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Musculoskeletal System > Week 9 - Knee Joint > Flashcards

Week 9 - Knee Joint Flashcards

1
Q

What type of joint is a knee joint?

A

A hinge type synovial joint

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2
Q

What are the articulating surfaces of the knee joint?

A
  • Tibiofemoral: the medial and lateral condyles of the femur articulate with the tibia
  • Patellofemoral: the anterior and distal part of the femur articulates with the patella
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3
Q

What does the tibiofemoral joint do?

A

The weight bearing joint of the knee

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4
Q

What does the patellofemoral joint do?

A

Allows the quadriceps femoris to be inserted directly over the knee

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5
Q

Describe the femoral condyles

A
  • The medial condyle is larger than the lateral, so it takes more weight
  • Between the condyles:
  • – Anteriorly = shallow depression for patella articulation
  • – Posteriorly = intercondylar fossa (a deep notch)
  • Above the condyles:
  • – Femoral epicondyles
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6
Q

Describe the femoral epicondyles

A

Found above the condyles

  • Site of attachment for collateral ligaments
  • The medial 1 has the adductor tubercle
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7
Q

Describe the tibial surface

A
  • Tibial plateau
  • Medial surface = slightly concave
  • Lateral surface = slightly convex
  • The 2 surfaces are separated by the intercondylar eminence
  • The femoral condyles rest on top of this
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8
Q

What are the menisci in the knee?

A

Fibrocartilage structures in the knee

  • There is a medial and a lateral meniscus
  • They are C-shaped
  • They attach at both ends to the intercondylar area of the tibia
  • The medial meniscus is also fixed to:
  • – Tibial collateral ligament
  • – Joint capsule
  • The lateral meniscus is smaller and does not have any extra attachments
  • They are thicker at the edges
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9
Q

What are the functions of the menisci?

A
  • Deepen the articular surfaces of the joint

- Act as shock absorbers

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10
Q

What are the 4 bursa found in the knee joint?

A
  • Suprapatella
  • Prepatella
  • Semimembranosus
  • Infrapatella
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11
Q

Describe the suprapatella bursa

A
  • An extension of the synovial cavity of the knee

- Located between the femur and quadriceps femoris

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12
Q

Where is the prepatella bursa found?

A

Between the apex of the patella and the skin

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13
Q

Describe the infrapatella bursa

A
  • Split into deep and superficial
  • The deep bursa lies between the tibia and the patella ligament
  • The superficial lies between the patella ligament and the skin
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14
Q

Where is the semimembranosus bursa found?

A
  • Located posteriorly in the knee joint

- Between the semimembranosus muscle and the medial head of the gastrocnemius

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15
Q

Which ligaments are found in the knee joint?

A
  • Patellar
  • Collateral (medial and lateral)
  • Cruciate (anterior and posterior)
  • Popliteal
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16
Q

What is the patellar ligament?

A
  • A continuation of the quadriceps femoris tendon distal to the patella
  • Attaches to the tibial tuberosity
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17
Q

What are the collateral ligaments?

A

2 strap-like ligaments

  • Extracapsular
  • Act to stabilise the hinge motion of the knee, preventing any medial or lateral movement
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18
Q

Describe the medial collateral ligament

A
  • Also called the tibial collateral ligament
  • A wide and flat ligament, found on the medial side of the joint
  • Proximally: attaches to the medial epicondyle of the femur
  • Distally: attaches to the medial surface of the tibia
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19
Q

Describe the lateral collateral ligament

A
  • Thinner and rounder than the tibial collateral ligament
  • Proximally: attaches to the lateral epicondyle of the femur
  • Distally: attaches to a depression on the lateral surface of the fibular head
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20
Q

What are the cruciate ligaments?

A
  • Intracapsular ligaments
  • They connect the tibia and femur
  • They cross over each other
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21
Q

Describe the anterior cruciate ligament

A
  • Attaches at the anterior intercondylar region of the tibia
  • Ascends posteriorly to attach to the femur in the intercondylar fossa
  • It prevents anterior dislocation of the tibia onto the femur
  • Limits hyperextension
22
Q

Describe the posterior cruciate ligament

A
  • Attaches at the posterior intercondylar region of the tibia
  • Ascends anteriorly to attach to the femur in the intercondylar fossa
  • It prevents posterior dislocation of the tibia onto the femur
  • The stronger of the 2 cruciate ligaments
  • It limits hyperflexion
  • In weight-bearing on a flexed knee, it is the main stabiliser
23
Q

What is the popliteal ligament?

A
  • Oblique
  • Arcuate
  • Found posteriorly
  • They strengthen the capsule
24
Q

What are the movements of the knee joint and which muscles produce them?

A
  • Extension: quadriceps femoris
  • Flexion: hamstrings, gracilis, sartorius, popliteus
  • Lateral rotation: biceps femoris
  • Medial rotation: semimembranosus, semitendinosus, gracilis, sartorius, popliteus
25
Q

How can the knee joint be stabilised?

A
  • Deepen the articular surface of the tibial element (menisci)
  • Support the joint by outside structures (muscles, ligaments)
26
Q

How can the collateral ligaments be damaged?

A

Injury is caused by a force being applied to the side of the knee when the foot is placed on the ground

27
Q

How can you assess collateral ligament damage

A

By asking the patient to medially rotate and laterally the leg

  • Pain on medial rotation indicates damage to the lateral ligament
  • If the medial collateral ligament is damaged, it is more than likely that the medial meniscus is torn, due to their attachment
28
Q

How can the anterior cruciate ligament be damaged?

A
  • Hyperextension of the knee joint

- By the application of a large force to the back of the knee with the joint partly flexed

29
Q

What is the effect of anterior cruciate ligament damage?

A

Can cause a triad of injuries

  • Tearing of the ACL causes the unstable femur to shift medially
  • This tears the lateral meniscus and the medial collateral ligament
  • The medial meniscus can also be torn due to its attachment to the medial collateral ligament
30
Q

How can the posterior cruciate ligament be damaged?

A
  • ‘Dashboard injury’
  • – Occurs when the knee is flexed and a large force is applied to the shins, pushing the tibia posteriorly
  • – Often seen in car accidents, where they hit the dashboard
  • By hyperextension of the knee joint
  • By damage to the upper part of the tibial tuberosity
31
Q

How can the bursae within the knee joint become inflamed?

A
  • Prepatella: friction between the skin and the patella can cause inflammation
  • – Produces a swelling on the anterior side of the knee
  • – Known as “housemaid’s knee”
  • Infrapatella: friction between the skin and tibia can cause inflammation
  • – Results in clergyman’s knee
32
Q

What is a popliteal cyst?

A

Also called a Baker’s cyst

  • Abnormal fluid filled sacs of synovial membrane in the popliteal fossa
  • A sign of chronic knee effusion
33
Q

What are the hamstrings?

A

A collective name of the muscles in the posterior compartment of the thigh

  • Consists of the biceps femoris, semitendinosus and semimembranosus
  • As a group, they act to extend at the hip and flex at the knee
  • They are innervated by the sciatic nerve
34
Q

Describe the biceps femoris

A
  • Has 2 heds: a long and short head
  • The most lateral of the muscles in the posterior thigh
  • The common tendon of the 2 heads can be felt laterally at the posterior knee
35
Q

Where is the biceps femoris found?

A
  • Long head origin: ischial tuberosity of the pelvis
  • Short head origin: linea aspera on posterior surface of the femur
  • The heads form a tendon together, which inserts into the head of the fibula
36
Q

What are the actions of the biceps femoris?

A
  • Flexion at the knee
  • Extension of the leg at the hip
  • Laterally rotates at the hip and knee
37
Q

What is the innervation of the biceps femoris?

A
  • Long head: tibial nerve

- Short head: common fibular nerve

38
Q

Describe the semitendinosus

A
  • A largely tendinous muscle
  • Lies medially to the biceps femoris
  • Covers the majority of the semimembranosus
39
Q

Where is the semitendinosus muscle found?

A
  • Origin: ischial tuberosity of the pelvis

- Attaches to the medial surface of the tibia

40
Q

What are the actions of the semitendinosus muscle?

A
  • Flexion of the leg at the knee joint
  • Extension of thigh at the hip
  • Medially rotates the thigh at the hip joint and the leg at the knee joint
41
Q

What is the innervation of the semitendinosus?

A

Tibial nerve

42
Q

Where is the semimembranosus muscle found?

A
  • Located underneath the semitendinosus
  • Origin: ischial tuberosity (but superiorly than the semitendinosus and biceps femoris)
  • Attaches to the medial tibial condyle
43
Q

What are the actions of the semimembranosus?

A
  • Flexion of the leg at the knee joint
  • Extension of the thigh at the hip joint
  • Medial rotation of the thigh at the hip joint and the leg at the knee joint
44
Q

What is the innervation of the semimembranosus?

A

Tibial nerve

45
Q

What is a pulled hamstring?

A

Excessive stretch or tearing of the muscle fibres

  • Often seen in athletes involved in running or kicking sports
  • Damage to the muscle fibres is likely to rupture the surrounding blood vessels
  • – Produces a haematoma
  • – This is contained by the overlying fascia lata
46
Q

How can you palpate the popliteal pulse?

A

A hard pulse to find

  • Lies deep in the popliteal fossa so requires deep palpation to feel
  • To make it easier, can ask patient to slightly flex their leg
  • – This relaxes the fascia around the popliteal fossa
47
Q

Describe patella dislocations

A
  • Often happens during sports or dancing
  • Mostly seen in teenagers
  • Usually dislocates laterally
  • More common in women
48
Q

What is the popliteal fossa?

A

A diamond shaped area found on the posterior side of the knee
- The main path by which structures move from the thigh to the leg

49
Q

What are the borders of the popliteal fossa?

A
  • Superiomedial: Semimembranosus
  • Superiolateral: biceps femoris
  • Inferiomedial: medial head of gastrocnemius
  • Inferiolateral: lateral head of gastrocnemius
  • Floor: formed by the posterior surface of the knee joint capsule and the posterior surface of the femur
  • Roof: made up of 2 layers: popliteal fascia, skin
50
Q

What are the contents of the popliteal fossa?

A

Medial to lateral:

  • Popliteal artery
  • Popliteal vein
  • Tibial nerve
  • Common fibular nerve
  • Small saphenous vein pierces the popliteal fascia of the popliteal fossa to enter the diamond and empty into the popliteal vein
51
Q

What is the adductor hiatus?

A

Perforations in the adductor part of the adductor magnus

- The femoral artery and vein pass through it

52
Q

What is the blood supply to the knee joint?

A 
Popliteal artery branches to give:
- Superior and inferior medial + lateral genicular arteries
- Descending genicular artery
- Middle genicular artery
These anastomose around the knee

Musculoskeletal System (12 decks)

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