Lower Extremity Anatomy > Knee > Flashcards

Knee Flashcards

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1
Q

Tibia

A
  • Long bone with a diaphysis and a proximal and distal epiphyses
  • Transfers majority of weight between femur and talus
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2
Q

Tibia articulates with

A
  • Femur
  • Fibula
  • Talus
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3
Q

Structures at anterior proximal end of tibia

A
  • Medial/lateral condyle
  • Intercondylar eminence
  • Anterior/posterior intercondylar surface
  • Tibial tuberosity
  • Gerdy’s tubercle
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4
Q

Medial condyle of tibia

A
  • Larger with larger articular surface

- Oval shaped

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5
Q

Lateral condyle of tibia

A
  • Smaller than medial

- Circular shaped articular surface

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6
Q

Intercondylar eminence

A
  • Located between condyles

- Medial and lateral intercondylar tubercles

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7
Q

Anterior and posterior intercondylar surface

A
  • Attachment of cruciate ligaments
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8
Q

Tibial tuberosity

A
  • Attachment of patellar ligament
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9
Q

Gerdy’s tubercle (tubercle of the iliotibial tract)

A
  • Small projection
  • Lateral to tibial tuberosity and patellar apex (when knee is extended)
  • IT tract attaches
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10
Q

Structures at posterior proximal end of tibia

A
  • Groove for semimembranosus tendon

- Fibular articular facet

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11
Q

Groove for semimembranosus tendon

A
  • Posteromedial edge of medial condyle
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12
Q

Fibular articular facet

A
  • Facet on lateral condyle

- Articulates with fibular head

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13
Q

Fibula

A
  • Long slender bone
  • IMPORTANT for ankle stability
  • Transmits small amounts of weight (~15%)
  • Site of muscle attachment
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14
Q

Fibula articulates with

A
  • Tibia

- Talus

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15
Q

Proximal fibula structures

A
  • Head of fibula
  • “Square-ish” in shape
  • Subcutaneous, easily palpated
  • Common fibular nerve
  • Articular facet
  • Apex of fibula (styloid process)
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16
Q

Common fibular nerve passes

A
  • Around fibular head/neck

- Easily damaged

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17
Q

Articular facet of proximal fibula

A
  • Articulates with lateral condyle of tibia
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18
Q

Patella

A
  • Sesamoid bone in quadriceps tendon
  • Superficial, easily palpated
  • Increases mechanical advantage of quadriceps muscles
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19
Q

Patella articulates with

A
  • Femoral condyles to form the patellofemoral joint

- Triangular in shape

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20
Q

Apex of patella

A
  • Pointed inferior end

- Just proximal to knee joint line when knee is extended

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21
Q

Base of patella

A
  • Wide superior end

- Outer border is rough b/c of tendon/ligament attachment

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22
Q

Patella development

A
  • 1 or 2 ossification centers that appear between 3-6th year

- Fusion at puberty

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23
Q

Lack of patella fusion

A
  • Bipartite patella
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24
Q

Patella posterior surface

A
  • Smooth

- Covered with thick articular (hyaline) cartilage in a living person

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25
Articular facets of patella
- Separated by a vertical ridge - Medial facet - Lateral facet - Odd facet
26
Medial facet of patella
- Articulates with medial femoral condyle
27
Lateral facet of patella
- Larger | - Articulates with the lateral femoral condyle
28
Odd facet of patella
- Most medial aspect of medial facet
29
Patella stabilized by
- Medial and lateral retinacula | - Multi-layered connective tissue structure
30
Patella retinacula attach to
- Patella - Tibia - Femur
31
Patella retinacula derived from neighboring structures
- Crural fascia - MCL (medial side patellofemoral and patellotibial ligaments: medial and lateral sides) - IT band (lateral side) - Quadriceps aponeurosis (medial and lateral sides)
32
Genu varus
- Leg angled inward - Knee shifted laterally - Apex of deformity is lateral
33
Genu valgus
- Leg angled outward - Knee shifted medially - Apex of deformity is medial
34
Normal development of knee
- Varus until about 2 years - “Physiological bowing” - Valgus at age 3 - Degree of valgus decreases to adult level by age 7 - Remains slightly valgus
35
Knee joint consist of articulations between
- Femur and patella (patellofemoral joint)
36
Characteristics of knee condyles
- Medial/lateral femoral condyles: convex | - Medial/lateral tibial condyles: concave
37
Knee joint
- Modified hinge joint | - Combination of gliding, pivot, and hinge joints
38
Knee joint (modified hinge joint) allows for
- Rotation in sagittal plane: flexion/extension - Rotation in transverse plane: internal and external rotation - Translation in sagittal plane
39
Muscles surrounding knee are most important in
- Stability
40
Knee joint capsule is reinforced by
- Ligaments posteriorly and laterally
41
Anterior knee joint capsule is formed by
- Patellar ligament | - Medial and lateral retinacula
42
Synovial membrane (lines joint capsule) attaches to
- Articular margins of the patella, femoral cartilage, and meniscal edges
43
Synovial membrane covers
- Cruciate ligaments anteriorly | - Posterior aspect of the infrapatellar fat pad
44
Cruciate ligaments and posterior aspect of the infrapatellar fat pad are considered
- Intracapsular but extra-synovial | - Outside the synovial space
45
Infrapatellar fat pad
- Adipose found inferior to patella - Deep to patellar ligament - Between patellar tendon and synovial membrane
46
Infrapatellar plica (ligamentum mucosum)
- Synovial fold - Embryological remnant of knee joint division - Other plica: - Suprapatellar - Medial and lateral patellar
47
Menisci of knee
- Crescent shaped fibrocartilage plates - Intracapsular, intrasynovial (outer surface is not intrasynovial) - Thicker at periphery, thin centrally
48
Menisci function
- Improve congruency between tibia and femur - Shock absorption - Load dispersion
49
Menisci attachments
- Attached to tibia via coronary ligaments | - Connected by transverse ligament of knee anteriorly
50
Anterior/posterior horns of menisci
- Each attaches to the intercondylar area
51
Medial meniscus
- “C”-shaped - Less mobile - Attached to MCL - Wider posterior than anterior
52
Lateral meniscus
- More circular in shape - Covers a large portion of lateral condyle - More movable - Uniform width - Broader than medial meniscus - Popliteus attaches and is located posterolaterally
53
Menisci vascularity
- Outer 25% well vascularized | - Inner is nourished by synovial fluid
54
Extracapsular and capsular ligaments of knee
- Patellar ligament (anteriorly) | - Retinacula anteromedially and anterolaterally
55
Fibular collateral ligament (lateral collateral ligament of knee)
- Extracapsular - Lateral epicondyle to apex of fibular head (at biceps femoris insertion) - Narrow, rope like ligament
56
Fibular collateral ligament (LCL) resists
- Varus stress to knee | - Taut in extension
57
Tibial collateral ligament (medial collateral ligament of knee)
- Medial epicondyle to medial tibial condyle and tibial shaft - Broad ligament that blends with the capsule (capsular ligament) - Attaches firmly to medial meniscus
58
Damage to MCL
- Usually causes damage to medial meniscus as well
59
MCL resists
- Valgus stress to knee | - Taut in extension
60
Oblique popliteal ligament
- Capsular ligament - Blends with and supports the posterior capsule - Extension from semimembranosus tendon - Attaches to lateral femoral condyle
61
Arcuate popliteal ligament
- Capsular ligament - Y-shaped ligament - Attaches to apex of fibula and divides into 2 limbs - Supports posterolateral knee
62
Division of arcuate popliteal ligament
- Medial limb curves over popliteus muscle and blends with oblique popliteal ligament (also attaches to tibia) - Lateral limb blends with lateral capsule
63
Intracapsular ligaments of knee
- Within capsule | - Extrasynovial (outside synovium)
64
Cruciate ligaments
- Resist anterior/posterior translation and rotation | - Guide movement
65
Anterior cruciate ligament attaches
- Anterior intercondylar fossa of tibia to medial side of lateral femoral condyle in intercondylar notch - Travels in a superior posterolateral direction
66
Anterior cruciate ligament resists
- Posterior displacement of femur (anterior displacement of tibia - Knee hyperextension(taut in extension
67
Posterior cruciate ligament
- Thicker and stronger than ACL
68
Posterior cruciate ligament attaches to
- Posterior intercondylar fossa of tibia to lateral side of medial femoral condyle in intercondylar notch - Travels in a superior anteromedial direction
69
Posterior cruciate ligaments resist
- Anterior femur displacement (or posterior tibial displacement - Knee hyperflexion
70
Extracapsular ligaments of knee
- Fibular collateral ligament (LCL)
71
Capsular ligaments of knee
- Tibial collateral ligament (MCL) - Oblique popliteal ligament - Arcuate popliteal ligament
72
Intracapsular ligaments of knee
- Anterior cruciate ligament (ACL) - Posterior cruciate ligament (PCL) - Transverse ligament (transverse genicular ligament) - Meniscofemoral ligaments - Meniscotibial ligaments (coronary ligaments)
73
Transverse ligament of the knee (transverse genicular ligament)
- Not always present | - Attaches to anterior horn of medial meniscus and anterior margin of lateral meniscus
74
Meniscofemoral ligaments
- Span from the posterior horn of lateral meniscus to the lateral aspect of medial femoral condyle - Named based on their relationship to the PCL
75
Meniscofemoral ligaments (names)
- Anterior meniscofemoral ligament (Ligament of Humphrey) | - Posterior meniscofemoral ligament (Ligament of Wrisberg)
76
Anterior meniscofemoral ligament (Ligament of Humphrey)
- Anterior to PCL
77
Posterior meniscofemoral ligament (Ligament of Wrisberg)
- Posterior to PCL
78
Meniscotibial ligaments (coronary ligaments)
- Attach to menisci periphery and tibial plateau | - Also anchors horns of menisci to tibia
79
Popliteus
- Partially intracapsular and extracapsular - Proximal tendon is found between LCL and lateral meniscus - Covered by fascia derived from semimembranosus
80
Popliteus origin
- Lateral femoral condyle (popliteal groove) - Lateral meniscus - Knee joint capsule
81
Popliteus insertion
- Superior to soleal line (tibia)
82
Popliteus innervation
- Tibial nerve
83
Popliteus blood supply
- Posterior tibial artery | - Medial inferior genicular artery
84
Popliteus function
- Unlocks knee by laterally rotating femur on tibia or medially rotating tibia on femur - Pulls meniscus posteriorly
85
Knee movement
- Mostly flexion and extension - Rotation in sagittal plane - Some medial and lateral rotation - Rotation in transverse plane Translation
86
Open kinetic chain (foot off the ground) during knee extension
- Tibia glides (translates) anteriorly on femur | - Last 15-20ᵒ of extension, tibia rotates externally on femur
87
Open kinetic chain (foot off the ground) during knee flexion
- Tibia glides posteriorly on femur | - First 15-20ᵒ of flexion, tibia rotates internally on femur
88
Closed kinetic chain (foot is on the ground) during knee extension
- Femur translates posteriorly on stable tibia | - Last 20ᵒ femur rotates internally on tibia
89
Closed kinetic chain (foot is on the ground) during knee flexion
- Femur glides anteriorly on tibia | - First 20ᵒ femur rotates externally
90
Screw home mechanism
- Occurs last 15-20ᵒ of knee extension - Medial tibial plateau is longer, movement continues on medial side - Position of maximal stability, ligaments are taut
91
Muscles of knee extension
- Rectus femoris - Vastus lateralis - Vastus intermedius - Vastus medialis
92
Muscles of knee felxion
- Biceps femoris (long/short heads) - Semitendinosus - Semimembranosus - Gracilis - Sartorius - Popliteus - Plantaris
93
Muscles of knee internal (medial) rotation (when knee is flexed)
- Gracilis - Sartorius - Semitendinosus - Semimembranosus - Popliteus
94
Muscles of knee external (lateral) rotation (when knee is flexed)
- Biceps femoris - Long head - Short head
95
Knee blood supply
- Genicular anastomoses | - Intracapsular structures supplied by genicular anastomoses and middle genicular artery
96
Knee nerve supply: articular branches from
- Femoral nerve (posterior division) - Muscular branches and saphenous nerve - Tibial - Common fibular - Obturator (posterior division)
97
Knee bursae function
- Prevent friction between structures during movement
98
Anterior knee bursae (names)
- Prepatellar bursa - Superficial infrapatellar bursa - Deep infrapatellar bursa - Suprapatellar bursa
99
Prepatellar bursa
- Located in the superficial fascia between patella and skin | - Bursitis: housemaid’s knee
100
Superficial infrapatellar bursa
- Between tibial tuberosity and skin | - Bursitis: Clergymans knee
101
Deep infrapatellar bursa
- Between tibial tuberosity and patellar ligament | - Bursitis: Clergymans knee
102
Suprapatellar bursa
- Superior extension of synovial membrane of the knee joint - Between femur and quadriceps tendon - Communicates with knee joint
103
Medial knee bursa
- Anserine bursa
104
Anserine bursa
- Between pes anserinus and MCL | - Extends between tendons of the pes anserinus
105
Lateral knee bursae
- Between LCL and biceps femoris | - Between LCL and popliteus tendon
106
Posterior knee bursae
- Popliteal bursa - Medial gastrocnemius bursa - Lateral gastrocnemius bursa - Semimembranosus bursa
107
Popliteal bursa
- Between popliteal tendon and lateral condyle of tibia | - Communicates with knee joint joint
108
Medial gastrocnemius bursa
- Between medial head of gastrocnemius and joint capsule | - Can communicate with joint cavity
109
Lateral gastrocnemius bursa
- Between the lateral head of the gastrocnemius and joint capsule - Can communicate with joint cavity
110
Semimembranosus bursa
- Between semimembranosus tendon and medial head of gastrocnemius and medial femoral condyle - Can communicate with joint cavity and medial gastrocnemius bursa
111
Medial meniscus (clinical)
- Commonly injured with MCL | - More commonly injured than LCL
112
Unhappy triad (O’Donoghue triad) is disruption in the
- MCL - Medial meniscus - ACL
113
Unhappy triad (O’Donoghue triad) is often caused by
- Valgus stress induced by a lateral blow to the knee
114
ACL tear
- Anterior drawer test is (+) | - (+) Lachmans test
115
PCL tear
- Posterior drawer test is (+)
Lower Extremity Anatomy
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