Week 3 Knee 🦵🏻 Flashcards
O’Donoghue’s Unhappy Triad?
Rupture of MCL, ACL and damage to medial meniscus.
Palpate all boney areas on distal femur and cartilage on the skeleton / person (13)
Medial and lateral condyles and epicondyles, adductor tubercle, patella (trochlear) groove/surface, intercondylar fossa, medial and lateral supracondylar line, linea aspera, popliteal surface, lateral buttress wall, articular hyaline cartilage.
Palpate on skeleton or human all boney features on the proximal tibia (10)
Medial and lateral condyles (tibia has no epicondyles), tibial tuberosity, anterior border of tibia, tibial plateau, intercondylar eminences, pes anserine (anteromedial aspect of tibia), soleal line, articular facet of fibular head
What are the 3 boney parts of the patella? Also describe the inferior and superior aspect.
Most medial = odd, middle area = medial, and most lateral = lateral.
Most inferior aspect = apex, most superior aspect = base.
Fibular or peroneal nerve is located where and innervates what?
Posterior fibular head, winds antero-inferiorly around neck of fibular and splits into superficial fibular nerve: fibularis longus and brevis that evert the foot, and deep fibular nerve: tibialis anterior, extensor digitorum longus (extends four toes and dorsiflexion) and extensor hallucis longus (big toe extension, inversion). Damage can result in foot drop.
Patella is triangular shaped and what sort of bone? What is the joint called at the patella?
Sesamoid bone. Patello-femoral joint.
What kind of joint is the knee joint? Name the joint and degrees and freedom.
Synovial bicondylar modified hinge, articulating the femoral and tibial condyles and mensci connecting the two. Two degrees of freedom, flexion / extension and medial / lateral rotation.
Describe the femoral medial and lateral condyle shape?
Medial femoral condyle = projects more distally and is thinner. Lateral femoral condyle = outer stouter, shorter, wider and projects more anteriorly.
Describe the medial and lateral meniscus.
Semi lunar articulating fibro elastic cartilage. Peripheral / outer meniscus is vascular and thicker, and inner meniscus is avascular and thinner.
Medial (mediC) is C shaped, lateral (laterO) is O shaped. Medial meniscus is less rigid, more commonly damaged and blends with the joint capsule. Lateral meniscus is rigid, and no blending with the capsule.
The intracondylar spine separates the two menisci and is concave to receive convex femoral condyles. Both have an anterior (ventral) and posterior (dorsal) horn.
What is the function of the patella?
Acts as a pulley to improve mechanical efficiency of the quads by increasing the movement arm and increasing angular torque.
What is the Q Angle? Normal for men and women, and abnormal values?
The angle between the quadriceps (Q) and patella. The femur sits at an oblique angle. ASIS to central patella line, and central patella to tibial tuberosity.
Men = 13° Women = 18° Abnormal = <13° and >18°
More than 18° can predispose the patella to lateralisation.
What is alta / baja patella?
Patella sits too high / long patella tendon = patella alta
Patella sits too low / short patella tendon = patella baja
What soft tissues and boney landmarks maintain patella stability / position?
Vastus medialis, medial retinaculum,
Vastus lateralis, lateral retinaculum, lateral buttress wall, IT Band
Vastus lateralis and medialis ratio
Vastus intermedius and rectus femoris
Superior tibia-fibular joint - type and describe.
Synovial plane joint that can be palpated as you dorsiflex and plantarflex.
Articulating surfaces = head of fibular, lateral tibial condyle and knee joint capsule.
3 purposes of the menisci (fibro elastic cartilage)
1) Deepens tibial articular surface and therefore increases tibial femoral joint stability
2) Shock absorbers
3) Conforms to changing shape of femoral condyles during movement
What do the coronary ligaments do in the knee?
Attach the menisci to tibial plateaux.
Describe knee joint capsule and attachments.
Synovial membrane envelops it but excludes the extrasynovial crucible ligaments
Anteriorly attaches to patella tendon and retinaculum
Posteriorly attaches to posterior femoral and tibial condyles and intercondylar fossa
Medially attaches to gastroc and semimem, medial femoral and tibial condyles, blends with MCL
Laterally attaches to fibular head, lateral femoral condyle and lateral femur above popliteus
ACL and PCL run in which direction?
Attachment points?
ACL = posteriorly, lateral, superior. Supralaterally. Up and out. Anterior intercondylar area of tibia up to posterior intercondylar area of lateral femoral condyle. PCL = anteriorly, medically, superiorly. Supramedially. Posterior intercondylar area of tibia up to lateral aspect of medial femoral condyle.
MCL characteristics, function and attachments?
Broad, flat and fan shaped. 10cm long. Two insertions.
Prevents valgus movement. Stop unwanted movement and controls normal movement.
Medial femoral epicondyle to medial proximal shaft of tibia (not as distal as pes anserine) and knee joint capsule and medial meniscus.
LCL characteristics, function and attachments?
Thinner, strong rounded chord.
Limits varus (stop unwanted movement and control normal movement) Lateral femoral condyle to head of fibular.
Name the 6 bursae in the knee.
Suprapatella (superior to patella, below quadriceps tendon)
Pre patella (superficial / ventral to patella)
2 infra patella: subcutaneous infrapatella (below skin, above patella tendon) and deep infrapatella (deep / posterior to patella tendon
Subsartorial (pes anserine)
Semimembranosis
Where is Hoffa’s fat pad?
Deep to patella tendon
Also called infra patella fat pad
Name some accessory movements at the patella femoral joint, superior tibia fibular joint and the knee joint.
PFJ: medial / lateral glide, longitudnal caudal
STFJ: AP PA
Knee J: valgus (medial) / varus (lateral) glide and AP PA
What anatomical regions are used to use a goniometer to measure knee flexion?
Greater trochanter, lateral femoral epicondyle, lateral malleolus
