Tibiofemoral Joint Flashcards
What type of joint is the Tibiofemoral joint?
Synovial; bicondylar; complex modified ovoid
How many degrees of freedom does the tibiofemoral joint have?
1 (cardinal swing flex/ext)
What is the capsular pattern of restriction at the tibiofemoral joint?
Marked loss of flexion
Less of extension
What is the close packed position of the tibiofemoral joint?
Weight bearing full extension with external rotation of the tibia
What part of the tibiofemoral joint is concave? convex?
concave: proximal tibia (plateau)
convex: distal femur (med. and lat. condyles)
Which part of the knee joint is bigger? medial or lateral?
medial
- What is the shape of the medial and lateral menisci?
- How are the menisci attached to the periphery of the tibiofemoral joint?
- What part of the menisci is vascularized? avascularized?
- Medial: semicircle. Lateral: ring shaped.
- both: coronary ligaments and joint capsule. Medial: MCL. Lateral: transverse ligament, PCL, Meniscofemoral ligament, and popliteus muscle.
- vascularized: peripheral border. avascularized: inner border.
- What muscle does the joint capsule blend with posteriorly?
- What ligament strengthens the jt. capsule centrally?
- Does it attach to the MCL? LCL?
- What does the capsule attach to anteriorly?
- gastrocnemius
- oblique popliteal ligament
- MCL: yes. LCL: no.
- expansions of vastus med and lat to form med and lat retinaculum.
What are the attachments of the medial collateral ligament?
adductor tubercle of femur to the medial surface of the shaft of the tibia below pes anserinus group. Deeper portion attaches to medial meniscus.
What are the attachments of the posterior oblique ligament?
Adductor tubercle of the femur to:
- post. edge of tibia close to menisci (central arm)
- continuous with post. aspect of capsule and oblique popliteal ligament of semimembranosus (Capsular arm)
- poorly defined portion of the sheath of semimembranosus attachment (distal arm).
What are the attachments of the anterior cruciate ligament?
Ant. intercondylar fossa of the tibia and lat. margin of medial articular surface upwards, post. and lat. to the post. and med. surface of the lateral femoral condyle.
What are the attachments of the posterior cruciate ligament?
post. intercondylar fossa of the tibia forward upward and medially to the ant. part of the lateral surface of the medial femoral condyle.
Name the innervations of the following muscles of the knee:
- Quadriceps
- Hamstrings
- Popliteus
- Gastrocnemius
- Sartorius
- Gracilis
- Quadriceps: L2-L4
- Hamstrings: L5-S2
- Popliteus: L5, S1
- Gastrocnemius: L5, S1
- Sartorius: L2, L3
- Gracilis: L2-4
Name the actions of the following muscles of the knee:
- Quadriceps
- Hamstrings
- Popliteus
- Gastrocnemius
- Sartorius
- Gracilis
- Quadriceps: all: extend knee. RF: flex hip
- Hamstrings: all: flex knee, extend hip. SM/ST: med. rotation of knee & hip. BF: lat. rotation of knee & hip.
- Popliteus: Closed chain: lat. rotation of femur on tibia and assists with flexion of knee. Open Chain: med. rotation of tibia on femur and flexes knee.
- Gastrocnemius: flexion of knee. PF of ankle
- Sartorius: flexion and med. rotation of knee.
- Gracilis: flexion and med. rotation of knee.
Where do the following bursae lie?
- Suprapatellar
- Subpopliteal
- Gastrocnemius
- Prepatellar
- Infrapatellar
- Suprapatellar: between femur and quad tendon 2 finger widths above prox. pole of patella.
- Subpopliteal: between tendon of popliteus and lat. condyle of tibia
- Gastrocnemius: deep to medial head of gastroc to separate it from femur.
- Prepatellar: between skin and ant. surface of patella (allows for motion of skin across patella during flex/ext).
- Infrapatellar: between distal patellar tendon and tibial tuberosity.
What nerve roots innervate the following dermatomes?
- Ant. med. thigh
- Ant. lat. thigh
- lat. thigh
- post thigh.
- Ant. med. thigh: L2-L3
- Ant. lat. thigh: L4
- lat. thigh: L5
- post thigh: L5-S2
Name the peripheral nerves that innervate the following muscles:
- Semitendonosis, Semimembranosis
- Biceps Femoris
- Popliteus, Gastrocnemius
- Quadriceps Femoris, Sartorius
- Gracilis
- Sciatic (tibial branch)
- Sciatic (peroneal (fibular) branch)
- Tibial
- Femoral
- Obturator
Look at page 220 of the notes to see the vascularity of the knee.
If you’re that nerdy.
When going from 90 degrees of flexion to full extension in a non-weight bearing knee, explain what happens at 30 degrees of flexion.
lateral condyles become congruent, causing tibial ext. rotation (ant. glide of medial plateau and lat. rotation of tibia with distortion of lat. meniscus)
When going from 90 degrees of flexion to full extension in a non-weight bearing or weight bearing knee, the tibial condyles glide/slide and the femoral condyles rock.
When in this sequence is the gliding/sliding at it’s maximum? When is there no more sliding, only rocking?
Gliding/Sliding is at maximum in the last 10-15 degrees of extension (10 degrees specifically in closed chain). The last 5 degrees is pure spin with a rock, no more sliding.
During gait, at heel strike, how does unlocking of the knee occur? What decelerates this unlocking?
passively via the momentum of the knee. This is decelerated by the PCL and quads.
What do the hamstrings and gastrocnemius do when standing up from a squat?
concentrically extend the knee.
What 2 viscerogenic conditions can refer symptoms to the knee?
prostatitis
pelvic inflammatory disease
What spondylogenic condition can refer symptoms to the knee?
L3-S3 spinal dysfunctions (discs, tumors, fractures, stenosis)
What other joints can refer symptoms to the knee?
Hip/SI
foot/ankle
(and tumors of the femur are listed here. not sure why)
Which of the following causes capsular patterns of restriction at the knee joint? non-capsular? unrestricted
meniscal tears, patellar fracture, patellofemoral dysfunction, grade 2 quad/HS tears, bursitis, loose bodies, arthritis, tendonitis, myositis ossificans, hemarthrosis, ligamentous injuries and adhesions.
Capsular restrictions: arthritis.
Unrestricted: tendonitis, bursitis, patellofemoral dysfunction, some meniscal injuries.
Non-capsular restrictions: all the rest.
