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Orthopedic Surgery Ultimate > Thigh/Knee Anatomy > Flashcards

Thigh/Knee Anatomy Flashcards

1
Q

what is the intertrochanteric line?

A

anterior, between LT and GT

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2
Q

what is the intertrochanteric crest?

A

posterior, line between LT and GT

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3
Q

where is the adductor tubercle?

A

medial aspect of the distal femur (essentially the medial epicondyle)

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4
Q

where is the gluteal tuberosity?

A

the lateral continuation of the linea aspera superiorly to the GT

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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.

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6
Q

anteversion of the hip

A

15°

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7
Q

head-neck angle of the femur

A

127° coxa vara if < 120 coxa valga if > 135

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8
Q

anterior radius of curvature of the femur

A

120 cm

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9
Q

when does the tri-radiate cartilage fuse?

A

14-16

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10
Q

3 functions of the labrum

A
  1. seal with hydrostatic pressure 2. lubrication 3. deepens the acetabulum
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11
Q

name the ligaments of the hip

A

iliofemoral (ASIS to intertrochanteric line - strongest)

pubofemoral

ischiofemoral

ligamentum teres

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12
Q

what are the longitudinal retinacular fibres?

A

travel along the neck carrying blood vessels

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13
Q
A

adductor longus

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14
Q
A

femoral artery and vein

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15
Q
A

sartorius

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16
Q
A

medial intermuscular septum

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17
Q
A

vastus medialis

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18
Q
A

vastus intermedius

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19
Q
A

rectus femoris

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20
Q
A

vastus lateralis

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21
Q
A

sciatic nerve

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22
Q
A

lateral intermuscular septum

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23
Q
A

biceps femoris - short head

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24
Q
A

biceps femoris - long head

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25
Q
A

semitendinosus

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26
Q
A

semimembranosus

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27
Q
A

adductor magnus

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28
Q
A

gracillis

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29
Q
A

adductor brevis

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30
Q
A

vastus lateralis

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31
Q
A

vastus medialis and intermeius

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32
Q
A

rectus femoris

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33
Q
A

sartorius

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34
Q
A

adductor longus

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35
Q
A

adductor brevis

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36
Q
A

gracillis

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37
Q
A

semitendinosis

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38
Q
A

gluteus maximus

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39
Q
A

vastus lateralis

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40
Q
A

tensor fascia lata

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41
Q
A

rectus femoris

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42
Q
A

sartorius

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43
Q
A

adductor longus

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44
Q
A

adductor brevis

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45
Q
A

pectineus

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46
Q
A

iliopsoas

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47
Q
A

vastus intermedius

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48
Q
A

adductor magnus

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49
Q

origin of glut max

A

dorsal ilium

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50
Q

insertion of glut max

A

fascia lata and gluteal tuberosity

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51
Q

origin glut med

A

dorsal ilium inferior to iliac crest

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52
Q

insertion of glut med

A

superolateral GT

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53
Q

origin of glut min

A

dorsal ilium between inferior and anterior gluteal lines

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54
Q

insertion of glut min

A

anterior GT

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55
Q

origin of iliacus

A

upper 2/3 of iliac fossa

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56
Q

insertion of iliacus

A

LT

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57
Q

TFL origin

A

ASIS

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58
Q

TFL insertion

A

IT band

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59
Q

origin sartorius

A

ASIS

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60
Q

insertion sartorius

A

superior part of the pes on the proximal, medial tibia

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61
Q

origin rectus femoris

A

AIIS - straight head

groove above acetabulum - reflected head

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62
Q

insertion rectus femoris

A

base of patella

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63
Q

origin vastus lateralis

A

intertrochanteric line

anterior-inferior GT

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64
Q

insertion vastus lateralis

A

lateral base and border of patella

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65
Q

origin vastus medialis

A

intertrochanteric line

medial lip of linea aspera

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66
Q

insertion vastus medialis

A

medial base and border of patella

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67
Q

origin vastus intermedialis

A

superior 2/3 anterolateral surface of femur and lateral intermuscular septum

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68
Q

insertion of vastus intermedialis

A

lateral border of patella

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69
Q

what is the articularis genu?

A

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

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70
Q

adductor brevis origin

A

anterior inferior pubic ramus

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71
Q

insertion adductor brevis

A

pectineal line

medial lip of linea aspera

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72
Q

origin adductor longus

A

anterior surface of body of pubis

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73
Q

insertion adductor longus

A

middle third of linea aspera

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74
Q

origin adductor magnus

A

inferior pubic ramus

ischial ramus

inferolateral area of ischial tuberosity

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75
Q

insertion adductor magnus

A

gluteal tuberosity

medial lip of linea aspera

medial supracondylar ridge

adductor tubercle

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76
Q

innervation of adductor magnus

A

posterior obturator

sciatic for hamstring portion*

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77
Q

origin pectineus

A

pecten pubis

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78
Q

insertion pectineus

A

pectineal line on femur

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79
Q

innervation of pectineus

A

femoral nerve

AND

obturator nerve

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80
Q

origin gracillis

A

inferior margin of pubic symphysis and ischial ramus

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81
Q

insertion of gracillus

A

second on pes (just posterior to sartorius)

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82
Q

biceps femoris long head origin

A

ischial tuberosity

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83
Q

insertion of biceps femoris long head

A

fibular head

LCL

lateral tibial condyle

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84
Q

origin of biceps femoris short head

A

lateral lip of linea aspera

lateral supracondylar ridge

lateral intramuscular septum

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85
Q

insertion of biceps femoris short head

A

fibular head

LCL

lateral tibial condyle

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86
Q

innervation of biceps femoris short head

A

common peroneal nerve

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87
Q

origin semitendinosis

A

ischial tuberosity with long head biceps femoris

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88
Q

insertion of semitendinosis

A

bottom of the pes

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89
Q

semimembranosus origin

A

ischial tuberosity with long head of biceps and semiT

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90
Q

insertion semimembranosus

A

posterior surface of the medial tibial condyle

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91
Q

name the 5 insertions of semimembranosus

A

posterior medial tibial condyle

oblique popliteal ligament

posterior capsule and posterior horn of medial meniscus

posterior oblique ligament

aponeurosis of popliteal muscle

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92
Q
A

iliacus

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93
Q
A

sartorius

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94
Q
A

rectus femoris

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95
Q
A

obturator internus and gemeli

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96
Q
A

piriformis

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97
Q
A

glut min

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98
Q
A

vastus lateralis

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99
Q
A

vastus intermedius

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100
Q
A

vastus medialis

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101
Q
A

iliopsoas

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102
Q
A

quadratus

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103
Q
A

adductor magnus

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104
Q
A

obturator externus

105
Q
A

adductor brevis

106
Q
A

gracillis

107
Q
A

pectineus

108
Q
A

obturator internus

109
Q
A

adductor magnus

110
Q
A

semitendinosis

biceps femoris

111
Q
A

semimembranosus

112
Q
A

Gemeli

113
Q
A

adductor brevis

114
Q
A

adductor magnus

115
Q
A

glut max

116
Q
A

pectineus

117
Q
A

vastus lateralis

118
Q
A

iliopsoas

119
Q
A

quadratus femoris

120
Q
A

glut med

121
Q
A

obturator externus

122
Q
A

rectus femoris

123
Q
A

sartorius

124
Q
A

glut min

125
Q
A

glut med

126
Q
A

glut max

127
Q

what are the boundaries of the femoral triangle?

A

inguinal ligament - sartorius - adductor longus - pectineus

floor: iliopsoas, pectineus, adductors
contents: NAVEL

128
Q

what are the boundaries of the adductor canal?

A

anteriolateral = vastus medialis

posterior = adductor longus and magnus

contents = FA, FV, FN, saphenous nerve, nerve to vastus medialis

129
Q

course of the superficial femoral artery

A

under sartorius between the adductors and vastus medialis, then exits the adductor hiatus posterior to the medial femoral condyle

130
Q

components of the cruciate anastomosis

A

medial circumflex

lateral circumflex

inferior gluteal

1st perforator

131
Q

course of the medial circumflex artery

A

between pectineus and iliopsoas

then obturator externus and adductor brevis

then adductor magnus and brevis

then along cranial edge of quadratus femoris

132
Q

course of the lateral circumflex

A

deep to rectus and sartorius

133
Q

origin of the saphenous nerve

A

a terminal branch of femoral nerve providing sensation to medial lower leg

134
Q

origin of the sural nerve

A

medial cutaneous branch from tibial nerve and lateral cutaneous branch from common peroneal that combine

135
Q

normal degree of knee valgus

A

5-7°

136
Q

normal rotation of the knee

A

3° internal

137
Q

normal posterior tibial slope

A

8-10°

138
Q

main motion of the medial plateau

A

pivot

139
Q

main motion of the lateral plateau

A

glide

140
Q

average thickness of the patella

A

23-25 mm

141
Q

thickness of the patella you must maintain in arthroplasty

A

12 mm

142
Q

how does the contact point of the knee joint change with dynamic movement?

A

in extension the contact point is anterior to the coronal slice through middle

in flexion the contact is much more posterior

143
Q

what inserts at Gerdy’s tubercle?

A

IT band

144
Q

describe the surface of the tibial plateau

A

lateral and medial condyles

lateral and medial intercondylar tubercles

posterior intercondylar surface

145
Q

what is the typical deformity in a proximal tibia fracture?

A

valgus

procurvatum

146
Q

how many facets on the patella?

A

7:

3 medial

3 lateral

odd (extra medial)

147
Q

what is fractured?

A

nothing.

this is a bipartite patella (2% of the population)

148
Q

what attaches to the fibular head?

A

biceps

LCL

149
Q

how does the fibula move during plantarflexion?

A

externally rotates and distalizes

150
Q

difference between verticle and mechanical axis of femur

A

3°

151
Q

difference between mechanical and anatomical axis of the femur

A

6°

152
Q

what is Q angle?

A

ASIS to patella

patella to tibial tubercle

normal is 14 for males, 17 for females

153
Q

ligaments from the fibula to to tibia

A

anterior ligament

posterior ligament

interosseous membrane

154
Q

12 ligaments of the knee

A

ACL

PCL

MCL

LCL

MPFL

Retinacular

arcuate

oblique popliteal

coronary

wrisberg

humphrey

transverse

155
Q

what is the retinacular ligament?

A

both lateral and medial transverse and longitudinal components

156
Q

describe the 3 layers of the medial knee

A

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
Q

5 structures that converge at the posteromedial corner of the knee

A
  1. MPFL
  2. Adductor magnus tendon
  3. Medial gastrocs tendon
  4. Superficial MCL
  5. Posterior oblique ligament

*all insert on the adductor tubercle

158
Q

how many insertions does the superficial MCL have?

A

2 on tibia

1 on medial condyle of femur

159
Q

what is schottle’s point?

A

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
Q

2 main structures of the posterior knee capsule

A

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
Q

describe the layers of the posterolateral corner of the knee

A

superficial: anterior - ITB, posterior - biceps femoris
middle: lateral retinaculum, popliteal fibular ligament
deep: joint capsule, popliteus, LCL, arcuate ligament

162
Q
A

oblique popliteal ligament

163
Q
A

arcuate popliteal ligament

164
Q

what is the dial test?

A

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
Q

innervation of ACL

A

tibial nerve

166
Q

blood supply to ACL

A

middle geniculate artery

167
Q

describe the anatomy of the ACL

A

medial surface of the lateral femoral condyle to the anteromedial tibia

*has 2 bundles - AM (tight in flexion), PL (tight in extension, stronger)

168
Q

what is the anterolateral ligament?

A

anterior bundle of the LCL - remember segond #

169
Q

where in space does the PCL exist?

A

extrasynovial, intraarticular

from posterolateral tibia to lateral aspect of medial femoral condyle

*2 bundles, AL (tight in flexion) and PM (tight in extension

170
Q

from which meniscus do wrisberg and humphrey arise?

A

posterolateral

171
Q

how do the menisci absorb load?

A

lateral takes 70% of lateral compartment

medial takes 50% of medial compartment

*more load is experienced in flexion

172
Q

describe the structure of the menisci

A

mostly type 1 collagen

most fibres are oriented circumferentially to resist compression

some fibres radially resist longitudinal force

surface meshwork resists shear

173
Q

blood supply to meniscus

A

from medial and lateral genicular arteries to the outer third

174
Q

4 bursa of the anterior knee

A

suprapatellar

prepatellar

superficial infrapatellar

deep infrapatellar

175
Q

boundaries of the popliteal fossa

A

semi M / semi T medially

biceps laterally

two heads of gastrocs inferomedial and lateral

176
Q

contents of the popliteal fossa

A

vessels

tibial and common peroneal nerves

177
Q
A

anterior tibial artery

anterior tibial vein

deep peroneal nerve

178
Q
A

tibia

179
Q
A

interosseous membrane

180
Q
A

great saphenous vein

saphenous nerve

181
Q
A

tibialis posterior

182
Q
A

flexor digitorum longus

183
Q
A

fibular artery and veins

184
Q
A

posterior tibial artery

posterior tibial vein

tibial nerve

185
Q
A

flexor hallicus longus

186
Q
A

deep fascia of leg

187
Q
A

plantaris tendon

188
Q
A

medial head of gastrocs

189
Q
A

medial sural cutaneous nerve

190
Q
A

small saphenous vein

191
Q
A

sural communicating branch of the lateral sural cutaneous nerve

192
Q
A

lateral head of gastrocs

193
Q
A

soleus

194
Q
A

transverse intermuscular septum

195
Q
A

lateral sural cutaneous nerve

196
Q
A

fibula

197
Q
A

posterior intermuscular septum

198
Q
A

peroneus brevis

199
Q
A

peroneus longus

200
Q
A

deep fascia of the leg

201
Q
A

anterior intermuscular septum

202
Q
A

superficial peroneal nerve

203
Q
A

extensor digitorum longus

204
Q
A

extensor hallicus longus

205
Q
A

tibialis anterior

206
Q

where is peroneus tertius?

A

anterior compartment!

207
Q

order of contents of the anterior compartment from medial to lateral

A

tib ant

EHL

anterior tibial artery

deep peroneal nerve

EDL

tertius

208
Q

origin of peroneus tertius

A

low anterior fibula

209
Q

origin of EDL

A

proximal anterior fibula

210
Q

origin of EHL

A

mid fibula and interosseous membrane

211
Q

order of muscles in lateral compartment

A

longus is superficial to brevis

212
Q

origin of FDL

A

posterior tibia

213
Q

origin of FHL

A

posterior fibula

214
Q

origin of tib post

A

posterior interosseous membrane

215
Q

insertion of tibialis anterior

A

medial cuneiform and base of 1st metatarsal

216
Q

insertion of EHL

A

base of distal phalanx

217
Q

insertion of EDL

A

base of middle and distal phalanges

218
Q

insertion of peroneus tertius

A

base of 5th metatarsal

219
Q

insertion of peroneus longus

A

plantar surface of the medial cuneiform and base of the 1st metatarsal

220
Q

insertion of peroneus brevis

A

base of the 5th metatarsal

221
Q

origin of plantaris

A

lateral femoral supracondylar line

222
Q

3 origins of popliteus

A

lateral condyle just anteroinferior to LCL

fibular head

posterior horn of lateral meniscus

223
Q

how does the knee lock in extension?

A

tibia externally rotates in last few degrees of extension - the popliteus counters this by medially rotating the tibia and therefore, unlocking the knee

224
Q

when is the knee most stable?

A

in full extension

225
Q

insertion of FHL

A

plantar base of distal phalanx

226
Q

insertion of FDL

A

plantar surface of base of distal phalanges 2-5

227
Q

insertion of tib post

A

navicular tuberosity and medial cuneiform (plantar surface)

228
Q

course of the tibial nerve

A

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
Q

course of the common peroneal nerve

A

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
Q

course of deep peroneal nerve

A

sharp turn after split to enter anterior compartment

runs along anterior surface of interosseous membrane

231
Q

where does the superficial peroneal nerve give off its muscular branches?

A

upper 1/3 of leg only

232
Q

course of superficial peroneal nerve

A

lateral surface of fibula for first 1/3

then under longus, on brevis

runs between brevis and EDL

233
Q

what is the orientation of the femoral/saphenous nerve as it runs distally?

A

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
Q

medial to lateral structures in the popliteal fossa

A

artery

vein

nerve

235
Q

where is the popliteal artery during TKA?

A

9mm posterior to the tibial plateau in 90° flexion

superficial to popliteus

deep to soleus

236
Q

course of branches of popliteal artery

A

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
Q

order of structures posterior to the medial malleolus

A

tib post

FDL

artery

vein

nerve

FHL

238
Q

termination of the posterior tibial artery

A

medial and lateral plantar arteries

239
Q

where is the peroneal artery?

A

deep to FHL in the deep posterior compartment!

terminates as calcaneal branch and anterior perforating artery

240
Q

course of the great saphenous vein

A

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
Q

During a posterior apporach to the hip, what
muscle is your landmark so that you don’t
de-vascularize the head?

A

quadratus femoris

242
Q

What is the only muscle in the thigh innervated by the
peroneal branch of the sciatic nerve?

A

short head of biceps

243
Q

Which bands of ACL and PCL are tight in flexion?

A

anterior bands

244
Q

A patient undergoes meniscal suturing of the medial
meniscus. Which of the following structures is most at
risk posteriorly?

A

saphenous nerve

245
Q

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

A

decreased sensation in second web space

246
Q

2

A

saphenous vein

247
Q

3

A

sartorius

248
Q

4

A

semitendinosis tendon

249
Q

5

A

medial head of gastrocs

250
Q

6

A

popliteal artery

251
Q

7

A

biceps femoris

252
Q

boundaries of the adductor canal

A

anterior - sartorius

posteromedial - magnus and longus

medial - vastus medialis

253
Q

contents of adductor canal

A

superficial femoral artery

femoral vein

saphenous nerve

motor branch to vastus medialis

254
Q
A

double PCL sign = incarcerated bucket handle meniscal tear

255
Q

Where does the medial patello-femoral ligament insert on the
patella:

A

superomedial aspect

256
Q

average radius of curvature of the femur

A

120 cm anterior

257
Q

if someone is dial + at 30 and 90, what other exam abnormality will you find?

A

increased varus opening at 0 flexion

  • PCL
  • LCL
  • popliteus tendon

*all torn

258
Q

pathology?

A

this is a segond # - disruption of the anterior oblique band of the LCL

meaning ALL is avulsed and likely ACL is also torn

Orthopedic Surgery Ultimate (88 decks)

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