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711 Kinesiology > the knee > Flashcards

the knee Flashcards

1
Q

purpose of knee

A

allow bending to clear foot during gait, to lower the body and COM and to transfer forces

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2
Q

what stabilizes the knee

A

muscles, ligaments, and mensci provides stability

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3
Q

what are the 3 facets

A

medial, odd, and lateral facets

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4
Q

top of patella

A

base

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5
Q

bottom of patella

A

apex

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6
Q

true or false: medial facet is larger and has a larger meniscus

A

true

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7
Q

Femoral/tibial condyles

_____ ________is not concave in all areas - slightly convex in some areas

A

tibial plateau

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8
Q

____ _____ is steeper and higher on lateral side to protect form lateral dislocation

A

femoral condyle

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9
Q

true or false: femoral condyle is smaller than tibial condyles (poor congruence)

A

false: femoral condyle is larger than tibial condyles

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10
Q

what helps with screw home mechanism

A

the curve of medial condyle

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11
Q

what is Q angle

A

its the angle between femoral and tibial shaft - male is 12 degree and female is 16 degree

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12
Q

is it normal to have a mild gene valgum and why?

A

extension of the femoral condyle and hip angle of inclination

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13
Q

increase of q angle will cause

A

increase of gene valgum

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14
Q

the importance of synovium

A

it projects inward to exclude the ACL/PCL form the synovial cavity, so they are intra-articular but extrasynovial ligaments

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15
Q

what communicates with the joint cavity

A

supra patellar bursa

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16
Q

what is a vestigial remnant of mesenchymal tissue - not uncommon, but not considered normal

A

plicae

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17
Q

true or false: plicae can also be normal folds in the capsular tissue that just become pathologically thickened

A

true

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18
Q

plicae can remodel over time, but may not, and when it remains, it can become ____ and cause friction related pain from rubbing on articular cartilage

A

thickened

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19
Q

true or false: if you have plicae it is common have it surgically removed

A

true

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20
Q

name the main three bursa

A

infra patellar bursae
prepatallar bursae
suprapatallar bursae

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21
Q

purpose of infrapatellar fat pad - what could happen after surgery

A

protection; can get impinge

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22
Q

true or false: you can get as many as 13 bursae

A

false: 14

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23
Q

what is Hoffa Syndrome

A

the scarring after a BPTB graft and there’s impingement on the infrapatellar fat pad. impingement of the joint that causes pain

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24
Q

purpose of ligaments and tendon

A

stabilize and guide arthorkinematics

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25
Q

tendons actively ____ osteokinamtic motino

A

induce

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26
Q

ligaments, capsule and retinaculum passively ___ arthrokinematics

A

guide

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27
Q

MCL has

A

superficial and deep fibers

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28
Q

purpose of superficial fibers

A

provide major restraint to values forces at the knee

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29
Q

true or false: MCL is more taut in full flexion

A

false: full extension

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30
Q

Deep fibers of MCL is more often injured due to?

A

they experience more than 20% stretch so they are usually injured more frequently

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31
Q

collaterals can stretch ____ normally

A

20 percent

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32
Q

description of Lateral collateral ligament

A

extra capsular, feels ropy, or like a pencil, major restraint to arms force at the knee

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33
Q

ACL is taut in

A

EXTENSION

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34
Q

PCL is taut in

A

flexion

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35
Q

AM and PL buddies are parallel, so both are fairly taut. in flexion, AM bundle is ____ and PL bundle is ____

A

taut, loose

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36
Q

true or false: it is difficult to mimic both bundles in grafts, so the repair is never quite the same as the original

A

true

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37
Q

why does curates don’t heal on their own

A

they are bathed in synovial fluids and it washes away any clotting that occurs

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38
Q

intracapsular but extrasynovial - posterior invagination of the synovium excludes the ______ ______ from the synovial cavity

A

cruciate ligaments

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39
Q

purpose of menisci

A

reduce stress, disperse force and provide proprioception

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40
Q

menisci compress and bulge; tear causes _____ of hoop stresses

A

loss

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41
Q

MOI of menisci

A

forceful, axial rotation of the femoral condyles over partially flexed and weight bearing knee

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42
Q

lateral tibial articular surface is ____ to _____. medial is ___

A

flat to convex
concave

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43
Q

meniscal attachments to the tibia is known as ____

A

horns of menisci

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44
Q

purpose of coronary ligaments

A

provide further mescal attachment to tibia (can mimic meniscal tear when irritated)

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45
Q

quads and hamstrings send slips to the menisci to

A

move them during motion to match position of femur

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46
Q

coronary ligament are loose to allow for ____ ______

A

meniscal movement

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47
Q

transverse ligament connects the two menisci and prevents ____ _____ of the anterior horns

A

anterior translation

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48
Q

transverse ligament connects the 2 _____

A

menisci

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49
Q

true or false: medial menisci is greater than lateral menisci

A

true

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50
Q

medial meniscus attached to capsule and therefore to MCL; lateral meniscus attached to capsule only therefore LCL is

A

extra capsular

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51
Q

valgus force to lateral side sprains

A

MCL and tears meniscus via coronary/capsule/MCL connections to ligament

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52
Q

medial meniscus covers smaller percentage of tibial plaque - more direct contact femur/tibia resulting increase of ____-

A

OA

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53
Q

true or false: medial is more resilient and lateral is more likely to get injured

A

false: lateral is more resilient and medial is more likely to get injrued

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54
Q

other third of the menisci gets more blood but you move inward you lose vascularization meaning?

A

less blood flow

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55
Q

passive stability:

A

oblique popliteal ligament reinforces the posterior capsule

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56
Q

active stability:

A

popliteus

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57
Q

cause of evolute

A

shapes of bone, cartilage and menisci, as well as pull of ligaments at different degree of motion

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58
Q

tibia on femur

A

OKC

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59
Q

femur on tibia

A

CKC

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60
Q

screw home mechanism OKC:

A

Tibial ER on fixed femur during full extension - flexing will unlock it (IR of tibia)

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61
Q

screw home mechanism CKC:

A

Femoral IR on fixed tibia during standing (full ext) - squatting (bending) will unlock it (ER of femur)

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62
Q

what are three factors that causes screw home mechanism

A
  • shape of medial femoral condyle
  • tension in ACL
  • Lateral pull of quads
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63
Q

screw home is called conduct and does not occur during isolation. when does it occur?

A

during extension and releases during flexion

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64
Q

What does screw home mechanism help with?

A

improves congruency and stability in extension (standing)

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65
Q

what muscle best facilitate the unlocking of knee flexion and rotation

A

popliteus

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66
Q

which meniscus moves farther and why?

A

lateral moves farther because its not attached to LCL - therefore its more mobile

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67
Q

what happens to the menisci during femoral roll in flexion?

A

moves posteriorly

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68
Q

what happens to the menisci during femoral roll in extension?

A

moves anteriorly

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69
Q

what muscle are taut in flexion?

A

PCL

70
Q

what muscles are taut in extension?

A
  • ACL
    -MCL
  • oblique popliteal ligament
71
Q

most ligaments get more loose in ______?

A

flexion
- ACL, MCL, Posteromedial capsule, oblique popliteal ligament, LCL

72
Q

what happens if you have a loss of ACL?

A

loss of majority of knee stability

73
Q

what muscle provide a posterior glide of the tibia in which it helps with protecting the ACL

A

hamstrings

74
Q

_____ provides 85% of passive resistance to anterior glide

A

ACL

75
Q

MOI to ACL

A

foot paneled, large valves force, axial rotation either direction, hyperextension (can also be flexed)

76
Q

why does cruciate ligament not heal on its own?

A

bathed in synovial fluid

77
Q

why does ACL not regain full strength and function after torn?

A

takes time for graft to revascularize and goes through necrosis until vascularization is complete

78
Q

true or false: women is 5x higher at risk for ACL tear compared to males

A

true

79
Q

reasons why ACL are higher risk of ACL tear?

A
  • smaller ACL, wider pelvis, increase in Q angle
  • hormones - estrogen
  • neuromuscular control- lack of ability to control dynamic valgus
    -stiffer landing form jump
  • less muscle mass or strength
  • greater quad/ham ratio on lading
80
Q

PCL is taut in?

A

flexion

81
Q

what muscle is the secondary restraint if PCL is ruptured

A

popliteus

82
Q

true or false: PCL is thinner than ACL and injured more frequently

A

false: PCL is thicker and injured less frequently

83
Q

MOI of PCL

A

dashboard injury

84
Q

patella is ____ on femur in flexion but _____ in extension

A
  • inferior
  • anterior
85
Q

patellofemoral (patella) - in flexion the pull the quads and tendons causes?

A

higher JFR

86
Q

greatest patellofmeroal contact comes at what degrees?

A

60 to 90 degrees

87
Q

in full extension, out of the groove, apex of the patella has the most contact what should you avoid?

A

avoid exercise if pain is at the apex or inferior pole

88
Q

at 90 degree of the patella, the contact is more at the base of the patella, and you’re having pain near quad tendon, which position should you avoid exercising?

A

avoid exercises that are in deeper flexion

89
Q

patellofemoral motions: three axes of motion

A
  • tilt
  • flex/ext
  • spin
90
Q

medial lateral tilt of the patellofemoral happens in what axis

A

vertical axis

91
Q

nodding and shift (flexion/extension) of the patellofemoral happens in what plane

A

sagittal plane

92
Q

spinning of patellofeoral happens in what axis

A

z axis

93
Q

the actual motion oof patellofemoral motions is included by

A

shape of notch, femoral position (rotation) , and tension in reticular fibers

94
Q

function of the patella

A

space sesamoid bone that increases MA - MA greatest at 20-60 degree of flexion

95
Q

3 factors determine MA

A
  • shape and position of patella
  • shape of distal femur
  • migrating medial/lateral axis
96
Q

patellectomy

A

patella increase strength of quads so more force required todo same task without patella

97
Q

compressive force (with an equal and opposite patellofemoral JRF)

A

determined by quad force and joint angle

98
Q

why is compressive force higher as the squat gets deeper?

A

patella is interposed with extensor mechanism, so patellar tendons dan quads pull in opposite direction causes a compressive force that increases with flexion in CKC

99
Q

different compressive forces on PFJ with different activities (walk vs SLR vs starts vs deep knee bend)

A
  • walking: 1.3x
  • SLR: 2.6x
  • Stairs: 3.3x
  • Deep knee bend: 7.8
100
Q

why is SLR Cf higher than walking?

A

due to high quad force in full extension OK plus smaller particular contact, so force is focused on smaller area

101
Q

PFPS

A

patellofemoral pain syndrome - most common knee pathology treated in PT

102
Q

best positions to do exercise to reduce PFJ stress :

A

0-45 degree CKC, 90-45 degrees OKC

103
Q

patellar tracking is affect by

A

muscle pull, ITB, retinaculum

104
Q

quad pulls ____, _____ ,and ___

A
  • laterally
  • posteriorly (stabilizes but also compresses PFJ)
  • medially
105
Q

vastus lateralis oblique has a _____ PCSA, which can lead to _____ tracking

A

large
lateral

106
Q

normal range for q angle

A

13-15

107
Q

ITB can pull patella ______

A

laterally

108
Q

purposes of posterior pull

A

stabilization, especially in full extension, when patella is out of the groove

109
Q

local factors in pathologic lateral patellar traciking

A
  • bowstringing and q angle
  • ITB
  • lateral patellar fibers
110
Q

mitigating force

A
  • CMO
  • lateral femoral condyle
  • medial reticular fibers; medial patellofemoral ligament
111
Q

global factors in pathologic lateral patellar tracking

A
  • anything that places knee in valgus or medial axial rotation extreme or shallows the groove will case lateral tracking
112
Q

what could cause more bow straining

A

increased valgus, coxa vara, pronated feet, hip abudctor weakness, ER weakness, IR tightness

113
Q

surgery for patellar tracing

A

treatment will focus on minimizing scarring restrictions, correcting faulty mechanics, restoring functional strength/ROM

114
Q

muscle extensors

A

VL, RF, VML, VMO

115
Q

___ produce 80% of torque, ___ is other 20%

A

Vasti, rectus femoris

116
Q

what attach to menisci

A

lateralis and medialis attach to the menisci

117
Q

what has the largest x section

A

lateralis

118
Q

what projects farther distally

A

medialis: two fibers - longus and obliquus

119
Q

what pulls anterior capsule

A

articularis genu

120
Q

deep fibers of the vast are attached to capsule and keeps the capsule from getting _______ in _______

A

impinged in extension

121
Q

different pulls of the quadriceps muscles helps with

A

stabilization and medial stability to counteract lateral subluxation/dislocation

122
Q

extensor function

A

isometric
eccentric
concentric

123
Q

normal quad and hamstring ration

A

50-80 % and lower in females

124
Q

extensor function - isometric purpose

A

stabilization

125
Q

extensor function - eccentric

A

controls rate of descent of COM, shock absorption, extent of flexion, dampens impact of loading - deceleration; force dissipation; shock absorption

126
Q

extensor function - concentric

A

accelerates tibia or femur toward extension, raise COM - acceleration propulsion

127
Q

external torque against extensors - torque in OKC

A

increase from 90 to 0 deg (most in full ext, least in flexion)

128
Q

external torque against extensors - torque in CKC

A

decrease from 90 to 0 (most in deep squat, least in standing upright)

129
Q

trade offs-

A

CKC more functional and more joint congruence, but also more JRF

OKC less functional, less congruent, but less likely to increase JRF

130
Q

max internal torque is greatest at

A

around 45 deg (max leverage due to longest moment arm)

131
Q

why is max torque between 3-80 degrees when max leverage is 20-60 degrees

A

leverage depends only on moment arm , torques also condor force and distribution of mass

132
Q

3 areas to consider internal torque

A
  • MA (leverage)
  • CSA
  • length tension - number of cross bridges
133
Q

function - what arc of motion is where most functional activities re performed

A

squats
sports
sit to stand

134
Q

true or false: internal torque is smallest at full extension

A

true: greatest at 20-60

135
Q

in flexion, quads have superior line of pull and hamstrings pull posterity so both are redoing _____.

A

ACL strain while stabilizing joint

136
Q

with extension, get anterior translation of tibia on femur (strain on graft) - flexion protects

A

graft

137
Q

co-contraction of ____ can help mitigate glide of tibia

A

hamstrings

138
Q

what is extensor lag

A

internal torque decreases to minimum - just as external torque is at maximum
- weakness of quad - causes inability to extend fully

139
Q

muscles of flexors/rotators

A

hamstrings
sartorius
gracilis
popliteus
gastroc

140
Q

which muscle is the key to unlock screw home mechanism through flexion and rotation

A

popliteus

141
Q

IR of ___ on femur in OKC - screw home mechanism

A

tibia

142
Q

ER of ____ on tibia in CKC - screw home mechanism

A

femur

143
Q

true or false: popliteus is the only rotator in extension with good leverage and stability for unlocking the extended knee ( other rotators have but leverage at 70-90 deg flexion)

A

true

144
Q

gastric only ____ the knee

A

flex

145
Q

rotation is most free with ___

A

flexion

146
Q

rotation with extension is near ____ - only comes from hip

A

zero

147
Q

during swing phase, is tibia on femur or femur on tibia?

A

tibia on femur

148
Q

purpose of concentric quad into extension during gait

A

accelerate and lift during the swing phase of gait

149
Q

purpose of eccentric hamstrings and hip extensors

A

decelerate during terminal swing of gait

150
Q

contraction of vast stretches distal semitendonisus: purpose of this is to?

A
  • store entry to help with hips extension effort of proximal semitendinsosus and glute max
  • slows contraction velocity creating higher force production
151
Q

semitendinosus is _____ = transfers energy from contracting vast to extending hip

A

transducer

152
Q

concentric quad =

A

stretch of HSs

153
Q

low contraction of HS =

A

high force production

154
Q

glute max contraction =

A

stretch of rectus femoris

155
Q

patients with glute weakness tends to do what during their gait to compensate for their weak hip extensors

A

lead backward

156
Q

leaning backwards decreases hip flexion moment which results in?

A

causes less load on glute max and hamstring

157
Q

backward leaning will have an increases in knee flexion moment by brining the GRF further behind the knee axis resulting in

A

increases load on quads to maintain knee extension - increases load on patellofemoral joint, leading to OA and/or uses

158
Q

backward lean causes increase of the ankle plantar flexion moment by bringing GRF behind ankle axis results in

A

increases load dorsiflexors

159
Q

why does medial compartment have more incidence of did?

A

GRF is medial to knee and causes various torque or moment.
- also doesn’t have as much freedom as lateral compartment, and it is more exposed due to C-shaped medial meniscus

160
Q

true or false: virus increases medial compression

A

true

161
Q

causes of valgus deformity

A

coxa vara, obesity, stretched MCL, genetics, mm weakness(foot)

162
Q

symptoms of valgus collapse

A
  • lateral hip stress
  • anterior hip impingement
  • ITB stress
  • weak glutes
  • MCL strain
163
Q

genu recurvatum and treatment

A

weakness of hamstrings - stretches posterior capsule/ligaments and the problem keeps getting worse

treatment: strengthen HS, bracing, heel lifts

164
Q

osgood schlatter’s

A

ensthesis issue (patellar tendon pulls its bony attachment away from the tibia, new bone growth fills the gap

165
Q

tenonditis

A

true inflammation, swelling

166
Q

tendinitis/tendinopathy

A

chronic pain with no signs and symptoms of inflammation

167
Q

bakers cysts

A

ballooning of post joint capsule - irritation of bursa between gastric and semimembranosus

168
Q

PFPS

A

anterior knee pain - patellar tracking, abnormal joint mechanics, overuse, mobility issues, neuromuscular control issues, mm weakness

169
Q

chondromalacia patella

A

softening/breakdown of retropatellar cartilage (usually due to disuse)

170
Q

unhappy train

A

ACL
MCL
medial meniscus

711 Kinesiology (11 decks)

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