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1019 Regional > Thigh and Knee > Flashcards

Thigh and Knee Flashcards

1
Q

What are the muscles attached to the greater trochanter?

A

Gluteus medius, Gluteus minimus, Obturator internus, gemellus superior and inferior, piriformis

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2
Q

What tendon is attached to the lesser trochanter?

A

Iliopsoas tendon

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3
Q

What muscles are attached to the intertrochanteric crest?

A

Quadratus femoris

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4
Q

How does the oblique orientation of the distal femur assist in standing/weight bearing?

A

Allows knee to be closer to the midline, under the body’s center of gravity

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5
Q

What is attached to the base of the patella?

A

Quadriceps tendon

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6
Q

What is attached to the apex of the patella?

A

Patellar ligament

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7
Q

What is present on the posterior surface of the patella?

A

Medial and lateral articular facets for articulation with the medial and lateral (bigger) condyles.

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8
Q

Where do the cruicate ligaments and meniscus attach to?

A

Superior surface of the medial and lateral condyles

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9
Q

What muscles attach to the posterior surface of the tibia?

A

Sartorius, Gracillis, Semitendinosus

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10
Q

Where does the patella ligament attach to?

A

tibial tuberosity

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11
Q

Which bone is more lateral? Tibia or fibula?

A

Fibula

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12
Q

Does fibula take part in weight bearing?

A

no

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13
Q

What are the mechanical axes of the thigh and leg?

A

Femoral mechnical axis, Tibial mechanical axis and Hip-Knee angle

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14
Q

Where does the femoral mechanical axis run?

A

Centre of femoral head to intercondylar notch

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15
Q

Where does the tibial mechanical axis run?

A

Centre of proximal tibia to centre of ankle joint (between 2 malleolus)

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16
Q

What is the hip-knee angle formed by?

A

Intersection of femoral and tibial mechanical axis

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17
Q

What is the degree of the angle?

A

1 degree VARUS

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18
Q

How does the VARUS alignment of the knee help in standing/weight-bearing

A

Increases adductor moment and increases load on the medial compartment

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19
Q

What happens if the knee is aligned in a VALGUS position?

A

Increase in abduction moment and increases load on lateral compartment

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20
Q

Where does the anatomical axis run?

A

Lines are through the shaft of the bones

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21
Q

How does the anatomical axis assist in standing/weight bearing?

A

Shaft of femur is inclined more laterally and medial femoral condyle extends further distally.

The shaft of tibia, howver, is vertical.

This brings feet closer to midline for bipedal gait and decreasing lateral moment of centre of axis

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22
Q

What is the degree of the anatomical axis?

A

5 degrees genu VALGUS

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23
Q

How does anatomical position provide stability?

A

Screw Home mechanisam (Locking mechanism), Extensor moment (Center of gravity anterior to knee joint to maintain extension),
Shape of femoral condyles (flatter tibial plateau provides more stability)

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24
Q

What are the ligaments of the knee?

A

Patellar ligament, Collateral ligaments (Fibular and tibial), Cruciate ligaments (Anterior/Posterior) and Anterolateral ligament

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25
Q

What is the function of collateral ligaments?

A

Stabilise the hinge-like motion of the knee

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26
Q

Where does the fibular collateral ligament attach to?

A

Superiorly to lateral femoral epicondyle

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27
Q

What force does the fibular collateral ligament resist?

A

VARUS force

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28
Q

What is the tibial collateral ligament attached to?

A

Medial epicondyle

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29
Q

What force does the tibial collateral ligament resist?

A

VALGUS force

Knee extension

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30
Q

What force does the Anterior cruciate ligament resist?

A

Extension

VALGUS force

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31
Q

What are the 2 bands of the Anterior cruciate ligament?

A

Anterolateral and Posterolateral

32
Q

When does the posterolateral band taut?

A

Extension

33
Q

When does the anterolateral band tighten?

A

Flexion

34
Q

What movements do the anterior cruciate ligament resist?

A

Anterior translation of tibia on femur and Posterior translation of femur on tibia

35
Q

What degree is the rotation stability in the anterior cruciate ligament?

A

10 and 30 degrees flexion

36
Q

What motion tightens the anterior cruciate ligament?

A

End range extension

37
Q

What movement does the posterior cruciate ligament resist?

A

Posterior translation of tibia on femur
Hyperextension
Valgus and Varus

38
Q

What does injury to posterior cruciate ligament cause?

A

Hyperflexion/Hyperextension

39
Q

What is the function of the anterolateral ligament?

A

Resists tibial rotation and provides anterolateral stability at >35 degrees flexion

40
Q

What is the origin and insertioin of the anterolateral ligament?

A

Posterior to lateral epicondyle (Femoral origin), halfway between Gerdy’s tubercle and head of fibula (Tibial insertion)

41
Q

What is the functional classification of the knee joint?

A

Uniaxial Synovial hinge joint

42
Q

How does the knee joint assist in movement/standing?

A

Involved in weight-bearing and has locking mechanism to reduce the amount of energy needed to keep the joint extended

43
Q

What joints make up the knee joint?

A

Tibiofemoral joint and Patellofemoral joint

44
Q

What is the functional classification of the tibiofemoral joint?

A

Synovial bicondylar joint

45
Q

How does the tibiofemoral joint assist in standing?

A

Where weight-bearing action is

46
Q

How does patellofemoral joint assist in standing?

A

The quadriceps is relaxed and the patella can be moved freely, relative to the femur

47
Q

Where are the menisci located?

A

Between femoral condyles and tibia

48
Q

What is the function of the meniscus?

A

Accommodate changes in shape of articular surfaces during movement, therefore improving congruency between femoral and tibial condyles. The surface of the femoral condyle articulating with tibial plateau changes from small curved surfaces in flexion, to larger flat surfaces in extension.

49
Q

Which meniscus is more mobile?

A

Lateral

50
Q

What is the medial meniscus attached to?

A

Capsule of the joint and tibial collateral ligament

51
Q

What reinforces the anterior side of the fibrous membrane?

A

Expansions from vastus lateralis and medialis

52
Q

What reinforces the anterolateral side of the fibrous membrane?

A

Fibrous extension from iliotibial tract and tendon of semimembranosus

53
Q

What does the medial side of the fibrous membrane attach to?

A

Tibial collateral ligament and internal surface to medial meniscus

54
Q

What reinforces the posterior side of the fibrous membrane?

A

Oblique popliteal ligament (resists hyperextension)

55
Q

What connective tissue separates the patellar ligament from the anterior part of the synovial membrane?

A

Infrapatellar fat pad

56
Q

What are the 4 bursas in the knee region?

A

Suprapatellar, Prepatellar, Subcutaneous and Deep infrapatellar bursa

57
Q

Describe the contact area and amount change through range

A

As there is increasing knee flexion, contact area of patella moves proximally and increases while contact point of femur moves distally.

58
Q

What does the Q angle represent

A

Lateral pull of quadriceps

59
Q

What are the 2 lines of the Q angle

A

ASIS through centre of patella (Line 1), Tibial tubercle through centre of patella (Line 2)

60
Q

What is joint reaction force

A

Transmission of high forces through small contact areas.

61
Q

When does reaction force increase?

A

With increasing flexion

62
Q

What is joint reaction force determined by?

A

Quadriceps force of contraction and angle of knee flexion

63
Q

What is joint stress determined by?

A

Patellofermoral joint reaction force and angle of knee flexion

64
Q

Which articulation has more stress?

A

Lateral patellar facet and lateral femoral condyle

65
Q

What are the primary Restraints to Valgus force in the knee?

A

Medial/Tibial Collateral Ligament

66
Q

What are the Primary restraints to Varus force in the knee?

A

Lateral collateral ligament

67
Q

What are the secondary restraints to Valgus force?

A

Anterior and posterior cruciate ligaments
Lateral Joint articulation
Gastrocnemius
Compression of lateral meniscus
Tendons of sartorius, gracilis, semitendinosus
Medial head of Gastrocnemius

68
Q

What are the secondary restraints to Varus Force?

A 
iliotibial band
Biceps femoris tendon
Medial Joint articulation
Compression of medial meniscus
Cruciate ligaments
Lateral head of Gastrocnemius
69
Q

Describe the Patellofemoral Joint force

A

transmission of high forces through small contact areas. It increases with increasing flexion.

It is determined by quadriceps force of contraction and angle of knee flexion

Resultant compression force acting on the joint

With increasing knee flexion, contact area of patella moves proximally and contact point on femur moves distally = femur is pushed into patellar surface which increasing compression force

70
Q

Describe the patellofemoral joint stress

A

Joint stress is determined by patellofemoral joint rxn force and angle of knee flexion. The articulation of the lateral patellar facet + lateral femoral condyle produces more stress

Stress = PFJRF/contact area

Increase contact area with same PFJRF = decrease stress

Increase PFJRF = increase stress

Excessive stress can lead to possible overload of hyaline cartilage in that area and inadequate loading of cartilage on medial side

Poor medial femoral stability when quadriceps contract laterally on small contact area = patellofemoral pain

71
Q

Which is the most common direction of deviation / subluxation / dislocation of the patella?

A

Lateral dislocation

72
Q

What is the main non-bony passive restraint to lateral dislocation of the patella

A

vastus medialis obliquus (VMO) muscle.

This is the most distal portion of the quadriceps muscle, and exerts a medially directed pull which helps maintain the patella well positioned.

Weakness or dysplasia of this muscle increases the risk for dislocations.

73
Q

Why are lateral dislocations in the patella more common?

A

because the direction of pull of the quadriceps muscle is slightly lateral to the mechanical axis of the limb.

74
Q

What is the function of the Medial Patellofemoral Ligament?

A

medial patellofemoral ligament (MPFL) is the largest, strongest, and clinically most significant portion of the medial retinaculum

the primary static restraint to lateral patellar instability during the first 20 degrees of knee flexion

75
Q

What is a consequence of an increase in Q angle?

A

Increases lateral force on patella

76
Q

What factors increase the Q angle?

A

Femoral anteversion

External tibial torsion

Laterally displaced tibial tubercle

Valgus alignment: increases the obliquity of the femur and concomitantly, the obliquity of the pull of the quadriceps

1019 Regional (9 decks)

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