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186 Cards in this Set
- Front
- Back
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What is the largest joint of the knee complex?
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The tibiofemoral joint.
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Name the 3 joints of the knee and what type of joint they are?
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Tibiofemoral- complex joint, patellofemoral- compound joint, proximal tibiofibular- simple joint.
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The knee complex is the most common site of what type of impairment?
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Permanent.
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There are large forces at what 2 joints in the knee complex and this is due to what?
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Tibiofemoral and patellofemoral due to very long levers.
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What is the posterior compartment of the knee and what is the anterior compartment of the knee?
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Posterior- tibiofemoral joint. Anterior- Patellofemoral joint.
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What are the femoral condyles like?
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Egg shaped and separted by a fossa.
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Will the radius of the femoral condyles be larger anterior or posterior?
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Anterior.
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What will the significance of egg shaped femoral condlyes be?
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They will need a variable socket to articulate with the tibia and that is what the menisci are for.
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What is conjoint rotation of the knee?
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Screw home mechanism which is external rotation seen in the last few degrees of knee extension.
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Conjoint rotation pivots around what?
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The lateral femoral condyles during extension.
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What femoral condyles have what type of angulation and why?
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Posterior angulation to increase flexion and decrease extension of the knee.
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What will valgus and varus mean?
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Valgus- distal part bent outward, knocked kneed. Varus- distal part bent inward, bowlegged.
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Which femoral condyle will have the longer larger articulare surface? Why?
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Medial. It allows for conjoint rotation.
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The medial femoral condyle will also have a larger epicondyle, but why?
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This will affect the axis of the knee.
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What will the angle of the medial femoral condyle be like?
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It will be more oblique than the lateral.
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Which femoral condyle will extend more distally and what can this lead to?
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Medial and this causes valgus of the knee.
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What is the pivot point of conjoint rotation?
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The shorter smaller articular surface of the lateral femoral condyle.
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What will the angle of the lateral femoral condyle be like?
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Less oblique A-P.
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The tibial femoral rotation of the skrew home mechanism happens when?
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The last 15-0 degrees of extension of the knee.
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What is femoral torsion?
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anetversion ( degree to which an anatomical structure is rotated forwards (towards the front of the body) or backwards (towards the back of the body) respectively, relative to some datum position)
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What is the normal femoral torsion or anteversion?
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10-20 degrees.
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What is an anteverted femur?
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one rotated forward more than 20 degrees.
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What will an anteverted femurs impact be on the knee?
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Medial orientation.
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What is a medial orentation of the the patella aka?
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Squinting patella.
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What is a common compensation for a anteverted femur?
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Genu valgum.
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What is a retroverted femur?
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One that has femoral torsion or anteversion of 10 degrees or less.
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What is the impact on the knee for a retroverted femur?
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Lateral orientation.
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What is the common compensation for a retroverted femur?
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Genu varum.
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What is the superior surface of the tibial condyles like?
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Flat with tibial spines.
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What is the purpose of the tibial spines?
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Attachment site for ACL and menisci, and to resist side to side translation and rotation.
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What are the tibial facets on the tibial plateau like?
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Flat they are not concave.
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Which tibial facet is larger medial or lateral?
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Medial is larger.
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What is the angle of the proximal tibia like? Why?
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Posterior angulation. To increase flexion ROM.
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What is tibial torsion like?
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External.
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Where is the patellar surface of the femur at?
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The anterior distal femur. Anterior to condyles.
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What is the patellar surface of the femur like?
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It has a medial facet/lip a lateral facet/lip and a cdentral groove.
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Which facet/lip of the anterior distal femur is bigger? Why?
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Lateral because the patella wants to go laterally and this keeps it from displacing.
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What is the anterior distal part of the femur (facets/lips) lined with?
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Hyaline cartilage.
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What is the main function of the patella?
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Increase angular pull of quadraceps (increase leverage at extension).
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What is the shape of the patella like?
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Triangular with the apex pointing down.
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What is the posterior part of the patella like?
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Medial and lateral facet with a central ridge, and once and a while there will also be an odd medial facet.
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What is the purpose of the central ridge on the patella?
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makes bone more wedge shaped.
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What will cause the patella to have the odd medial facet?
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repeated or sustained deep flexion.
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What is the cartilage of the patella like and why?
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The thickest cartilage in the body due to highest compression and shear forces on the body.
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What represents the pull of the quads?
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The patellofemoral Q angle.
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How is the patellofemoral Q angle measured?
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First line goes from ASIS to center of the tibia. Second line goes from center of the patella to the tibial tuberosity. Then measure the angle.
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What is the normal range for the patellofemoral Q angle?
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5-15 degrees with a mean of 10 degrees.
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What will the patellofemoral Q angle be like for males vs. females?
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Males- 8-10 degrees. Females- 10-12 degrees.
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The patellofemoral Q angle affects what?
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The tendency of the patella to track laterally.
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What is the patellofemoral ratio?
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A ratio of distance; tibial tuberosity to patellar apex: Patellar apex to base.
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What is a normal patellofemoral ratio?
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one.
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When would the patellofemoral ratio be considered low and what is this known as?
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less than 0.8 aka Baja.
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When would the patellofemoral ratio be considered high and what is this known as?
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More than 1.2 and this is aka alta.
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What will a Warberg, magna and parva patella mean?
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Warberg- too wedge shaped. Magna- too large. Parva- too small.
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What will functionally increase and decrease the patellofemoral Q angle?
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Increase- lateral/external rotation of the tibia. Decrease- medial/internal rotation of the tibia.
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What will excessive foot flare do to the Q angle?
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Increase the Q angle and lead to an unstable patella.
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When will the patella be less stable with extension or flexion? Why?
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Less stable with extension. Due to shallower groove.
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What muscle was mentioned that if weak will make the patella less stable?
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VMO. Also mentioned the medial retinaculum.
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Will genu vagum or varum make the patella less stable?
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Vlagum.
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What muscle was mentioned that if too tight will make the patella less stable?
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Vastus lateralis or ITB.
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What shapes of the patella will make it less stable?
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Too small or facet angle is too flat.
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Will patella baja or alta make the patella less stable?
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Alta.
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What rotation of the tibia will make the patella less stable?
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Externally rotated.
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What foot position will make the patella less stable?
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Pronation.
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What position of the knee will make the patella more stable? Why?
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Flexed knee. Due to deeper groove and increased compression force.
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What muscle if strong will make the patella more stable?
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VMO.
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What will genu varum do to patellar stability?
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Increase it.
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What patellar shapes will increase patellar stability?
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Normal, large lateral lip.
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What will patella baja do to patellar stability?
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Increase it but wil lead to increase wear and tear due to excessive compression.
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What foot position will make the patella more stable?
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Normal or under pronated.
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What type of large force is placed on the patellofemoral joint?
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Compression.
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Cartilage compression of the patellofemoral joint will increase with what knee position?
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Flexion.
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What will the comprssion forces be like on the patellofemoral joint with; walking, joggin, stair climbing (walking), Descending stairs (walking), 90 degree squat?
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Walking- half of BW, jogging- 4 X BW, Stair climbing- 2.5 X BW, descending stairs- 3.5 X BW, 90 degree- 7.5 BW.
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What will the compression forces on the patellofemoral joint be like with jumping?
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10 X BW.
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What are the compression forces on the patellofemoral joint like with full extension of the knee?
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No compression force through this joint.
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During flexion of the knee what direction will the patella travel?
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It glides inferior and posterior in the patellar sulcus.
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What part of the patella will contact the femur with; zero degrees of flexion, 20 degrees, 45 degrees, 90 degrees, 135 degrees?
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zero- no direct contact, 20- distal or apex, 45- central, 90- proximal or base, 135- Lateral and medial part of patella.
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How much will the extensor leverage of the patella increase with 90-120 degrees and 0-5 degrees flexion?
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90-120- 13%. 0-5- 31%.
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With a 5, 15, 30, 45, 75 degree squat how much of the body weight will the quadraceps be able to lift?
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5- 30%. 15- 100%. 30- 200%. 45- 300%. 75- 500%.
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Walking on a level surface produces _____ x BW on quadraceps tendon, jogging produces about ____ X BW on quadraceps tendon, and jumping produces about ____ X BW on Quadraceps tendon.
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1, 5, more than 10.
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What muscle would respond faster to tension and faster to stress the VMO or Vastus lateralus and why?
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Tension- Vastus lateralus. Stress- VMO due to faster twitch.
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What are the ligaments of the anterior compartment of the knee?
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Medial and lateral retinaculum.
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What will the medial and lateral retinaculum allow for with a quadraceps tendon injury?
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Allow patient to still extend the knee.
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What could cause a tear of the medial retincaulae of the knee?
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Valgus sprains and patellar dislocations.
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A medial retinacular tear would lead to what?
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Lateral patellar instability.
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What would a weak or stretched medial retinaculum or a tight lateral retinaculum cause?
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Lateral patellar tracking.
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Where will the ITB be located at and what compartment of the knee?
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Lateral knee and is included in the anterior compartment.
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What are the 2 parts to the ITB and where will it insert at?
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Smaller patellar band, larger tibial band, and inserts on patella and Gerdy's tubercle.
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What would happen with a tight ITB?
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Rubs on the lateral epicondyle of the femur and pulls on the patella. Leading to lateral tracking dysfunction.
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What is a lateral release of the ITB?
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CUT ITB and or lateral retincaulum leading to decreased tension on lateral patella.
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What are synovial plica?
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Remnant of 3 embryotic parts of the knee that if they remain can cause recurrent snapping and pain in the knee.
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What are mnost synovial plica like?
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Small and asymptomatic.
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What should be done with synovial plica?
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No pain then leave alone, but if there is pain then they should be checked out.
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What are the menisci made of?
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Fibrocartilagenous.
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How will the menisci help the joint articulation to fit?
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Deepen socket and increases stability and congruency. Allow for flexible socket and this accommodates the egg shaped femoral condyles.
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The menisci accommodate what type of movement? Why?
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Slide which decreases shear
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How will the menisci help reduce compression?
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Force is directed to peripheray away from articular surfaces.
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How much of the compressive load will the lateral and medial menisci direct to the periphery?
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Lateral- 70%. Medial- 50%.
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With a partial and a total meniscectomy how much wear and tear increase will occur?
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Partial- 50-60% increase in wear and tear. Total- 200-235% increase.
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What are the shapes of the lateral and medial meniscus?
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Lateral- o shaped. Medial- C shaped.
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What are the designs of the lateral and medial meniscus and which one is injured most often?
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Medial- skinnier, thinner, more fixed and is injured most often. Lateral- Stronger, more mobile and only about 25% of meniscus tears happen in the lateral menisci.
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What part ot the medial menisci will tear the most often?
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The posterior horn.
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Where will the coronary ligaments attach to?
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Inferior- tibia and menisci. Superior femur and menisci.
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Name the other attachments of the menisic besides the coronary ligaments?
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Medial collateral ligament, Intercondylar area, intermeniscal ligament, posterior meniscofemoral ligament, anterior meniscofemoral ligament, popliteus, semimembranosus.
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What is another name for the posterior meniscofemoral ligament and what is its purpose?
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Wrisberg and it stabilizes the posterior horn.
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What is another name for the anterior meniscofemoral ligament and what is its purpose?
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AKA humphry and I don’t know its purpose but it is rare.
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What part of the menisci will the popliteus and semimembranosus attach to?
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Popliteus- lateral meniscus. Semimembranosus- medial meniscus.
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What happens to the menisci with flexion of the knee?
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They slide posterior.
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Which menisci will slide posterior the most with knee flexion and why?
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Lateral because it is not attached to the Lateral collateral ligament.
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When flexed at the knee where will the focal weight bearing be at?
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The posterior horn.
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Deep squats (over 90 degrees) will increase stree where?
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Posterior horns.
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What happens to the synovial fluid of the knee joint complex when the knee is flexed?
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It is squeezed in a posterior direction.
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What will support the posterior horn and the lateral meniscus?
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Popliteus and meniscofemoral ligaments.
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What happens to the menisci with knee extension?
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They slide anterior.
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Which menisci will slide anterior more with knee extension?
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Lateral.
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Which menisci will deforme more with knee extension and why?
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Medial because it is attached to the medial collateral ligament.
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What position is the knee in while fully extended?
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Tight packed.
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What is the pressure on the menisici like with full extension?
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More spread out so pressure is less.
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What happens to the synovial fluid of the knee joint complex when the knee is extended?
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It shifts anterior.
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How will the menisci move with knee rotation?
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With the femur and opposite the tibia.
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What happens to the medial and lateral menisci with internal rotation?
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Medial- rotates anterior and is more prominent in anterior part of the medial joint line. Lateral- moves posterior and deepr within the joint thus the lateral joint line deepens. MORE PRESSURE IS EXERTED ON THE MEDIAL MENISCUS WITH INTERNAL ROTATION.
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What happens to the medial and lateral menisci with external rotation?
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Medial- joint deepens. Lateral- rotates anterior into the anterolateral joint line. PRODUCES MORE PRESSURE ON THE LATERAL MENISCUS.
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Abnormal movements of the menisci with fixation leads to what?
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Meniscal tears.
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How can you prevent abnormal movements of the menisci with fixation?
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Adjustments.
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What is the stress test that will test for movements/changes with VARUS and VALGUS?
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Bohlers test.
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How is VARUS tested?
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Pinches medial meniscus and tractions lateral meniscus thru coronary ligaments.
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How is the VALGUS test done?
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Pinches lateral meniscus and tractions medial meniscus thru medial collateral and coronary ligaments.
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Where is the hip joint at?
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Between the acetabulum and the femoral head.
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The hip joint in general is unstable in who?
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Infants especially female and northern european infants.
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What % of congenital hip dislocations are female?
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90%.
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What are the 3 parts of the acetabulum and where are they located at?
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Ilium- superior, Iscium (posteroinferior), pubis- anteroinferior.
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What is the difference between the acetabular brim and notch?
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The brim is 4/5 of a full circle and the notch encloses the anteroinferior 1/5.
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What is the thickest cartilage of the hip joint?
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The superior semilunar cartilage because it is the main weight bearing region.
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What are the other cartilage of the hip joint (besides the superior semilunar cartilage)?
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Labrum and trans. Ligament.
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Where will the labrum and transverse ligament be at and what are they made of?
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Labrum- upper 4/5 of ring. Transverse ligament- the inferior part that covers the notch. Both are made of fibrocartilage.
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What is the anteversion angle like for the acetabulum in males vs. females and infants?
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Larger angle for females. Infants- more anterverted than adults.
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Increased anterversion of the acetabulum will do what?
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Decrease stability.
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What will inferior acetabular tilt be like for males vs. females, and adults vs. infants?
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Males larger than females. Adults greater than infants.
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Increased inferior tilit of the acetabulum will do what?
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Increase stability.
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What is the shape of the femur head?
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2/3 sphere and larger in diameter thatn the acetabulum @ labrum.
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What are the 2 keeper rings?
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Labrum and zona orbicularis of the capsule.
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What is the articular cartilage of the femur head like?
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Thickest superior since all pressure is here.
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Where is proximal physis of the femur located at and this causes what?
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It is proximal to the neck and this creates a lot of shear force as we grow.
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When will a slipped capital femoral epiphysis be seen?
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In early teens and tall and large people.
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What does trochanter mean?
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To turn.
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During growth the distal femur normally becomes ______.
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twisted medially relative to the proximal end.
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What is the normal, anterverted and retroverted angles of the femoral torsion?
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Normal- 10-20degrees. Anteverted- >20degrees. Retroverted- <10 degrees.
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What will make the hip more and less stable anterverison or retroversion?
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Anterversion- less stable. Retroversion- more stable.
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What is femoral inclination?
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Draw a line from the femoral head parallel to the shaft. Then draw another line parallel to the long shaft of the femur and then measure the inside angle?
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What is the normal femoral inclination angle?
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120-130 degrees.
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What will femoral inclination angles of >130 and <120 mean?
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>130- coxa valga- less stable hip. <120- coxa vara- more stable hip.
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What is the femoral inclination angle like at birth?
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150 degrees.
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Coxa vara is often seen in who?
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The elderly.
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Coxa vara will make the hip more stable, but what is the down part to coxa vara?
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More shear stress on femoral neck increases the risk of fracture.
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Both coxa vara and valga cause what?
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Abnormal wear and tear on articular surfaces and may lead to osteoarthrosis.
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Will increased abductor or adductor strength make the hip joint more or less stable?
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Increased abductor- increases stability. Increased adductor- less stable.
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Will extension, external rotation and abduction make the hip joint more stable?
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yes.
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Will flexion, internal rotation, and adducted position make the hip joint more stable?
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No it makes it unstable.
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What are the 3 types of femoral trabeculae?
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1. vertical- compression on femoral head. 2. Acruate- bending of neck. 3. Intertrochanteric- torsion between trochanters.
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What happens to the femoral trabeculae with age?
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Vertical trabelculae are saved and others are depleted in osteoporosis.
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Loss of the arcuate and intertrochanteric trabeculae in elderly leads to what?
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Femoral neck fracutures in the weak cortical zone.
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Pelvic trabeculae direct forces from acetabulum to where?
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SI.
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What is gynecoid?
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Like a women.
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What are gynecoid pelvic lines of stress like?
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Larger oval outlet.
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What are android pelvic lines of stress like?
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Smaller heart haped outlet.
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What are the lines of force transfer like for the pelvic lines of stress while sitting and standing?
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Sitting- ischium ---> SI joint and sacrum. Standing- femur ----> SI joint and sacrum.
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What are hip joint ligaments like?
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Very strong.
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How many tight packed positions of the hip are there?
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Two and it is one of the most stable joints in adults.
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What is the shape of the iliofemoral ligament and it is aka?
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Y and aka ligament of bigalow.
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What is the hip ligament that is not structurally significant and why is it there?
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Ligamentum teres and it mainly supports Blood vessels.
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Which hip ligament is the strongest?
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Y-ligament aka iliofemoral ligament aka ligament of bigalow.
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Toe flexion?
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S1-2.
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Toe extension?
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L5.
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Hallux extension?
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L5.
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Dorsiflexion?
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L4-5.
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platnar flexion?
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S1-2.
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inversion?
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L4-5.
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eversion?
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S1.
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knee extension?
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L3-4.
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Knee flexion?
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Medial hams L5. Lateral hams S1.
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hip flexion?
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L1-2.
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Hip extension?
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L5-S1.
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Hip adduction?
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L5-S1.
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Internal rotation of the hip?
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L5-S1.
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Hip abduction?
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L5-S1.
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Hip external rotation?
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L5-S1.
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