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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
What is the function of collateral ligaments?
Stabilise the hinge-like motion of the knee
26
Where does the fibular collateral ligament attach to?
Superiorly to lateral femoral epicondyle
27
What force does the fibular collateral ligament resist?
VARUS force
28
What is the tibial collateral ligament attached to?
Medial epicondyle
29
What force does the tibial collateral ligament resist?
VALGUS force Knee extension
30
What force does the Anterior cruciate ligament resist?
Extension VALGUS force
31
What are the 2 bands of the Anterior cruciate ligament?
Anterolateral and Posterolateral
32
When does the posterolateral band taut?
Extension
33
When does the anterolateral band tighten?
Flexion
34
What movements do the anterior cruciate ligament resist?
Anterior translation of tibia on femur and Posterior translation of femur on tibia
35
What degree is the rotation stability in the anterior cruciate ligament?
10 and 30 degrees flexion
36
What motion tightens the anterior cruciate ligament?
End range extension
37
What movement does the posterior cruciate ligament resist?
Posterior translation of tibia on femur Hyperextension Valgus and Varus
38
What does injury to posterior cruciate ligament cause?
Hyperflexion/Hyperextension
39
What is the function of the anterolateral ligament?
Resists tibial rotation and provides anterolateral stability at >35 degrees flexion
40
What is the origin and insertioin of the anterolateral ligament?
Posterior to lateral epicondyle (Femoral origin), halfway between Gerdy's tubercle and head of fibula (Tibial insertion)
41
What is the functional classification of the knee joint?
Uniaxial Synovial hinge joint
42
How does the knee joint assist in movement/standing?
Involved in weight-bearing and has locking mechanism to reduce the amount of energy needed to keep the joint extended
43
What joints make up the knee joint?
Tibiofemoral joint and Patellofemoral joint
44
What is the functional classification of the tibiofemoral joint?
Synovial bicondylar joint
45
How does the tibiofemoral joint assist in standing?
Where weight-bearing action is
46
How does patellofemoral joint assist in standing?
The quadriceps is relaxed and the patella can be moved freely, relative to the femur
47
Where are the menisci located?
Between femoral condyles and tibia
48
What is the function of the meniscus?
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
Which meniscus is more mobile?
Lateral
50
What is the medial meniscus attached to?
Capsule of the joint and tibial collateral ligament
51
What reinforces the anterior side of the fibrous membrane?
Expansions from vastus lateralis and medialis
52
What reinforces the anterolateral side of the fibrous membrane?
Fibrous extension from iliotibial tract and tendon of semimembranosus
53
What does the medial side of the fibrous membrane attach to?
Tibial collateral ligament and internal surface to medial meniscus
54
What reinforces the posterior side of the fibrous membrane?
Oblique popliteal ligament (resists hyperextension)
55
What connective tissue separates the patellar ligament from the anterior part of the synovial membrane?
Infrapatellar fat pad
56
What are the 4 bursas in the knee region?
Suprapatellar, Prepatellar, Subcutaneous and Deep infrapatellar bursa
57
Describe the contact area and amount change through range
As there is increasing knee flexion, contact area of patella moves proximally and increases while contact point of femur moves distally.
58
What does the Q angle represent
Lateral pull of quadriceps
59
What are the 2 lines of the Q angle
ASIS through centre of patella (Line 1), Tibial tubercle through centre of patella (Line 2)
60
What is joint reaction force
Transmission of high forces through small contact areas.
61
When does reaction force increase?
With increasing flexion
62
What is joint reaction force determined by?
Quadriceps force of contraction and angle of knee flexion
63
What is joint stress determined by?
Patellofermoral joint reaction force and angle of knee flexion
64
Which articulation has more stress?
Lateral patellar facet and lateral femoral condyle
65
What are the primary Restraints to Valgus force in the knee?
Medial/Tibial Collateral Ligament
66
What are the Primary restraints to Varus force in the knee?
Lateral collateral ligament
67
What are the secondary restraints to Valgus force?
Anterior and posterior cruciate ligaments Lateral Joint articulation Gastrocnemius Compression of lateral meniscus Tendons of sartorius, gracilis, semitendinosus Medial head of Gastrocnemius
68
What are the secondary restraints to Varus Force?
``` iliotibial band Biceps femoris tendon Medial Joint articulation Compression of medial meniscus Cruciate ligaments Lateral head of Gastrocnemius ```
69
Describe the Patellofemoral Joint force
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
Describe the patellofemoral joint stress
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
Which is the most common direction of deviation / subluxation / dislocation of the patella?
Lateral dislocation
72
What is the main non-bony passive restraint to lateral dislocation of the patella
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
Why are lateral dislocations in the patella more common?
because the direction of pull of the quadriceps muscle is slightly lateral to the mechanical axis of the limb.
74
What is the function of the Medial Patellofemoral Ligament?
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
What is a consequence of an increase in Q angle?
Increases lateral force on patella
76
What factors increase the Q angle?
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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