for tibial translation joint play?

A

Anterior drawer test.

196
Q

Why are there so many ACL injuries in female athletes?

A

When running, cutting and jumping, girls exhibit less upper body strength and control

197
Q

What muscles do females rely on for deceleration of the lower extremity?

A

Females rely more on quadriceps (increases tension on ACL) rather than hamstring, gluteal and calf muscles. Also, females are more likely to land from a jump with the knees in a genu valgum position

198
Q

What is the most common ligamentous problem?

A

MCL Sprain

199
Q

Where will the PCL attach to?

A

Attaches to the lateral aspect of medial femoral condyle to posterio proximal tibia (NOT TO THE TIBIAL PLATEAU).

200
Q

The PCL crosses _______ to the ACL.

A

Posteromedial.

201
Q

Which ligament is stronger the ACL or PCL and by how much?

A

PCL is 2X as strong as ACL.

202
Q

The PCL is also always tense but it is least tense when?

A

with 25-40 degrees flexion.

203
Q

What are the parts of the PCL?

A

smaller anterior and larger posterior bands.

204
Q

The PCL is primarily resistant to what?

A

Posterior translation.

205
Q

What is the gravity sag sign and what will it mean?

A

It is posterior sagging of tibia when supine/ knee bent postion and it is a tear of the PCL.

206
Q

What is the most serious ligmaentous injury of the knee?

A

ACL.

207
Q

Which Cruciate ligament will be less likely to require corrective surgery when torn?

A

PCL.

208
Q

What muscle protects the PCL?

A

Quadriceps

209
Q

What muscle protects the ACL?

A

Hamstrings

210
Q

Why will the PCL be less likely to requrie surgery if torn?

A

Massive contribution of quadraceps.

211
Q

What is the test for posterior tibial translation joint play?

A

Posterior drawer test.

212
Q

When will the cruciate ligaments twist around each other and then when will they untwist?

A

Twist- internal rotation. Untwist- external rotation.

213
Q

During what rotation is sthe ACL weaker and more likely to tear?

A

During internal rotation

214
Q

What motion of the foot can lead to increased twisting and eventual ACL failure?

A

Increased pronation of the foot

215
Q

Injury to the ACL increases pronation and this leads to what?

A

Increased twisting and increased stress.

216
Q

What is the secondary stabilizers of the knee?

A

Dynamic stability of muscle contractions.

217
Q

What will happen to the knee with isometric contraciton during a sustained squat?

A

about 60% decrease in rotational laxity and about 300% increase in joint stiffness.

218
Q

What is the difference between closed and open chain with the knee complex?

A

Closed- increases co-contraction compared with open chain (increased velocity —> increased con-contraction of antagonists).

219
Q

What three muscle groups need to be balanced for a stable knee complex?

A

Quads - hams, medial tibial rotators (pes answerine/popliteus) and lateral tibial rotators (ITB/biceps)

220
Q

what is the difference between quads and hams with slow and fast contraction?

A

Q:H slow 60:40. Fast- 10:9

221
Q

What muscle is most importatn to the patellar stability?

A

VMO.

222
Q

What muscle is reflexivley faster the VMO or the VL?

A

VMO.

223
Q

Which muscle will atrophy faster the VMO or the VL?

A

VMO.

224
Q

What is the priamry and seconary stabilizer for anterior translation?

A

1- ACL, PFL. 2- hams and ITB.

225
Q

What is the priamry and seconary stabilizer for posterior translation?

A

1- PCL, s -quads and popliteus.

226
Q

What is the priamry and seconary stabilizer for valgus?

A

1- MCL. 2- Medial retinaculum, poplteus, medial hams and pes anserine.

227
Q

What is the priamry and seconary stabilizer for varus?

A

1- LCL. 2- lateral retinaculum, ITB, and biceps tendon.

228
Q

What is the priamry and seconary stabilizer for flexion?

A

1- PCL (anterior bundle) 2 - quadraceps (no ligaments).

229
Q

What is the priamry and seconary stabilizer for extension?

A

1- ALL and cruciate ligaments. 2- hams, gastroc, popliteus.

230
Q

What is the priamry and seconary stabilizer for medial rotation?

A

1- cruciates and posterior capsule. 2- lateral retinaculum, ITB, Biceps tendon.

231
Q

What is the priamry and seconary stabilizer for lateral rotation?

A

1- collaterals and posteriomedial capsule. 2- medial retinaculum, poplieus, medial hams and pes anserine.

232
Q

Damage to the ACL and lateral complex will lead to what type of instability?

A

Anterolateral rotational.

233
Q

Damage to the ACL and medial complex will lead to what type of instability?

A

Anteromedial rotational.

234
Q

Damage to the PCL and lateral complex will lead to what type of instability?

A

Posteriolateral rotational.

235
Q

Damge to the PCL and medial complex will lead to what type of instability?

A

Posteromedial rotational.

236
Q

What are the bursae found within the joint cavity?

A

1) Suprapateller bursa 2) Popliteal bursa 3) gastrocnemius bursa

237
Q

What is a baker’s cyst?

A

Swollen posterior bursa

238
Q

What other bursae of the knee are not connected to the joint cavity?

A

1) Prepatellar 2) infrapatellar 3) pes answerine 4) ITB

239
Q

How is fluid moved within the joint cavity and bursae?

A

Fluid movement occurs with flexion and extension

240
Q

Where is the hip joint found?

A

Between the acetabulum and the femoral head.

241
Q

The hip joint in general is unstable in who?

A

Infants especially female and northern european infants.

242
Q

What % of congenital hip dislocations are female?

A

90%.

243
Q

What are the 3 parts of the acetabulum and where are they located at?

A

Ilium- superior, Iscium (posteroinferior), pubis- anteroinferior.

244
Q

What is the difference between the acetabular brim and notch?

A

The brim is 4/5 of a full circle and the notch encloses the anteroinferior 1/5.

245
Q

What is the thickest cartilage of the hip joint?

A

The superior semilunar cartilage because it is the main weight bearing region.

246
Q

What are the other cartilage of the hip joint (besides the superior semilunar cartilage)?

A

Labrum and trans. Ligament.

247
Q

Where will the labrum and transverse ligament be at and what are they made of?

A

Labrum- upper 4/5 of ring. Transverse ligament- the inferior part that covers the notch. Both are made of fibrocartilage.

248
Q

What is the anteversion angle like for the acetabulum in males vs. females and infants?

A

Larger angle for females. Infants- more anterverted than adults.

249
Q

Increased anterversion of the acetabulum will do what?

A

Decrease stability.

250
Q

What will inferior acetabular tilt be like for males vs. females, and adults vs. infants?

A

Males larger than females. Adults greater than infants.

251
Q

Increased inferior tilit of the acetabulum will do what?

A

Increase stability as it puts a greater cap over top of the hip

252
Q

What is the shape of the femur head?

A

2/3 sphere and larger in diameter thatn the acetabulum @ labrum.

253
Q

What are the 2 keeper rings?

A

Labrum and zona orbicularis of the capsule.

254
Q

What is the articular cartilage of the femur head like?

A

Thickest superior since all pressure is here.

255
Q

Where is proximal physis of the femur located at and this causes what?

A

It is proximal to the neck and this creates a lot of shear force as we grow.

256
Q

When will a slipped capital femoral epiphysis be seen?

A

Slipped capital femoral epiphysis happens d/t increased growth and shear In early teens and tall and large people. More common in males.

257
Q

What does trochanter mean?

A

To turn.

258
Q

During growth what normally happens to the distal femur?

A

twisted medially relative to the proximal end.

259
Q

What is the normal, anterverted and retroverted angles of the femoral torsion?

A

Normal- 10-20 degrees. Anteverted- >20degrees. Retroverted- <10 degrees.

260
Q

What will make the hip more and less stable anterverison or retroversion?

A

Anterversion- less stable. Retroversion- more stable.

261
Q

What is femoral inclination?

A

Draw a line directly through the center of the fovea capitis femoris. Then draw another line parallel to the long shaft of the femur and then measure the inside angle

262
Q

What is the normal femoral inclination angle?

A

120-130 degrees.

263
Q

What will femoral inclination angles of >130 and <120 mean?

A

> 130- coxa valga- less stable hip. <120- coxa vara- more stable hip.

264
Q

What is the femoral inclination angle like at birth?

A

150 degrees.

265
Q

Coxa vara is often seen in who?

A

The elderly.

266
Q

Coxa vara will make the hip more stable, but what is the negative trade off to coxa vara?

A

More shear stress on femoral neck increases the risk of fracture.

267
Q

Both coxa vara and valga cause what?

A

Abnormal wear and tear on articular surfaces and may lead to osteoarthrosis.

268
Q

Will increased abductor or adductor strength make the hip joint more or less stable?

A

Increased abductor- increases stability. Increased adductor- less stable.

269
Q

Will extension, external rotation and abduction make the hip joint more stable?

A

yes.

270
Q

Will flexion, internal rotation, and adducted position make the hip joint more stable?

A

No it makes it unstable.

271
Q

Will increased or decreased acetabular anteversion favor hip joint stability?

A

Decreased acetabular anteversion

272
Q

Will increased or decreased inferior acetabular tilt favor hip joint stability?

A

Increased inferior acetabular tilt

273
Q

Will femoral anteversion or retroverion favor hip joint stability?

A

Femoral Retroversion

274
Q

Will coxa vara or coxa valga favor hip joint stability?

A

Coxa Vara

275
Q

Will a male (android pelvis) or female (gynecoid pelvis) favor hip joint stability?

A

Male/android pelvis

276
Q

Will being an adult or infant favor hip joint stability?

A

Adult

277
Q

What are the 3 types of femoral trabeculae?

A
  1. vertical- compression on femoral head. 2. Acruate- bending of neck. 3. Intertrochanteric- torsion between trochanters.
278
Q

What happens to the femoral trabeculae with age?

A

Vertical trabelculae are saved and others are depleted in osteoporosis.

279
Q

Loss of the arcuate and intertrochanteric trabeculae in elderly leads to what?

A

Femoral neck fracutures in the weak cortical zone.

280
Q

Pelvic trabeculae direct forces from acetabulum to where?

A

SI.

281
Q

What is gynecoid?

A

Like a women.

282
Q

What are gynecoid pelvic lines of stress like?

A

Larger oval outlet.

283
Q

What are android pelvic lines of stress like?

A

Smaller heart haped outlet.

284
Q

What are the lines of force transfer like for the pelvic lines of stress while sitting and standing?

A

Sitting- ischium —> SI joint and sacrum. Standing- femur —-> SI joint and sacrum.

285
Q

What are hip joint ligaments like?

A

Very strong.

286
Q

How many tight packed positions of the hip are there?

A

Two and it is one of the most stable joints in adults.

287
Q

What are the two tight packed positions of the hip?

A

Figure 4 (extended, adducted, internally rotated) and Flexed, internally rotated and adducted position in side posture

288
Q

Why are the ligaments of the hip joint relatively unstable in infants?

A

Because of the ligaments being lax from relaxin from mom

289
Q

What is the shape of the iliofemoral ligament and it is aka?

A

Y and aka ligament of bigalow.

290
Q

What is the hip ligament that is not structurally significant and why is it there?

A

Ligamentum teres and it mainly supports Blood vessels.

291
Q

Which hip ligament is the strongest?

A

Y-ligament aka iliofemoral ligament aka ligament of bigalow.

Biomechanics 4 (Carnes) (11 decks)

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