Knee Joint - Physiology

Front 1

What are the bones which articulate to become the knee joint?

Back 1

The distal end of the femur

The proximal end of the tibia

Front 2

What are the movements of the knee joint?

Back 2

Flexion

Extension

Some rotation

Front 3

What are the movements of the knee joint in extension?

Back 3

movement of the posterior aspect of the leg away from posterior surface

Front 4

What is relative extension of the knee joint?

Back 4

movement which brings knee into full extension, starting from any type of flexion.

Occurs usually in walking when limb is off the ground.

Front 5

What are the movements of the knee joint in flexion?

Back 5

movement of posterior aspect of leg towards posterior aspect of thigh

Front 6

What does the range of knee flexion rely upon?

Back 6

The position of the hip

Whether the movement is active or passive

Active - 140 degrees

Passive 120 degrees

Front 7

Why is there a difference?

Back 7

Hamstrings lose some efficiency with extension of the hip.

Front 8

What is passive flexion?

Back 8

passive flexion is when the operator moves the client's joint.

passive flexion attains range of 160 degrees.

Allows heel to touch the buttock.

Front 9

Why is passive flexion important?

Back 9

important clinical test of the freedom of the knee

assessed in terms of distance between heel and buttock.

Front 10

pathology when doing passive flexion

Back 10

passive flexion is limited by retraction of extensor tendon.

Quadriceps is especially limited

Shortening of capsular ligaments due to trauma or faulty posture

Front 11

Why is it important to test both knee joints?

Back 11

In order to find any discrepencies or differences

one knee may flex more than the other.

Front 12

How would you test each knee indivdually?

Back 12

Compare it to the other knee

surface observation

creases

scars

inflammation

knee examination - medial or lateral rotation

medial and lateral gapping

Front 13

What is the axial rotation of the knee?

Back 13

rotation of the leg only performed when knee is flexed

knee must be 90 degrees

Front 14

What are the types of rotation?

Back 14

medial rotation - toes facing medially _adduction of foot)

lateral rotation - toes facing laterally - abduction of foot)

Front 15

Which rotation has the greatest degree of movement?

Back 15

passive rotation has a greater degree of movement than active movement.

Front 16

What type of joint is the knee joint?

Back 16

Hinge Joint

Front 17

What are the shapes of the articulate surfaces of the bones?

Back 17

"pulley shaped" gliding in a twin set of curved (femur condyles) and concave (tibia condyles) gutters.

Front 18

What articular surfaces are involved in axial rotation?

Back 18

To allow axial rotation, one needs a pivot.

The pivot is the intercondylar eminence/spines on tibial surfaces

Front 19

What is the shape of the capsule of the knee?

Where is the capsule attached?

Back 19

cylindrical in shape

Upper and lower ends of the "cylinder" are attached to the femur and the tibia.

Front 20

How does the capsule attach to the tibia?

Back 20

attaches anterior, lateral and medially

attaches as if its part of the posterior cruciate ligament

Does not go in between cruciate ligaments

Front 21

How does the capsule attach to the femur?

ANTERIOR

Back 21

attached to bone along edges of shallow fossa overlying patella surface

Forms deep recess - suprapatella bursa

Front 22

MEDIALLY and LATERALLY

Back 22

along margins of patella surface (parapatella recesses)

along edges of articular surfaces of condyles

lateral condyle - above insertion of popliteus tendon

Front 23

POSTERIOR and SUPERIOR

Back 23

along posterosuperior border of articular surfaces of condyles

distal to origins of gastrocnemius

capsule lies deep of these surfaces and separates them from condyles

Front 24

INTERCONDYLAR NOTCH

Back 24

medial condyle - runs below femoral attachment of PCL

Lateral condyle - lies between articular cartilage and femoral attacment of ACL

Front 25

Where is the infrapatella fold?

Back 25

Inbetween ligamentum patella, inferior aspect of patella, surface of femur and bounded by anterior intercondylar fossa of tibia

Front 26

Where can it be found?

Back 26

posterior surface of;

ligamentum patella

overlaps anterior intercondylar fossa

superior aspect;

strengthened by a fibroadipose band attached to apex of patella - infrapatellar fold

infrapatella pad extends superiorly along inferior part of sides of patella - alar folds

Front 27

What are the menisci of the knee made of?

Where can they be found?

Back 27

cresentric plate of fibrocartilage

on articular surfaces of the tibia

Front 28

What are the roles of the menisci of the knee?

Back 28

deepen surface

play a role in shock absorption

Front 29

What do the structures of the menisci look like?

Back 29

thick external margins

thin interior margins

attached to intercondylar area of the tibia

external margins attach to joint capsule of the knee

Front 30

What are the two types of the menisci?

Back 30

Medial Menisci

Lateral Menisci

Front 31

Medial menisci

What is the shape of the medial menisci?

What are the features of the medial menisci?

Back 31

C-shaped

broader posteriorly than anteriorly

Front 32

Medial menisci

Where does it attach?

Back 32

Anterior - attaches to anterior intercondylar area of tibia

Posterior - attaches to posterior intercondylar area, anterior to PCL.

Less mobile on tibial plateau than lateral menisci

Front 33

Lateral menisci

What is the shape of the lateral menisci?

What are the shapes of the menisci?

Back 33

1. nearly circular, smallwer and more freely movable than medial menisci

3 surfaces:

superior - concave

peripheral - cylindrical in shape

inferior - almost plane (resting on edges of medial and lateral tibial condyles

Front 34

What are the important aspects of the menisci?

Back 34

rings are incomplete in region of intercondylar tubercles of tibia.

They have an anterior and posterior horn.

transmits any compression forces between femur and tibia

Front 35

Where is the deep surface of the capsule attached to?

Back 35

attached to the menisci

Front 36

What are the important attachments

Back 36

2 anterior horns

Fibrous strands

Medial collateral ligament

Lateral collateral ligament

Semimembranosus tendon

Front 37

attachment of 2 anterior horns

Back 37

linked by transverse ligament of knee

atatched to pateall by strands of infrapatella pad

Front 38

Attachment of fibrous strands

Back 38

lateral edges of patealla to lateral borders of each menisci

Front 39

attachement of medial collateral ligament

Back 39

attachment by deep fibres

Front 40

attachment of lateral collateral ligament

Back 40

separate by tendon of popliteus

fibrous expansion to posterior border of lateral menisci

Front 41

attachment of semimembranous tendon

Back 41

sends out a fibrous expansion to posterior border of medial meniscus

Front 42

PCL and ACL

Back 42

separate set of fibres insert into:

PCL - posterior horn

ACL - anterior horn

Front 43

What happens during the morvements of the menisci?

Back 43

menisci move posteriorly unequally.

lateral moves twice as far

Front 44

Why do they move unequally?

Back 44

horns are at a fixed point

rest of the structure is freely movable

laterally - greater degree of distortion because horns are attached more closely

Front 45

What happens to the menisci during axial rotation?

Back 45

lateral rotation - lateral meniscus pulled towards anterior part of tibial condyle. medial menisci drawn posteriorly

medial rotation - medial menisci foward while lateral menisci recedes.

Front 46

What are the movements of the patella during flexion and extension?

Back 46

flexion and extension

patella moves in sagittal plane.

recedes whilst moving along arch of the circle.

end of movement - patella faces posteriorly and inferiorly.

Front 47

What are the movements of the patella during axial rotation?

Back 47

axial rotation: patella moves relative to tibia in frontal plane

lateral rotation: femur laterally rotated and this drags the patella laterally

Front 48

What are the functions of the collateral ligaments of the knee?

Back 48

stability depends upon action of powerful ligaments - cruciate and collateral

strengthens articular capsule on medial and lateral aspects

responsible for transverse stability of knee during extension

Front 49

Pathology

What is the knee subjected to?

Back 49

subjected to side to side movements.

when knee is severly sprained, abnormal side to side movements can be demonstrated.

Front 50

What happens when there is lateral movement of the knee?

Back 50

indicates rupture of medial collateral ligament

Front 51

What happenes when there is medial movement of the knee?

Back 51

indicates rupture of lateral collateral ligament.

Front 52

extra pathology information

Back 52

severe sprain of knee plays a vital part in securing stability of joint.

LCL - assisted by illiotibial tract which is tightened by TFL

MCL - assisted by contraction of medial tibial muscles (sartorius, semitendinosus and gracillus)

also assisted by quadriceps for anterior aspect of the joint

Front 53

What are the two types of drawer movements?

Back 53

Posterior drawer test - testing posterior cruciate

Anterior drawer test - testing anterior cruciate.

Front 54

What type of bone is the patella?

What are the functions of the patella bone?

Back 54

Sesamoid bone

embedded in extensor tendon of the knee

increases efficiency of the quadriceps by shifting anteriorly the line of action of its muscular pull.