Abos - Knee & Tibia/fibula - Knee: Gen Knowledge - Surgical Anatomy

Front 1

What are the two components of layer I?

Back 1

Sartorius associated fascia
Medial paterllar retinaculum

Front 2

What two structures lie between layers I and II?

Back 2

Gracilis
Semitendinosus

Front 3

What are the four components of layer II?

Back 3

Superficial medial collateral ligament (MCL)
Posterior oblique ligament (POL)
Medial patellofemoral ligament (MPFL)
Semimembranosus

Front 4

What are the two components of layer III?

Back 4

Deep MCL
Capsule

Front 5

What are three components of layer I?

Back 5

Iliotibial (IT) band
Biceps
Fascia

Front 6

What are the two components of layer II?

Back 6

Patellar retinaculum
Patellofemoral ligament

Front 7

What are the four components of layer III?

Back 7

Arcuate ligament
Fabellofibular ligament
Capsule
Lateral collateral ligament (LCL)

Front 8

What three structures make up the posteromedial corner?

Back 8

Semimembranosus insertions
POL (adductor tubercle origin)
OPL (oblique popliteal ligament)

Front 9

What is the function of the posteromedial corner?

Back 9

Rotatory stability

Front 10

What five structures make up the posterolateral corner?

Back 10

Popliteus
Popliteofibular ligament
Lateral capsule
Arcuate ligament
Fabellofibular ligament

Front 11

What exam finding is suggestive of disrupted PLC? What is the posterior cruciate ligament (PCL) is also disrupted?

Back 11

Asymmetric external rotation (ER) at 30 degrees knee flexion: isolated PLC injury
Asymmetric ER at 30 and 90 degrees PLC and PCL injuries

Front 12

What is the orientation of the superficial fibers?

Back 12

Radial

Front 13

What is the orientation of the deep fibers?

Back 13

Predominantly circumferential
Interspersed radial "tie fibers"

Front 14

What type of cartilage makes up the meniscus?

Back 14

Fibroelastic cartilage

Front 15

What is the predominant collagen type present within the meniscus?

Back 15

Predominantly type of I collagen

Front 16

What cell type makes up the meniscus?

Back 16

Fibrochondrocytes

Front 17

How is the meniscus innervated? Where is the meniscus especially well innervated?

Back 17

Peripheral two thirds innervated with type I & II nerve endings
Especially well innervated in the posterior horn (mechanoreceptions)

Front 18

What vessels provide the meniscal blood supply?

Back 18

Geniculates supply blood to peripheral one third

Front 19

What percentage of force does the meniscus transmit in extension? What percentage is transmitted in flexion?

Back 19

50% in extension
90% in flexion

Front 20

Is the medial or lateral meniscus more mobile? Why? Why is this clinically important?

Back 20

Lateral meniscus is more mobile
Because popliteus interrupts lateral meniscal attachment
May contribute to more common medial tears

Front 21

What is the classic magnetic resonance imaging (MRI) appearance of a displaced bucket-handle tear of the posterior horn of the medial meniscus?

Back 21

Posterior horn of lateral meniscus to medial femoral condyle with PCL

Front 22

Which of the meniscofemoral ligaments is anterior? Which is posterior?

Back 22

Humphrey's (anterior)
Wrisberg (posterior)

Front 23

What are the two main collagen types within the ACL and what is the relative proportions of each?

Back 23

90% type I
0% type II

Front 24

What vessels supplies the ACL? What supplies the fat pad?

Back 24

Middle geniculate supplies ACL
Inferior geniculates supplies fat pad

Front 25

What is the strength of the native ACL?

Back 25

2100N

Front 26

What are the two bundles of the ACL?

Back 26

Anteromedial
Posterolateral

Front 27

AT what flexion angle is the anteromedial bundle at maximum tension?

Back 27

60 degrees

Front 28

At what flexion angle is the posterolateral bundle at maximum tension?

Back 28

15 degrees

Front 29

What are the two bundles of the PCL?

Back 29

Anterolateral
Posteromedial

Front 30

At what flexion angle should the anterolateral bundle be tensioned intraoperatively?

Back 30

90 degrees

Front 31

At what flexion angle should the posteromedial bundle b tensioned?

Back 31

30 degrees

Front 32

How can the MCL or LCL be tested in isolation? What happens in extension?

Back 32

Valgus or varus stress at 30 degrees flexion isolated the respective collateral ligament
In extension, the PCL also contributes to stability

Front 33

What os the better restraint against valgus stress: superficial or deep MCL?

Back 33

Superficial

Front 34

What two structures does the superior geniculate (lateral, medial branches) supply?

Back 34

Patella
PCL

Front 35

What three structures does the middle geniculate supply?

Back 35

ACL
PCL
Collaterals

Front 36

What two structures does the inferior geniculate (lateral, medial branches) supply?

Back 36

Menisci
Fat pad

Front 37

In what interval does the lateral branch of the superior geniculate lie? With what procedure is this branch most commonly at risk?

Back 37

Femur/vastus lateralis
At risk with lateral release

Front 38

The inferior geniculate branch lies posterior to what anatomic landmark?

Back 38

Posterior to LCL

Front 39

Where does the tibial nutrient artery enter?

Back 39

Below PCL insertion

Front 40

What three facets make up the articular surface of the patella?

Back 40

Lateral facet
Medial facet
Odd facet

Front 41

What is the Wiberg classification?

Back 41

Type I: medial & lateral facets are equal
Type II & III: medial facet smaller than lateral
Type IV: (Jagerhut patella): no medial facet present

Front 42

What are the two most likely sites of bony injury following lateral paterllar dislocation?

Back 42

Medial facet of patella
Superior lateral condyle of femur

Front 43

Over what structure is the medial knee approach centered?

Back 43

Adductor tubercle

Front 44

Over what structure is the lateral knee approach centered? What is the interval for dissection?

Back 44

Centered over Gerdy's tubercle
Interval: iliotibial (IT) band/biceps femoris

Front 45

How far distal does the knee capsule extend? Where is the most distal extent?

Back 45

15 mm distal extent
Most distal extent is posterior to fibula

Front 46

Within what tendon odes the fabella lie?

Back 46

Lateral gastrocnemius

Front 47

The personal nerve lies at the posterior border of what structure?

Back 47

Biceps gastrocnemius

Front 48

What is the screw home mechanism?

Back 48

Femur internal rotation during the last 15 degrees of knee extension

Front 49

Where does the lower extremity mechanical axis pass through the knee?

Back 49

Medial to the medial tibial spine

Front 50

Starting at vertical, what is the relationship of the mechanical and anatomic axes?

Back 50

Mechanical axis lies in 3 degrees of valgus
Anatomic axis is 9 degrees of valgus
So, anatomic axis is 6 degrees of valgus relative to mechanical axis

Front 51

How is the Q angle measured?

Back 51

Anterior superior iliac spine (ASIS) to patella to tibial tubercle

Front 52

What is the approximate normal value of the Q angle in extension? In flexion?

Back 52

15 degrees in extension
8 degrees in flexion

Front 53

The highest joint reaction forces in the knee are experienced where? At what phase of gait?

Back 53

Medially
Stance phase

Front 54

Where id the highest joint reaction force experienced in the patella?

Back 54

Laterally