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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
Stability of the patellofemoral joint is dependant on:
Patella position Lateral femoral buttress wall Tightness of lateral retinaculum
26
Movements at the knee:
Flexion and extension Slight medial and lateral rotation Medial oration will occur of femur on tibia normally in standing
27
Is active/passive insuffiency present at knee joint?
Yes because muscles involved pass two joints: Rectus femoris All the hamstring muscles Gastrocnemius
28
Muscles of the knee Knee extensors: rectus femoris -
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
Muscles of the knee: Knee extensors - vastus intermedius -
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
Muscles of the knee Knee extensors: vastus medialis _
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
Muscles of the knee Knee extensors: vastus lateralis _
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
Muscles of the knee Knee flexors (150 degrees flexion available, limited by soft tissue apposition) Bicep femoris -
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
Muscles of the knee Knee flexors - semitendinosus -
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
Muscles of the knee Knee flexors - semitendinosus -
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
Muscles of the knee Knee flexors - sartorius -
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
Muscles of the knee Knee flexors - gracilis -
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
Muscles of the knee Knee flexors - gastrocnemius -
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
Muscles of the knee Knee flexors - plantaris -
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
Other muscles acting on the knee joint Tensor fascia lata -
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
Other muscles acting on the knee joint Popliteus -
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
Body space = popliteal fossa The boarders -
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
Contents of the popliteal fossa -
Popliteal artery and vein - descend from femoral artery and vein Common perineal and tibial nerves (more lateral) Lymph nodes and fat
43
Summaries the knee extensors and what they’re limited by:
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
Summarise knee flexors and what they’re limited by:
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
Summarise knee rotators Medial -
25 degrees (of tibia on femur) Knee must be flexed as the most open packed position Muscles - semimembranosus, semitendinosus, sartorius and popliteus
46
Summarise knee rotators Lateral -
45 degrees when knee is flexed as most open packed (of tibia on femur) Muscles - bicep femoris
47
Where is the pes anserine and what is it made up of?
Medial shaft of proximal tibia Made up of sartorious, gracilis and semitendinosus and pes anserine bursa
48
Name the three retro-patella articulate facets
Medial, lateral and odd facet
49
What factors contribute to patella stability?
Patella tendon Muscles around the knee Lateral femoral buttress wall
50
What is the nerve supply to the quadriceps?
Femoral nerve L2-L4
51
Name the movements available at the knee and the degrees available:
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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