Thigh/Knee Anatomy Flashcards
1
Q
what is the intertrochanteric line?
A
anterior, between LT and GT
2
Q
what is the intertrochanteric crest?
A
posterior, line between LT and GT
3
Q
where is the adductor tubercle?
A
medial aspect of the distal femur (essentially the medial epicondyle)
4
Q
where is the gluteal tuberosity?
A
the lateral continuation of the linea aspera superiorly to the GT
5
Q
what is the linea aspera?
A
the ridge on the posterior aspect of the femur created inferiorly by the supracondylar lines and superiorly by the lateral (gluteal tuberosity), intermediate (pectineal line) and medial ridges.
6
Q
anteversion of the hip
A
15°
7
Q
head-neck angle of the femur
A
127° coxa vara if < 120 coxa valga if > 135
8
Q
anterior radius of curvature of the femur
A
120 cm
9
Q
when does the tri-radiate cartilage fuse?
A
14-16
10
Q
3 functions of the labrum
A
- seal with hydrostatic pressure 2. lubrication 3. deepens the acetabulum
11
Q
name the ligaments of the hip
A
iliofemoral (ASIS to intertrochanteric line - strongest)
pubofemoral
ischiofemoral
ligamentum teres
12
Q
what are the longitudinal retinacular fibres?
A
travel along the neck carrying blood vessels
13
Q
A
adductor longus
14
Q
A
femoral artery and vein
15
Q
A
sartorius
16
Q
A
medial intermuscular septum
17
Q
A
vastus medialis
18
Q
A
vastus intermedius
19
Q
A
rectus femoris
20
Q
A
vastus lateralis
21
Q
A
sciatic nerve
22
Q
A
lateral intermuscular septum
23
Q
A
biceps femoris - short head
24
Q
A
biceps femoris - long head
25
semitendinosus
26
semimembranosus
27
adductor magnus
28
gracillis
29
adductor brevis
30
vastus lateralis
31
vastus medialis and intermeius
32
rectus femoris
33
sartorius
34
adductor longus
35
adductor brevis
36
gracillis
37
semitendinosis
38
gluteus maximus
39
vastus lateralis
40
tensor fascia lata
41
rectus femoris
42
sartorius
43
adductor longus
44
adductor brevis
45
pectineus
46
iliopsoas
47
vastus intermedius
48
adductor magnus
49
origin of glut max
dorsal ilium
50
insertion of glut max
fascia lata and gluteal tuberosity
51
origin glut med
dorsal ilium inferior to iliac crest
52
insertion of glut med
superolateral GT
53
origin of glut min
dorsal ilium between inferior and anterior gluteal lines
54
insertion of glut min
anterior GT
55
origin of iliacus
upper 2/3 of iliac fossa
56
insertion of iliacus
LT
57
TFL origin
ASIS
58
TFL insertion
IT band
59
origin sartorius
ASIS
60
insertion sartorius
superior part of the pes on the proximal, medial tibia
61
origin rectus femoris
AIIS - straight head
groove above acetabulum - reflected head
62
insertion rectus femoris
base of patella
63
origin vastus lateralis
intertrochanteric line
anterior-inferior GT
64
insertion vastus lateralis
lateral base and border of patella
65
origin vastus medialis
intertrochanteric line
medial lip of linea aspera
66
insertion vastus medialis
medial base and border of patella
67
origin vastus intermedialis
superior 2/3 anterolateral surface of femur and lateral intermuscular septum
68
insertion of vastus intermedialis
lateral border of patella
69
what is the articularis genu?
a small muscle that originates from the distal anterior surface of the femur to insert on the superior synovial membrane of the knee. It pulls the suprapatellar bursa superiorly during extension of the knee to prevent impingement
70
adductor brevis origin
anterior inferior pubic ramus
71
insertion adductor brevis
pectineal line
medial lip of linea aspera
72
origin adductor longus
anterior surface of body of pubis
73
insertion adductor longus
middle third of linea aspera
74
origin adductor magnus
inferior pubic ramus
ischial ramus
inferolateral area of ischial tuberosity
75
insertion adductor magnus
gluteal tuberosity
medial lip of linea aspera
medial supracondylar ridge
adductor tubercle
76
innervation of adductor magnus
posterior obturator
sciatic for hamstring portion\*
77
origin pectineus
pecten pubis
78
insertion pectineus
pectineal line on femur
79
innervation of pectineus
femoral nerve
AND
obturator nerve
80
origin gracillis
inferior margin of pubic symphysis and ischial ramus
81
insertion of gracillus
second on pes (just posterior to sartorius)
82
biceps femoris long head origin
ischial tuberosity
83
insertion of biceps femoris long head
fibular head
LCL
lateral tibial condyle
84
origin of biceps femoris short head
lateral lip of linea aspera
lateral supracondylar ridge
lateral intramuscular septum
85
insertion of biceps femoris short head
fibular head
LCL
lateral tibial condyle
86
innervation of biceps femoris short head
common peroneal nerve
87
origin semitendinosis
ischial tuberosity with long head biceps femoris
88
insertion of semitendinosis
bottom of the pes
89
semimembranosus origin
ischial tuberosity with long head of biceps and semiT
90
insertion semimembranosus
posterior surface of the medial tibial condyle
91
name the 5 insertions of semimembranosus
posterior medial tibial condyle
oblique popliteal ligament
posterior capsule and posterior horn of medial meniscus
posterior oblique ligament
aponeurosis of popliteal muscle
92
iliacus
93
sartorius
94
rectus femoris
95
obturator internus and gemeli
96
piriformis
97
glut min
98
vastus lateralis
99
vastus intermedius
100
vastus medialis
101
iliopsoas
102
quadratus
103
adductor magnus
104
obturator externus
105
adductor brevis
106
gracillis
107
pectineus
108
obturator internus
109
adductor magnus
110
semitendinosis
biceps femoris
111
semimembranosus
112
Gemeli
113
adductor brevis
114
adductor magnus
115
glut max
116
pectineus
117
vastus lateralis
118
iliopsoas
119
quadratus femoris
120
glut med
121
obturator externus
122
rectus femoris
123
sartorius
124
glut min
125
glut med
126
glut max
127
what are the boundaries of the femoral triangle?
inguinal ligament - sartorius - adductor longus - pectineus
floor: iliopsoas, pectineus, adductors
contents: NAVEL
128
what are the boundaries of the adductor canal?
anteriolateral = vastus medialis
posterior = adductor longus and magnus
contents = FA, FV, FN, saphenous nerve, nerve to vastus medialis
129
course of the superficial femoral artery
under sartorius between the adductors and vastus medialis, then exits the adductor hiatus posterior to the medial femoral condyle
130
components of the cruciate anastomosis
medial circumflex
lateral circumflex
inferior gluteal
1st perforator
131
course of the medial circumflex artery
between pectineus and iliopsoas
then obturator externus and adductor brevis
then adductor magnus and brevis
then along cranial edge of quadratus femoris
132
course of the lateral circumflex
deep to rectus and sartorius
133
origin of the saphenous nerve
a terminal branch of femoral nerve providing sensation to medial lower leg
134
origin of the sural nerve
medial cutaneous branch from tibial nerve and lateral cutaneous branch from common peroneal that combine
135
normal degree of knee valgus
5-7°
136
normal rotation of the knee
3° internal
137
normal posterior tibial slope
8-10°
138
main motion of the medial plateau
pivot
139
main motion of the lateral plateau
glide
140
average thickness of the patella
23-25 mm
141
thickness of the patella you must maintain in arthroplasty
12 mm
142
how does the contact point of the knee joint change with dynamic movement?
in extension the contact point is anterior to the coronal slice through middle
in flexion the contact is much more posterior
143
what inserts at Gerdy's tubercle?
IT band
144
describe the surface of the tibial plateau
lateral and medial condyles
lateral and medial intercondylar tubercles
posterior intercondylar surface
145
what is the typical deformity in a proximal tibia fracture?
valgus
procurvatum
146
how many facets on the patella?
7:
3 medial
3 lateral
odd (extra medial)
147
what is fractured?
nothing.
this is a bipartite patella (2% of the population)
148
what attaches to the fibular head?
biceps
LCL
149
how does the fibula move during plantarflexion?
externally rotates and distalizes
150
difference between verticle and mechanical axis of femur
3°
151
difference between mechanical and anatomical axis of the femur
6°
152
what is Q angle?
ASIS to patella
patella to tibial tubercle
normal is 14 for males, 17 for females
153
ligaments from the fibula to to tibia
anterior ligament
posterior ligament
interosseous membrane
154
12 ligaments of the knee
ACL
PCL
MCL
LCL
MPFL
Retinacular
arcuate
oblique popliteal
coronary
wrisberg
humphrey
transverse
155
what is the retinacular ligament?
both lateral and medial transverse and longitudinal components
156
describe the 3 layers of the medial knee
superficial:
anterior - medial patellar retinaculum
medial - deep fascia enclosing sartorius
posterior - deep fascia enclosing gastrocs and roof of popliteal fascia
Middle:
anterior - MPFL
medial - superficial MCL
posterior - tendon of semimembranosus
Deep:
joint capsule, deep MCL
157
5 structures that converge at the posteromedial corner of the knee
1. MPFL
2. Adductor magnus tendon
3. Medial gastrocs tendon
4. Superficial MCL
5. Posterior oblique ligament
\*all insert on the adductor tubercle
158
how many insertions does the superficial MCL have?
2 on tibia
1 on medial condyle of femur
159
what is schottle's point?
where the MPFL inserts
draw a line along the posterior femoral cortex then square it with the line along the anterior femoral joint surface
160
2 main structures of the posterior knee capsule
oblique popliteal ligament - medial tibia to lateral femur
arcuate popliteal ligament - fibular head to lateral femur
\*also popliteus from posteriomedial tibia to lateral knee joint
161
describe the layers of the posterolateral corner of the knee
superficial: anterior - ITB, posterior - biceps femoris
middle: lateral retinaculum, popliteal fibular ligament
deep: joint capsule, popliteus, LCL, arcuate ligament
162
oblique popliteal ligament
163
arcuate popliteal ligament
164
what is the dial test?
flex the knee to 30°
if there is a greater than 10° difference in external rotation of the knee then you have a posterolateral corner injury
\*if this is also true at 90° knee flexion then you have a PCL injury too
165
innervation of ACL
tibial nerve
166
blood supply to ACL
middle geniculate artery
167
describe the anatomy of the ACL
medial surface of the lateral femoral condyle to the anteromedial tibia
\*has 2 bundles - AM (tight in flexion), PL (tight in extension, stronger)
168
what is the anterolateral ligament?
anterior bundle of the LCL - remember segond #
169
where in space does the PCL exist?
extrasynovial, intraarticular
from posterolateral tibia to lateral aspect of medial femoral condyle
\*2 bundles, AL (tight in flexion) and PM (tight in extension
170
from which meniscus do wrisberg and humphrey arise?
posterolateral
171
how do the menisci absorb load?
lateral takes 70% of lateral compartment
medial takes 50% of medial compartment
\*more load is experienced in flexion
172
describe the structure of the menisci
mostly type 1 collagen
most fibres are oriented circumferentially to resist compression
some fibres radially resist longitudinal force
surface meshwork resists shear
173
blood supply to meniscus
from medial and lateral genicular arteries to the outer third
174
4 bursa of the anterior knee
suprapatellar
prepatellar
superficial infrapatellar
deep infrapatellar
175
boundaries of the popliteal fossa
semi M / semi T medially
biceps laterally
two heads of gastrocs inferomedial and lateral
176
contents of the popliteal fossa
vessels
tibial and common peroneal nerves
177
anterior tibial artery
anterior tibial vein
deep peroneal nerve
178
tibia
179
interosseous membrane
180
great saphenous vein
saphenous nerve
181
tibialis posterior
182
flexor digitorum longus
183
fibular artery and veins
184
posterior tibial artery
posterior tibial vein
tibial nerve
185
flexor hallicus longus
186
deep fascia of leg
187
plantaris tendon
188
medial head of gastrocs
189
medial sural cutaneous nerve
190
small saphenous vein
191
sural communicating branch of the lateral sural cutaneous nerve
192
lateral head of gastrocs
193
soleus
194
transverse intermuscular septum
195
lateral sural cutaneous nerve
196
fibula
197
posterior intermuscular septum
198
peroneus brevis
199
peroneus longus
200
deep fascia of the leg
201
anterior intermuscular septum
202
superficial peroneal nerve
203
extensor digitorum longus
204
extensor hallicus longus
205
tibialis anterior
206
where is peroneus tertius?
anterior compartment!
207
order of contents of the anterior compartment from medial to lateral
tib ant
EHL
anterior tibial artery
deep peroneal nerve
EDL
tertius
208
origin of peroneus tertius
low anterior fibula
209
origin of EDL
proximal anterior fibula
210
origin of EHL
mid fibula and interosseous membrane
211
order of muscles in lateral compartment
longus is superficial to brevis
212
origin of FDL
posterior tibia
213
origin of FHL
posterior fibula
214
origin of tib post
posterior interosseous membrane
215
insertion of tibialis anterior
medial cuneiform and base of 1st metatarsal
216
insertion of EHL
base of distal phalanx
217
insertion of EDL
base of middle and distal phalanges
218
insertion of peroneus tertius
base of 5th metatarsal
219
insertion of peroneus longus
plantar surface of the medial cuneiform and base of the 1st metatarsal
220
insertion of peroneus brevis
base of the 5th metatarsal
221
origin of plantaris
lateral femoral supracondylar line
222
3 origins of popliteus
lateral condyle just anteroinferior to LCL
fibular head
posterior horn of lateral meniscus
223
how does the knee lock in extension?
tibia externally rotates in last few degrees of extension - the popliteus counters this by medially rotating the tibia and therefore, unlocking the knee
224
when is the knee most stable?
in full extension
225
insertion of FHL
plantar base of distal phalanx
226
insertion of FDL
plantar surface of base of distal phalanges 2-5
227
insertion of tib post
navicular tuberosity and medial cuneiform (plantar surface)
228
course of the tibial nerve
arises from sciatic split above popliteal fossa
gives off medial sural cutaneous nerve
crosses on top of plantaris
dives deep to soleus and enters the deep compartment
runs just anterior to transverse intermuscular septum
runs between FDL and FHL
229
course of the common peroneal nerve
arises from split of sciatic above popliteal fossa
runs medial to biceps
crosses superficial to lateral head of gastrocs
gives off lateral sural cutaneous nerve
stays lateral to soleus
winds around fibular neck deep to peroneus longus 3-4 cm below tip of fibula
penetrates posterior intermuscular septum
divides into superficial and deep branches
230
course of deep peroneal nerve
sharp turn after split to enter anterior compartment
runs along anterior surface of interosseous membrane
231
where does the superficial peroneal nerve give off its muscular branches?
upper 1/3 of leg only
232
course of superficial peroneal nerve
lateral surface of fibula for first 1/3
then under longus, on brevis
runs between brevis and EDL
233
what is the orientation of the femoral/saphenous nerve as it runs distally?
starts lateral to vessels in the femoral triangle
crosses anterior to vessels in the adductor canal
emerges medial to vessels from the adductor canal
pierces fascia at medial knee between gracillis and sartorius to become subcutaneous
234
medial to lateral structures in the popliteal fossa
artery
vein
nerve
235
where is the popliteal artery during TKA?
9mm posterior to the tibial plateau in 90° flexion
superficial to popliteus
deep to soleus
236
course of branches of popliteal artery
divides to tibioperoneal trunk and anterior tibial artery just below fossa
runs superficial to tib post
tibioperoneal trunk divides again 2.5 cm below fossa to peroneal and posterior tibial arteries
the anterior tibial quickly pierces the interosseous membrane to run down the anterior aspect of the membrane, just medial to deep peroneal nerve, between TA and EHL
at extensor retinaculum anterior tibial artery passes under EHL and then runs lateral
237
order of structures posterior to the medial malleolus
tib post
FDL
artery
vein
nerve
FHL
238
termination of the posterior tibial artery
medial and lateral plantar arteries
239
where is the peroneal artery?
deep to FHL in the deep posterior compartment!
terminates as calcaneal branch and anterior perforating artery
240
course of the great saphenous vein
arises from the dorsal vein of 1st digit
anterior to medial mal
medial leg with saphenous nerve
posterior to medial condyle at knee
medial thigh
through fossa ovalis
241
During a posterior apporach to the hip, what
muscle is your landmark so that you don’t
de-vascularize the head?
quadratus femoris
242
What is the only muscle in the thigh innervated by the
peroneal branch of the sciatic nerve?
short head of biceps
243
Which bands of ACL and PCL are tight in flexion?
anterior bands
244
A patient undergoes meniscal suturing of the medial
meniscus. Which of the following structures is most at
risk posteriorly?
saphenous nerve
245
A patient has disruption of the superficial branch of
the peroneal nerve. Which of the following is correct
with regards to findings:
decreased sensation in second web space
246
2
saphenous vein
247
3
sartorius
248
4
semitendinosis tendon
249
5
medial head of gastrocs
250
6
popliteal artery
251
7
biceps femoris
252
boundaries of the adductor canal
anterior - sartorius
posteromedial - magnus and longus
medial - vastus medialis
253
contents of adductor canal
superficial femoral artery
femoral vein
saphenous nerve
motor branch to vastus medialis
254
double PCL sign = incarcerated bucket handle meniscal tear
255
Where does the medial patello-femoral ligament insert on the
patella:
superomedial aspect
256
average radius of curvature of the femur
120 cm anterior
257
if someone is dial + at 30 and 90, what other exam abnormality will you find?
increased varus opening at 0 flexion
- PCL
- LCL
- popliteus tendon
\*all torn
258
pathology?
this is a segond # - disruption of the anterior oblique band of the LCL
meaning ALL is avulsed and likely ACL is also torn
