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1. Anatomy (Royal College Exam Prep) > Thigh and knee > Flashcards

Thigh and knee Flashcards

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1
Q

What is the anteversion of the femoral neck?

A

15-20 degrees

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2
Q

What is the articularis genu?

A

Small muscle on the anterior aspect of the distal femur deep to vastus intermedius

O: anterior surface of distal femur, deep to vastus intermedius

I: synovial membrane of knee

I: femoral nerve

A: pulls the suprapatellar bursa superiorly during knee extension, preventing impingement of the bursa between patellar and femur

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3
Q

What innervates adductor Magnus?

A

Obturator (posterior branch) & sciatic (tibial portion)

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4
Q

What are the origins and insertions of biceps femoris?

A

O:

Long head: ischial tubeosity (with semitendinosus)

Short head: lateral linea aspera, lateral supracondylar ridge

I: fibular head, LCL, lateral tibial condyle

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5
Q

What comprises the conjoint tendon of the thigh?

A

Long head of biceps femoris & semitendinosus

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6
Q

Name the insertion sites of semimimbranosus:

A

Posterior medial tibial condyle

posterior capsule and posterior horn of medial meniscus

oblique popiteal ligament

posterior oblique ligament

popliteus aponeurosis

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7
Q

What are the borders of the adductor canal? Its contents?

A

Lateral: vastus medialis

Medial: sartorius

Floor: adductor longus/Magnus

Contents:

Femoral artery and vein

saphenous nerve

nerve to vastus medialis

***Note that the picture below has the vessels passing through the adductor hiatus of adductor magnus with a large portion of the muscle medially and a smaller portion laterally

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8
Q

What vessels are included in the Cruciate anastamosis? Where is it located?

A

1st perforating branch of the profunda femoris (main)

Medial femoral circumflex artery

Lateral femoral circumflex artery

Inferior gluteal artery

Located at the inferior margin of quadratus femoris

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9
Q

What degree is the tibial slope?

A

8-10 degrees posterior

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10
Q

What is the average thickness of the largest sesamoid bone in the body?

A

23-25mm Note: in TKA, it should not be cut to a thickness of less than 12-15mm as this increases the risk of patellar fracture

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11
Q

Describe the anatomic axis of the femur and tibia?

A

A line that runs down the intramedullary canal of the femur and tibia, respectively

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12
Q

How do you measure Q-angle? What are normal values in men and women?

What are 4 ways to increase Q-angles in TKA? (this is bad and should be avoided!)

A

Angle between a line from ASIS to the patellar centre and another extending proximally from tibial tubercle through patellar centre Normal: Men: 14 degrees Women: 17 degrees

In TKA you must ensure you dont:

  1. internally rotate the femoral component
  2. internally rotate the tibial component
  3. medialize the femoral component
  4. lateralize the patellar component
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13
Q

Name the 12 ligaments of the knee:

A

there are more than 12:

ACL

PCL

LCL

MCL

MPFL

Arcuate ligament

Oblique popliteal ligament

Retinacular ligament

Coronary ligament

Wrisberg ligament

Humphrey ligament

Transverse ligament

posterior oblique ligament

popliteofibular ligament

(ligamentum mucosum is not a ligament - misnomer - it is a plica)

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14
Q

Which ligaments of the knee contribute to the fibrous capsule of the knee posteriorly?

A

Medially:

  1. Oblique popliteal ligament: semimimbranosus to posterior wall of capsule

Laterally:

  1. Arcuate ligament: Y-shaped fibres from fibular head
  2. popliteal muscle to the posterior capsule
  3. LCL contributes to joint capsule
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15
Q

Which ligaments of the knee have attachments to the menisci (5)?

A
  1. MCL
  2. Coronary ligament: peripheral menisci to capsule/tibia
  3. Transverse: aka anterior intermeniscal ligament
  4. Wrisberg: behind PCL from posterior lateral meniscus to medial femoral condyle
  5. Humphrey: in front of PCL from posterior lateral meniscus to medial femoral condyle
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16
Q

Which parts of the ACL and PCL are tight in flexion? Extension?

A
  • PCL
    • AL
    • PM
    • **Remeber PAL (PCL has AL bundle)
  • ACL
    • AM
    • PL

Tight in flexion: PCL: anterolateral ACL: anteromedial

Tight in extension: PCL: posteromedial ACL: posterolateral

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17
Q

When is the ACL tightest?

A

In extension

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18
Q

Name the layers of the medial aspect of the knee and each layer’s contents:

A

What are the medial layers of the knee:

Layer 1

  1. Sartorius
  2. fascia
  3. patellar retinaculum

**gracilis, semitendinosis, and saphenous nerve run between layer 1 and 2

Layer 2

  1. superficial MCL
  2. posterior oblique ligament
  3. semimembranosis
  4. MPFL

Layer 3

  1. deep MCL
  2. capsule
  3. coronary ligament
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19
Q

What are the layers of the lateral aspect of the knee and their contents?

A

What are the lateral layers of the knee (according to Orthobullets)

Layer 1:

  1. - IT tract
  2. - biceps femoris

Common Peroneal nerve lies between layers 1 and 2

Layer 2:

  1. - Patellar retinaculum

Layer 3:

Superficial:

  1. LCL
  2. fabellofibular ligament
  3. ALL

****Lateral geniculate artery runs between deep and superficial layers

Deep:

  1. popliteus tendon
  2. Arcuate ligament
  3. popliteofibular ligament
  4. coronary ligament
  5. capsule
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20
Q

What part of the tibial plateau is concave and convex?

A

Medial is concave

Lateral is convex

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21
Q

What is the insertion of the IT band?

A

Gerdys tubercle

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22
Q

What is the insertion of the patellar tendon

A

tibial tubercle

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23
Q

What is the usual deformity of a proximal one third tibia fracture

A

valgus and procurvatum

(from Pes and extensor mechanism)

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24
Q

What attaches at the fibular head?

A

LCL

Biceps femoris tendon

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25
Q

What structure wraps around the neck of the fibula

A

Common peroneal nerve

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26
Q

What surface of the distal fibula is flat and accommodates plating

A

Posterolateral surface

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27
Q

What type of joint is the proximal tibiofibular joint and what ligaments strengthen it

A

(Arthrodial) Plane gliding joint

Stabilized by:

Anterior Superior Tib-fib ligament

Posterior Superior Tib-fib ligament

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28
Q

Name the four compartments of the leg

A

Anterior

Lateral

Superficial posterior

Deep posterior

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29
Q

Name the Contents of the anterior compartment of the leg

A

Anterior tibial artery and vein

Deep peroneal nerve

Muscles:

Tibialis anterior

EHL

EDL

Sometimes peroneus tertius (not in lateral compartment)

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30
Q

What is the innervation and blood supply to the anterior compartment of the leg?

A

Deep peroneal nerve

Anterior tibial artery

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31
Q

Where does the NV bundle run in the anterior compartment of the leg

A

Runs along the interosseous membrane, deep to the muscles - Its always surrounded by fat

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32
Q

With respect to the neurovascular bundle of the anterior compartment of the leg, describe its course at and below the ankle:

A

Above: between tibialis anterior and EHL (medial to EHL)

At the ankle: Crosses UNDER EHL

Below: Runs lateral to EHL

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33
Q

What are the contents of the lateral compartment of the leg

A

Peroneus longus - Superficial and very tendinous Peroneus brevis -superficial peroneal nerve

*SPN runs in anterior compartment ~25% of the time

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34
Q

What is the innervation of the lateral compartment of the leg

A

Superficial Peroneal Nerve

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35
Q

What is the orientation of the peroneal tendons above the ankle and once they dive behind the fibula

A

Above the distal fibula: - Longus is superficial to brevis Behind the fibula: - Longus is posterior to brevis in the groove

Longus then passes under the brevis and dives deep to insertions in the midfoot

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36
Q

Describe the tendon sheath of the peroneal tendons

A

They run in a common sheath until they are past the distal fibula, then they divide into individual tendon sheaths

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37
Q

Name the retinaculae that covers the peroneal tendons

A

Superior peroneal retinaculum

Inferior peroneal retinaculum

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38
Q

Name the contents of the deep posterior compartment of the leg

A

Posterior tibial artery

Peroneal artery

Tibial nerve

Muscles: - Tibialis posterior - FHL - FDL

Remember the orientation in the mid tibia is not the same at the ankle.

At ankle - Tom, Dick Harry

At the mid tibia - Dick, tom, harry

The FDL crosses over TP to lie lateral.

Remember that FDL also crosses UNDER the FHL at the knot of henry.

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39
Q

What is the arrangement of the muscles on the posterior compartment of the leg proximal to the ankle and at the ankle

A

Proximal to the ankle: - Medial to lateral: (opposite of what you’d think) - FDL - tibialis posterior - FHL

At the level of the ankle: - All structures pass posterior to the medial malleolus - Tom Dick And a Very Nervous Harry - This is A to P, M to L

NOTE: FHL is fleshy all the way down so its the fleshy one when you cut there

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40
Q

What is the innervation of the posterior compartment of the leg

A

Tibial nerve

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41
Q

Name the contents of the Superfical posterior compartment of the leg

A

Gastrocnemius

Soleus

Plantaris

Strictly speaking, no nerves or vessels run in this compartment - they are either superficial or deep

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42
Q

What is the innervation of peroneus tertius?

A

Deep peroneal nerve (NOT superficial) - It runs in the anterior compartment, not the lateral

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43
Q

What compartment does perneus tertius run in?

A

Anterior compartment

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44
Q

What is the action of peroneus longus?

A

Everts, plantarflexes

(Brevis is an everter and WEAK plantarflexor)

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45
Q

What are the muscles (2) of the lower leg that cross 2 joints?

What are the muscles (7) of the upper leg that cross 2 joints?

A

Lower leg:

  • Gastrocnemius - Medial and lateral femoral condyle to Achilles
  • Plantaris - Lateral femoral condyle to calcaneus (NOT via Achilles) - Runs medial to Achilles tendon

Upper leg:

  • Sartorius
  • TFL
  • Rectus femoris
  • (Gracilis)
  • SemiT, SemiMem, Biceps femoris
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46
Q

On which side of the Achilles tendon does plantaris run?

A

Medially, see image

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47
Q

What portion of the popliteus muscle is tendinous. What is its action?

What is it’s origin and insertion?

A
  • Proximal part is tendinous
  • its origin is distal to its insertion
  • Action is to unlock the knee from extension, initiating flexion - Remember, last few degrees of extension, the tibia ERs the leg to lock it into extension

Origin: Posterior surface of tibia - above soleal line

Insertion: Lateral condyle of femur just inferior to LCL origin, Also gives slips to fibular head and the posterior horn of lateral meniscus

Innervation: Tibial Nerve

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48
Q

Describe the course of the tibial nerve

A

Larger terminal branch of the sciatic nerve

  • Popliteal fossa
  • Medial sural cutaneous nerve branches here
  • Crosses on top of plantaris, popliteus
  • Dives deep to soleus through soleal arch and enters deep compartment
  • Travels down deep posterior compartment of the leg
  • Just deep to transverse intermuscular septum
  • Runs with posterior tibial artery and vein, between FDL & FHL
  • Supplies all muscles in superficial and deep posterior compartments
  • Passes posterior to medial malleolus, through tarsal tunnel
  • Divides into: medial and lateral plantar nerves
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49
Q

What nerve does the medial sural cutaneous nerve branch from?

A

tibial nerve, comes off in the popliteal fossa

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50
Q

What nerve does the lateral sural cutaneous nerve branch off from?

A

Common peroneal nerve. Joins the Med Sural cutaneous nerve (tibial nerve gives this off in the pop fossa) to form the sural nerve proper

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51
Q

What forms the sural nerve? What does it run with?

A

Medial and lateral sural cutaneous nerves, aka the tibial and common peroneal nerves - Runs with the small saphenous vein - The nerve is lateral to the vein

52
Q

What is the terminal branch of the sural nerve?

A

Lateral dorsal cutaneous nerve - Innervates the lateral side of the foot and lateral 5th toe

53
Q

Describe the course of the common peroneal nerve.

A

Small terminal branch of the sciatic nerve

terminal branch of the sciatic nerve

bifurcates in the popliteal fossa

runs medial and just anterior to biceps femoris

runs over the lateral head of gastric

  • comes from out behind the biceps once it is passed the knee joint and curves anterolaterally to come around the head of the fibula 3-4 cm distal to the tip. It then pierces the POSTERIOR intermuscular septum to come into the lateral compartment where it BIFURCATES. The deep peroneal nerve then continues through the anterior intramuscular septum to the anterior compartment where innervates TA, EDL, EHL, and PT
54
Q

Describe the course of the deep peroneal nerve

A
  • Branch of the common peroneal nerve
  • Makes a sharp turn and enters the anterior compartment through anterior septum
  • Travels along anterior surface of IoM with anterior tibial artery
  • Supplies all the muscles in the anterior compartment
  • Passes deep to the extensor retinaculum - Supplies EDB
55
Q

Describe the course of the superficial peroneal nerve:

A
  • Branch of the common peroneal nerve
  • Runs in the lateral compartment
  • Proximal one third runs on the lateral surface of the fibula
  • Then runs under peroneus longus and on top of brevis (between them)
  • It then heads anterior and runs between brevis and EDL between the lateral and anterior compartments
  • Pierces fascia 10-12cm above the lateral malleolus to run subcutaneously
  • Runs in fat, above fascia, down to the ankle
  • Runs just anterior to fibula
  • Bifurcates into the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve
56
Q

The saphenous nerve is a branch of which nerve?

A

Terminal branch of the femoral nerve

57
Q

Describe the course of the saphenous nerve

A

Terminal branch of femoral nerveTravels in adductor canal

  • Starts lateral to vessels, on top of the artery on the underside of sartorious
  • Emerges medial side of the vessels from the canal Pierces fascia at the medial knee between gracilis and Sartorius
  • Becomes subcutaneous
  • Gives off infrapatellar branch and medial crural branches
  • Continues on medial side of leg just posterior to tibia
  • Runs with great saphenous vein
  • Divides at the ankle
  • Smaller branch follows medial tibial border at level of ankle
  • Larger branch passes anterior to medial malleolus
  • Innervates skin on medial side of dorsal foot
58
Q

Describe the course of the great saphenous vein

A

Dorsal vein of first digit merges with dorsal venous arch - Passes anterior to medial malleolus - Travels up medial side of the leg with saphenous nerve - A the knee, its posterior to the medial epicondyle of the femur - Goes up medial side of thigh - Passes through fossa ovalis (aka saphenous opening) - This is a defect through the fascia lata - Drains into the femoral vein

59
Q

Describe the course of the popliteal artery

A

Continuation of the superficial femoral artery

  • Enters the popliteal fossa between biceps femoris and semimembranosus
  • Runs with (lateral to medial)
  • tibial n
  • popliteal vein
  • popliteal artery
  • Artery is always medial
  • Artery lies behind the posterior horn of the lateral meniscus, 9mm posterior to the posterior aspect of the tibial plateau in 90 deg of flexion
  • Passes superficial to popliteus
  • Deep to gastrocsésoleus and tibial nerve under a fibrous arch
  • Bifurcates at the distal aspect of the popliteus muscle - Anterior tibial artery and tibioperoneal trunk
  • Tibioperoneal trunk runs superficial to tib post

- Divides into posterior tibial artery and peroneal artery, 2.5cm distal to popliteal fossa

60
Q

How do you landmark the popliteal artery with respect to the tibial plateau

A

Behind the posterior horn of the lateral meniscus

9mm posterior to the posterior aspect of the tibial plateau with the knee in 90 deg of flexion

61
Q

Where does the tibioperoneal trunk divide and what does it divide into?

A

Divides 2.5cm below the popliteal fossa into the posterior tibial artery and the peroneal artery

62
Q

Describe the course of the anterior tibial artery

A

From the popliteal artery Passes between 2 heads of tib post Through superior IoM into the anterior compartment Gives off 1st branch: anterior tibial recurrent artery Runs down with: - Deep peroneal nerve (nerve is lateral) - Runs on anterior surface of IoM between EHL and tib ant Passes deep to superior and inferior extensor retinacula - NV bundle - Above ankle: between TA and EHL - At ankle: Crosses under EHL - Runs down lateral to EHL Continues down as dorsalis pedis artery

63
Q

Describe the course of the posterior tibial artery

A

From the tibioperoneal trunk Continues in deep posterior compartment Runs with: - Tibial nerve - Superrficial to tib post and gives off large nutrient artery to tibia At the ankle: - Posterior to medial malleolus, deep to flexor retinaculum - Terminates as medial and lateral plantar arteries

64
Q

Describe the course of the peroneal artery

A

From the tibioperoneal trunk Largest branch of the posterior tibial artery Runs in the deep posterior compartment - (NOT the lateral compartment) Runs deep to FHL Terminates as - Anterior perforating artery - Passes from posterior to anterior through distal IoM - Lateral calcaneal branch

65
Q

What is the average neck shaft angle of the hip?

A

127o

66
Q

Name the structures

A

Answers:

68
Q

Name the muscles of the Anterior, medial and posterior compartments of the thigh

A

Anterior:

Recturs femoris

Vastus lateralis

Vastus intermedius

Vastus medialis

Sartorious

Medial:

Adductor brevis

Adductor longus

Adductor magnus

Gracilis

Posterior:

Biceps (long head)

Biceps (Short head)

Semimembranosus

Semitendinosus

69
Q

What are the borders and contents of the femoral triangle?

A

Boundaries:

Superior: Inguinal ligament

Lateral: Sartorius

Medial: Adductor longus

Floor: iliopsoas, pectineus, adductor longus

Contents:

NAVEL towards the navel

nerve, artery (Deep profunda branch), vein (great saphenous vein), empty, lymphatics

70
Q

Specifically what artery and vein are located in the femoral triangle?

A

artery: common femoral and its main branches (superficial femoral, profunda)
vein: femoral vein and its branches (deep femoral and long saphenous)

71
Q

Which artery in the Cruciate anastomosis provides the most blood supply?

A

1st perforating artery

72
Q

What is the average angle between the anatomic and mechanical axes of the knee?

A

5-7o valgus

anatomic and mech axis of tibia are the same

so the question is the difference between anatomic and mech axis of femur, which is about 6 deg and valgus at knee (distal femur articular surface)

73
Q

What percentages of the load do the menisci in the knee take?

A

Lateral: 70% of the load of the lateral compartment

Medial: 50% of the load of the medial compartment

They both take more load in flexion

74
Q

Name the attachments of the pes anserinus:

A

Sartorius (most proximal)

Gracilis

Semitendinosus (most distal)

“Say Grace before T”

75
Q

Which ligament’s deep fibers are attached to the meniscus, LCL or MCL?

A

MCL

LCL deep fibers ARE NOT attached to the menisci

76
Q

what muscle is intra-articular at the knee?

A

popliteus

(long head of biceps brachii is the only other intra-articular tendon, at the shoulder)

77
Q

What muscle acting on the knee has its origins distal to its insertion?

A

Popliteus

78
Q

Name the bursa around the knee (4):

A
  1. Suprapatellar: extension of synovium under tendon of quadriceps femoris
  2. Prepatellar (housemaids knee)
  3. Infrapatellar: x2
    1. Superficial: clergyman’s knee
      • Deep (to patellar ligament)
79
Q

Name the borders and contents of the popliteal fossa:

A

Borders: Diamond shaped region behind the knee:

Semimembranosus

Biceps femoris

Medial heads of gastrocs

Lateral heads of gastrocs/plantaris

Contents:

Popliteal vessels

Tibial and common peroneal nerves (from sciatic)

Superficial to it: short/small saphenous veins draining into popliteal vein

80
Q

How does the intramedullary reaming of the femur alter the blood supply to cortical bone?

A

Decreases inner 2/3, increases outer 1/3

81
Q

Reaming of a femoral fracture does what to the cortical blood supply?

A

Increased by 30%

82
Q

Which muscle is solely innervated by the obturator nerve?

Gracilis

Adductor magnus

Semitendinosis

Sartorius?

A

Gracilis

83
Q

Which of the following is a landmark to the posterior appraoch to the knee?

Long head of biceps tendon

Medial sural cutaneous nerve

Popliteal artery

Medial aspect of the lateral gastrocs origin

Semitendinosis tendon

A

Medial sural cutaneous nerve

84
Q

Which structure is most at risk posteriorly with suturing of the medial meniscus?

Tibial nerve

Saphenous nerve

Popliteal artery

Middle geniculate artery

A

Saphenous nerve

85
Q

In a lateral approach to the knee, the most endangered structure is:

Lateral superior geniculate artery

Lateral inferior geniculate vein

Lateral inferior genicular artery

Lateral superior geniculate vein

Lateral collateral artery

A

Lateral Superior geniculate artery

86
Q

What is the only innervation of the peroneal nerve proximal to the knee?

A

Short head of biceps

87
Q

A patient has disruption of the superficial branch of the peroneal nerve. Which of the following is most correct with regards to findings?

Decreased sensation in the first web space

Decreased sensation in the second web space

Weakness of the first dorsal interosseous

Weakness of the extensor digitorum brevis

Decreased sensation in the lateral aspect of the foot

A

Decreased sensation in the second webspace

88
Q

A patient presents after trauma to the lower leg and has pain on passive extension of the toes. Which compartment is most likely involved?

A

Deep posterior

89
Q

All are true of the meniscus of the knee except:

Transmits 50% of the load

helps synovial flow

Protects articular cartilage from shear forces

There is a vascular frnge at the periphery of the meniscus but the vessels do not penetrate into the substance of the meniscus

There is good vascular supply to the meniscus near the popliteal tendon

A

There is good vascular supply to the meniscus near the popliteal tendon (this is false)

90
Q

Where does the MPFL insert on the patella?

What about the femur?

A
  • Patella - Superior medial aspect
  • Femur -Schottle’s Point – isometric point for insertion of MPFL
    • A reproducible anatomical and radiographic point:
    • 1 mm anterior to the posterior cortex extension line
    • 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line
    • on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center.
91
Q

What are the pertinent findings of the dial test?

A

Increased ER at 30o: Isolated PLC injury

Increased ER at 30/90o: PCL/PLC injury

Significance is 10-15o difference side to side

92
Q

A 25 yo M injured his knee in an MVC. Abnormal findings include:

10o increased external tibial rotation at 30/90o of knee flexion.

WHat other abnormal finding would you expect to find?

Increased opening to valgus stress at 30o of knee flexion

Increased varus opening at 0o knee flexion

Positive patellar apprehension

Positive pivot shift

Medial tibial plateau rests 10mm anterior to the medial femoral condyle

A

Increased varus opening at 0o of knee flexion

(another test for injury to the PLC)

93
Q

A soccer player sustains a knee injury and is noted to have a significant increase in tibial passive external rotation both at 30 and 90 degrees of knee flexion. His MRI would most likely show which of the following?

  1. A popliteus tendon tear
  2. A lateral collateral ligament tear
  3. A posterior cruciate ligament tear
  4. Answers 1 & 2
  5. Answers 1, 2 & 3
A

5: Answers 1, 2, 3

popliteus tendon tear

LCL tear

PCL tear

94
Q

A 17 year old quarterback sustained a left knee injury after being tackled five days ago. You suspect a posterolateral corner injury. What is the most accurate physical examination test to confirm your diagnosis?

  1. Increased posterior tibial translation at 90 degrees of knee flexion
  2. Positive pivot shift test
  3. Asymmetrical tibial external rotation at 30 degrees of knee flexion
  4. Asymmetrical tibial internal rotation at 30 degrees of knee flexion
  5. Excessive valgus laxity at 30 degrees of knee flexion
A
  1. Asymmetrical tibial external rotation at 30 degrees of knee flexion
95
Q

What is the OINA of Sartorius?

A

O: ASIS

I: Pes anserinus

N: Femoral

A: Flexes and laterally rotates hip joint

Flexes the knee

96
Q

Name the OINA for Rectus femoris

A

O:

Straight head: AIIS

Reflected head: Groove just above acetabulum

I: Base of patella to form central portion of quadriceps femoris tendon

N: Femoral

A: Extends the knee

97
Q

What is the OINA of Vastus lateralis

A

O:

Intertrochanteric line (peel when doing lateral hip approach)

Ant and inferior borders of GT

Superior border of lateral lip of linea aspera

Lateral aspect of gluteal tuberosity

I:

Lateral base and border of patella

Also forms lateral patellar retinaculum and lateral side of quadriceps femoris tendon

N: Femoral

A: Extends the knee

98
Q

Name the OINA of vastus medialis

A

O:

Intertrochanteric line

Medial lip of linea aspera

Medial supracondylar ridge

Medial intermuscular septum

I:

Medial base and border of patella

Also forms medial patellar retinaculum and medial side of quadriceps femoris tendon

N: Femoral

A: Extends knee

99
Q

OINA of vastus intermedialis

A

O:

Superior 2/3 of anterior and lateral surfaces of femur

Lateral intermuscular septum of thigh

I:

Lateral border of patella

Also forms deep portion of quadriceps tendon

N: Femoral

A:

Extends knee

Overall its more lateral than medial

100
Q

OINA of articular genu

A

O: anterior surface of distal femur, deep to vastus intermedialis

I:

Synovial membrane of knee joint

N: Femoral

A:

Pulls suprapatellar bursa superiorly during extension to prevent impingment of the synovial membrane between patellar and femur

101
Q

OINA of adductor brevis

A

O:

Anterior inferior pubic ramus, inferior to origin of adductor longus

I: Pectineal line and superior part of medial lip of linea aspera

N: Obturator

A: adducts and flexes thigh

Helps to laterally rotate thigh

102
Q

OINA of Adductor Longus

A

O:

Anterior surface of body or pubis, just lateral to pubic ramus

I:

Middle 1/3 of linea aspera, between adductor magnus/brevis (more medial) & origin of vastus medialis (more lateral)

N: Anterior division of obturator

A: adducts and flexes thigh

Helps laterally rotate thigh

103
Q

OINA of adductor magnus

A

O:

Inferior pubic ramus

ischial ramus

Iferolateral area of ischial tuberosity

I:

Gluteal ruberosity of femur

medial lip of linea aspera

medial supracondylar ridge

adductor tubercle

N: Dual innervation:

Posterior division of obturator nerve

Tibial portion of sciatic (innervates hamstring portion)

A:

Powerful thigh adductor

also thigh flexion

104
Q

OINA of Pectineus

A

O; Pecten pubis and pectineal surface of pubis

I: Pectineal line of femur

N: (Sometimes dual Innervated)

Femoral and (sometimes) obturator nerve

A: adducts thigh and flexes hip joint

** If obturator nerve KO’ed, can still adduct thigh b/c of pectineus (femoral innervated)

105
Q

OINA of Gracilis

A

O: Inferior margin of pubic symphysis

Inferior ramus of pubis

Adjacent ramis of ischium

I:

Medial surface of tibial shaft (pes anserinus), just posterior to sartorius

N: Anterior division of obturator nerve

A: Flexes the knee

adducts the thigh

medially rotates tibia on femur

106
Q

OINA of biceps femoris

A

O:

Long head: ischial tuberosity: common/conjoint tendon with semitendinosus

Short head: Lateral lip of linea aspera, lateral supracondylar ridge of femur, lateral intermuscular septum of thigh

I:

Fibular head & LCL and lateral tibial condyle

N:

Long head: tibial nerve

Short head: common peroneal nerve (Short head is the only innervation of the peroneal nerve proximal to the knee)

A: flexes knee

Rotates tibia laterally

Long head helps extend the hip

107
Q

OINA Semitendinosus

A

O: Common/conjoint tendon with long head of biceps femoris from superior medial quadrant of posterior portion of ischial tuberosity

I: Pes anserinus

N: Tibial branch of sciatic nerve

A: extends thigh and flexes the knee

Also rotates tibia, especially when knee is flexed

108
Q

OINA of Semimembranosus

A

O: Superior lateral quadrant of the ischial tuberosity

I: Posterior surfae of the medial tibial condyle (5 insertion sites)

N: Tibial portion of sciatic nerve

A: Extends thigh, flexes knee, rotates tibia medially especially when knee is flexed

109
Q

Name the insertion sites of semimembranosus

A

5 insertion sites:

Posterior medial tibial condyle (beneath MCL)

Oblique popliteal ligament

Posterior capsule and posterior horn of medial meniscus

Insertion on posterior oblique ligament (thickening of medial capsular ligament)

Expansion to aponeurosis of popliteal muscle

110
Q

OINA of Gluteus medius

A

O: Dorsal ilium inferior to iliac crest

I: Lateral and superior surfaces of GT

N: Superior gluteal nerve

A: Major abductor ot thigh

Superior fibers help rotate thigh medially

Posterior fibers help rotate thigh laterally

111
Q

OINA of Gluteus Maximus

A

O:

Posterior aspect of dorsal ilium, posterior to posterior gluteal line

PSIS

Posterior inferior aspect of sacrum and coccyx

Sacrotuberous ligament

I: Primarily in fascia lata at the IT band

Also: gluteal tuberosity on posterior femoral surface

N: Inferior gluteal nerve

A:

Major extensor of hip joint

Assists in laterally rotating thigh

Upper and middle sections of the muscles are abductors

113
Q

OINA of Tensor fascia lata

A

O:

ASIS

Outer lip of anterior iliac crest and fascia lata

I: IT Band

N: Superior gluteal nerve

A: Stabilizes hip and knee joints by putting tension on the IT band of fascia

114
Q

OINA of gluteus minimus

A

O:

dorsal ilium between inferior and anterior gluteal lines

Edge of greater sciatic notch

I: Anterior surface of GT

N: Superior gluteal nerve

A: Abducts and medially rotates hip joint

115
Q

OINA of Iliacus

A

O:

Upper 2/3 of iliac fossa of ilium

Internal lip of iliac crest

Lateral aspect of sacrum

Ventral SI ligament

Lower portion of iliolumbar ligament

I: LT

N: femoral

A: Hip flexor

(flexes the torso and thigh with respect to each other)

117
Q

What are the muscles that originate from the ASIS?

A

Sartorius

Tensor fascia lata

118
Q

What is the danger of the lateral approach to the femur?

A

Perforating branches of the profunda femoris artery

119
Q

What is the interval and dangers of the posterolateral approach to the distal femur?

A

Plane:

Vastus lateralis (femoral) and lateral intermuscular septum to linea aspera (covers hamstrings: sciatic)

Dangers:

Perforating branches of the profunda femoris. These pierce lateral intermuscular septums to supply v. lateralis

120
Q

Name the plane and dangers to the anteromedial approach to the distal femur:

A

Plane:

V. medialis (femoral) & rectus femoris (femoral), both innervated proxially

Dangers:

Medial superior geniculate artery

Detachment of vastus medialis needs to be reattached to patella

121
Q

What is the plane and dangers of the medial approach to the distal femur?

A

Plane:

Adductor magnus (post div of obturator/sciatic) & posterior border of vastus medialis

Dangers:

Saphenous nerve: identified over adductor tendon (crosses anterior to posterior at distal femur)

Femoral artery:

Crosses anterior to posterior 13 cm joint through the adductor hiatus

122
Q

Where does the femoral artery cross above the knee joint?

A

13cm above knee joint on the medial side

123
Q

What is the plane and the dangers of the posterior approach to the thigh?

A

Plane:

Proximally: Between lateral intermuscular septum (covering v. lateralis - femoral nerve) & biceps femoris (sciatic nerve)

Distally: reflecting short head of biceps from lateral lip of linea aspera medially (to protect sciatic nerve)

Dangers:

Posterior femoral cutaneous nerve

Sciatic nerve: medial to biceps femoris proximally, identified and protected distally when biceps moved laterally

Nerve to biceps femoris: branch of sciatic and inserts medailly high in the leg

124
Q

Convex or concave: Medial tibial plateau?

A

Concave

125
Q

Convex or convace, lateral tibial plateau?

A

Convex

126
Q

Notch sign: medial or lateral femoral condyle?

A

Lateral

The (deep) lateral femoral notch sign describes a depression on the lateral femoral condyle at the terminal sulcus, a junction between the weight bearing tibial articular surface and the patellar articular surface of the femoral condyle.

An abnormally large notch or an asymmetrical/irregular notch can be an indirect sign of an ACL injury as evidence of a pivot shift mechanism and rotatory subluxation.

127
Q

What are the components of the Posterolateral corner?

A

Static structures (Ligaments/capsule)

  1. lateral capsule
  2. LCL
  3. popliteofibular ligament
  4. Arcuate ligament
  5. +/- Fabellofibular ligament

Dynamic structures (MUSCLES):

  1. biceps femoris
  2. IT band
  3. Lateral head
  4. Popliteus

**The Arcuate ligament (variable) is a Y shaped thickening of the posterolateral capsule which arises from the fibular styloid and divides into 2 limbs:

  1. medial limb - curves over popliteus to join with the oblique popliteal ligament
  2. lateral limb - ascends to blend with the capsule near the lateral gastrocnemius muscle
128
Q

What are the branches of the femoral artery?

A
  1. superficial circumflex iliac artery
  2. superficial epigastric artery
  3. superficial external pudendal artery
  4. deep external pudendal artery
  5. profunda femoris artery
    1. Lateral circumflex femoral artery

Medial circumflex femoral artery

Perforating arteries - perforate the adductor magnus muscle to the posterior and medial compartments of the thigh.

  1. descending genicular artery

Details:

  1. The superficial circumflex iliac artery is a small branch that runs up to the region of the anterior superior iliac spine.
  2. The superficial epigastric artery is a small branch that crosses the inguinal ligament and runs to the region of the umbilicus.
  3. The superficial external pudendal artery is a small branch that runs medially to supply the skin of the scrotum (or labium majus).
  4. The deep external pudendal artery runs medially and supplies the skin of the scrotum (or labium majus).
  5. The profunda femoris artery is a large and important branch that arises from the lateral side of the femoral artery about 1.5 in. (4 cm) below the inguinal ligament. It passes medially behind the femoral vessels and enters the medial fascial compartment of the thigh. It ends by becoming the fourth perforating artery. At its origin, it gives off the medial and lateral femoral circumflex arteries, and during its course it gives off three perforating arteries.
  6. The descending genicular artery is a small branch that arises from the femoral artery near its termination within the adductor canal. It assists in supplying the knee joint.

1. Anatomy (Royal College Exam Prep) (11 decks)

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