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Anatomy > The Knee > Flashcards

The Knee Flashcards

1
Q

The primary functions of the knee:

A

Support body weight
Locomotion - squatting, running etc

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2
Q

Structure and the 3 joints:

A

Knee joint - femur and tibia
Patellofemoral joint - femur and patella
Proximal tibiofibular joint - tibia and fibular

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3
Q

Bony landmarks of distal femur:
Anterior -

Posterior -

A

Anterior - adductor tubercle
Medial and lateral Epicondyles
Lateral buttress wall (proximal to lateral Epicondyle and prevents lateral and superior displacement of patella)
Patella surface

Posterior - linea aspera
Medal and lateral supracondylar lines
Medial and lateral condyles
Adductor tubercle
Inercondylar fossa

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4
Q

Bony landmarks proximal tibia:
Anterior -

A

Anterior - medial and lateral tibial condyles
Tibial plateau
Intercondylar eminence (medial and lateral tubercles)
Tibial tuberosity
Anterior tibial crest

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5
Q

Bony landmarks of proximal fibula
(Sit laterally and slightly inferior to tibia) -

Bony landmarks of patella -

A

Head and neck of fibula
Apex of fibula
Interosseous membrane

Patella - Sesamoid bone
Within quadriceps tendon
Patella tendon
Triangular shaped
Base of patella (superior)
Apex (inferior)
Medial and lateral borders

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6
Q

Knee joint classification -

A

Tibiofemoral joint
Synovial modified hinge joint
2 degrees of movement - flexion/extension
Medial and lateral rotation (minor)

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7
Q

Knee joint surfaces classification -
Tibia -

A

Tibia - flatter peripherally and covered in semi-lunar cartilage (menisci)
Medial tibial condyle projects further to accommodate the medial femoral condyle
Covered in articular cartilage

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8
Q

Mensici overview -

A

Enhance tibia-femoral joint stability by deepening tibial articular surface
Acts as a shock absorber
Conforms to changing shape of femoral condyles during knee movement
Outer borders are thick and vascular
Inner borders are thin and avascular
Medial menisi is more C shaped
Lateral is more O shaped
Have two horns - anterior and posterior
Medial mensici is less mobile and therefore more easily damaged

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9
Q

The knee joint (tibiofemoral)
Lateral menisci attachments -

Medial meniscus attachments -

A

Lateral:
Anterior horn - anterior intercondylar eminence posterior to ACL
Transverse and coronary ligaments
Posterior horn - posterior area anterior to posterior horn of medial meniscus

Medial:
Anterior horn - intercndylar area and ACL transverse and coronary ligaments
Posterior horn - PCL and posterior horn of lateral meniscus blends with capsule and medial collateral ligament.

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10
Q

Classify the patellofemoral joint -

A

This is the kneecap joint
Synovial saddle joint and is between the patellar and femoral articular surfaces

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11
Q

Patellofmoral joint:
Patella articular surface-

A

Medial, lateral and odd articular facets
Lateral patella facet is the largest
Odd facet (most medial) only contracts medial femoral condyle in full knee flexion
‘V’ shaped patella groove on anterior surface of the distal femur articulates with patella.

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12
Q

Why is the patella needed?

A

Patella is a crucial fulcrum for ease of knee extension.

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13
Q

Classify Proximal tibiofibula joint-

Articular surfaces -

A

Synovial plane joint

Articular surfaces: head of fibula, tibial lateral condyle, capsule attached around joint margins

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14
Q

Ligaments present at the proximal tibiofibula joint -
Movement?

A

Anterior and posterior ligaments of fibula head
Small rotational movements during ankle DF/PF at this joint.

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15
Q

Position of synovial membrane at knee joint -

A

Synovial membrane projects posteriorly to envelop but exclude the cruciate ligaments.

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16
Q

Ligaments of the knee joint -
1) lateral collateral ligament: attachments and limits -

A

Proximal - lateral femoral Epicondyle
Distal - apex head of fibula
Limits - varus movement of the tibia on the femur
No connection with capsule or meniscus

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17
Q

Ligaments of knee joint:
2) medial collateral ligament: attachments and limits -

A

Proximal - medial femoral Epicondyle
Distal - shaft of tibia
Limits - vagus movement of tibia on the femur
Connects with capsule of meniscus

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18
Q

Ligaments of the knee:
3) anterior cruciate ligament: attachments and limits -

A

Proximal - posterior part of intercondylar area of lateral femoral condyle
Distal - anterior intercondylar area of tibia
Limits - anterior translation of the tibia on the femur and therefore prevents anterior displacement.

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19
Q

Ligaments at the knee joint:
Posterior cruciate ligament: attachments and limits -

A

Proximal - lateral surface o medial femoral condyle
Distal - posterior part of intercondylar area of tibia
Iimits - posterior translation of the tibia on the femur
ACL and PCL are in a cross shape

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20
Q

Soft tissues of the knee
Bursa overview -

A

Small sacks of fluid
Their main function is the prevent friction of other soft tissues
There are many in the knee

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21
Q

Name the different bursa present in the knee:

A

Suprapatella bursa - superior to patella
Prepatella bursa - anterior to patella
Subcutaneous infrapatella bursa - below patella
Deep infrapatella bursa - deep to patella tendon
Pes anserine bursa
Semimembranosus bursa - posterior to patella

22
Q

Morphology and stability of the knee
Q angle -

A

Angle between the quadriceps and patellar tendon
Measured as angle between line from ASIS to centre of patellar and line from centre patellar to tibial tuberosity.
Represents angle of quadriceps muscle force
Q angle tends to be larger in females due to wider pelvis

23
Q

Anatomical variance at knee:
Varus -
Valgus -
Genu recurvatum -

A

Varus - knee moves more laterally
Valgus - (knock knee) knees move medially
Genu recurvatum - hyperextension

24
Q

Stability of knee joint in standing -

A

When standing the knee joint is in a locked position
This reduces the amount of muscle work needed to maintain the standing position
Medial rotation of the femur on the tibia will occur during extension and tightens all associated ligaments
Bodies centre of gravity is positioned along a vertical line that passes anterior to the knee joint

25
Q

Stability of the patellofemoral joint is dependant on:

A

Patella position
Lateral femoral buttress wall
Tightness of lateral retinaculum

26
Q

Movements at the knee:

A

Flexion and extension
Slight medial and lateral rotation
Medial oration will occur of femur on tibia normally in standing

27
Q

Is active/passive insuffiency present at knee joint?

A

Yes because muscles involved pass two joints:
Rectus femoris
All the hamstring muscles
Gastrocnemius

28
Q

Muscles of the knee
Knee extensors: rectus femoris -

A

Most superficial quadricep muscle
Proximal - long/straight head of AIIS
Short/reflected head from ilium just superior to the acetabulum
Distal - quadriceps femoris tendon

Nerve supply - femoral nerve (L2 -L4)
Action - flexes thigh at hip joint and extends leg at knee

29
Q

Muscles of the knee:
Knee extensors - vastus intermedius -

A

Quad part, sits deep to rec fem and in front of femur
Proximal - upper two thirds of anterior femur
Distal - quadriceps femoris tendon, lateral margin of patella and lateral tibial condyle

Nerve supply - femoral nerve (L2-L4)
Action - extends leg at knee joint

30
Q

Muscles of the knee
Knee extensors: vastus medialis _

A

Medial to rec fem
Proximal - medial part of intertrochanteric line, medial lip of linea aspera and medial supracondylar line
Distal - quadriceps femoris tendon and medial border of patella

Nerve supply - femoral nerve (L2-L4)
Action - extends leg at knee joint

31
Q

Muscles of the knee
Knee extensors: vastus lateralis _

A

Lateral to rec fem
Proximal - lateral part of intertrochanteric line, margin of greater trochanter and lateral lip of linea aspera
Distal - quadriceps femoris tendon and lateral margin of patella

Nerve supply - femoral nerve (L2-L4)
Action - extends leg at knee joint

32
Q

Muscles of the knee
Knee flexors (150 degrees flexion available, limited by soft tissue apposition)
Bicep femoris -

A

Sits most laterally of hamstrings
Proximal - long head, inferomedial part of ischial tuberosity
Short head - lateral lip of linea aspera
Distal - head of fibula and lateral tibial condyle

Nerve supply - sciatic never (L5,S1,S2)
Action - extends and laterally rotates thigh at hip joint
Flexes and laterally rotates leg at knee joint

33
Q

Muscles of the knee
Knee flexors - semitendinosus -

A

Medial to bicep fem
Proximal - upper area of ischial tuberosity
Distal - medial surface of proximal tibia

Nerve supply - sciatic nerve (L5,S1,S2)
Action - extends thigh at hip and medially rotates thigh at hip and leg at knee joint
Flexes leg at knee joint

34
Q

Muscles of the knee
Knee flexors - semitendinosus -

A

Sits deep to semimembranosus
Proximal - supolateral impression on ischial tuberosity
Distal - medial tibial condyle

Nerve supply - sciatic never (L5,S1,S2)
Action - extends thigh at hip joint and medially rotates thigh at hip and leg at knee. Flexes leg at knee joint

35
Q

Muscles of the knee
Knee flexors - sartorius -

A

Long S shaped muscle
Proximal - ASIS
Distal - medial surface of tibia just inferomedial to tibial tuberosity

Nerve supply - femoral never (L2-L3)
Action - flexes thigh at high joint and flexes leg at knee joint

36
Q

Muscles of the knee
Knee flexors - gracilis -

A

Proximal - external surface of body of pubis, inferior pubic ramus and ramus of ischium
Distal - medial surface of proximal shaft of tibia

Nerve supply - obturator nerve (L2,L3)
Action - adducts thigh at hip joint and flexes leg at knee joint

37
Q

Muscles of the knee
Knee flexors - gastrocnemius -

A

Weak knee flexor therefore is a Synergist to knee flexion
Proximal - medial head - posterior surface of distal femur
Lateral head - lateral femoral condyle
Distal - via calcneal tendon to posterior surface of calcaneus

Nerve supply - tibial never (S1,S2)
Action - plantar flexes foot and flexes knee

38
Q

Muscles of the knee
Knee flexors - plantaris -

A

Sits posteriorally to back of the knee
Proximal - inferior part of lateral supracondylar line of femur and oblique popliteal ligament of knee
Distal - via calcaneal tendon to posterior surface o calcaneus

Nerve supply - tibial nerve (S1,S2)
Action - plantarflexes foot and flexes leg at knee

39
Q

Other muscles acting on the knee joint
Tensor fascia lata -

A

Proximal - lateral aspect of crest of ilium. Between ASIS and tubercle of the crest
Distal - gerdys tubercle

Nerve supply - superior gluteal nerve (L4,L5,S1)
Action - stabilises knee joint.
Weak abductor and internal rotator

40
Q

Other muscles acting on the knee joint
Popliteus -

A

Moves across medially
Proximal - lateral femoral condyle
Distal - posterior surface of proximal tibia

Nerve supply - tibial nerve (L4 to L5)
Action - stabilises knee joint, resits laterally rotation of tibia on femur.
Unlocks the knee joint from standing (unlocking means femur is laterally rotated on a fixed tibia)

41
Q

Body space = popliteal fossa
The boarders -

A

Located on posterior aspect of the knee joint
Lateral borders - bicep femoris
Lateral head of gastrocnemius

Medial borders - the two semi’s and medial head of gastrocnemius

Floor - popliteal surface of femur
Roof - fascia and skin (roof is more superficial)

42
Q

Contents of the popliteal fossa -

A

Popliteal artery and vein - descend from femoral artery and vein
Common perineal and tibial nerves (more lateral)
Lymph nodes and fat

43
Q

Summaries the knee extensors and what they’re limited by:

A

0 degrees plus or minus for hyper/loss of extension
Quad muscles: rectus femoris, vastus intermedius, vastus medialis, vastus lateralis

Limited by - ACL and LCL, oblique popliteal ligament and tension in antagonist.

44
Q

Summarise knee flexors and what they’re limited by:

A

150 degrees of flexion
Hamstrings - bicep femoris, semitendinosus and semimembranosus
As well as - sartorius, gracilis, gastrocnemius and plantaris

Limited by - soft tissue apposition, patella tendon and PCL

45
Q

Summarise knee rotators
Medial -

A

25 degrees (of tibia on femur)
Knee must be flexed as the most open packed position
Muscles - semimembranosus, semitendinosus, sartorius and popliteus

46
Q

Summarise knee rotators
Lateral -

A

45 degrees when knee is flexed as most open packed (of tibia on femur)
Muscles - bicep femoris

47
Q

Where is the pes anserine and what is it made up of?

A

Medial shaft of proximal tibia
Made up of sartorious, gracilis and semitendinosus and pes anserine bursa

48
Q

Name the three retro-patella articulate facets

A

Medial, lateral and odd facet

49
Q

What factors contribute to patella stability?

A

Patella tendon
Muscles around the knee
Lateral femoral buttress wall

50
Q

What is the nerve supply to the quadriceps?

A

Femoral nerve L2-L4

51
Q

Name the movements available at the knee and the degrees available:

A

Flexion - 150 degrees
Extension - 0+/- 5
Medial rotation - 25 degrees when knee flexed
Lateral rotation - 45 degrees when knee flexed

Anatomy (9 decks)

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